Updated
8 March 2024
Mid Yorkshire Teaching NHS Trust provides care for over half a million people every year, in their homes, in the community and across three hospital sites at Pontefract, Dewsbury and Pinderfields. In addition, the trust provides two specialist regional services: burns and spinal injuries. The trust is made up of a team of 9,200 staff.
The Pinderfields Hospital building was opened in 2011; is the largest of the trust’s three hospitals and is the main site for patients requiring acute care. A range of inpatient, outpatient, diagnostic and maternity services are provided. The hospital provides both urgent and emergency care as well as services such as elective surgery. Pinderfields is the busiest hospital within the trust. In any one year there may be over 127,000 attendances to the A&E and over 58,000 emergency admissions.
Dewsbury and District Hospital provides services, usually for patients living in the North Kirklees district. The hospital provides urgent and emergency care, diagnostics, elective care, midwife services and care of the elderly services. The hospital treats over 340,000 patients every year.
The trust works in partnership with two local authorities, two integrated care system (ICSs) commissioners and a wide range of other providers, including voluntary and private sector organisations. It also works as a member of the West Yorkshire and Harrogate Partnership, which is the Integrated Care System within which the Trust resides.
We carried out an unnanounced focussed inspection of medicine (including older peoples services) and urgent and emeregency care at Pinderfields Hospital and Dewsbury and District Hospital. Our inspection was a follow up on concerns about the quality and safety of urgent and emergency care and medical services raised during the last inspection in April 2022. At this inspection we found the core service overall ratings of emergency care and medicine remained the same, requires improvement. However, at Pinderfields Hospital the domains of effective and well led in urgent and emergency care had improved to good. The domain of responsive had improved in medical services to good. At Dewsbury and District Hospital the rating of the well led domain for urgent and emergency care improved to good. We also saw other improvements since our last inspection althrough the overall and domain rating did not change.
The team that carried out the inspection of urgent and emergency care services comprised of an inspector, assistant inspector and 2 specialist advisors with expert clinincal knowledge in the areas inspected.
The team that carried out the inspection of the medicine service comprised of 2 inspectors and 2 specialist advisors plus an inspector who carried out a short observational framework on one of the medical wards.
An inspection manager oversaw the inspection of both services.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/ how-we-do-our-job/what-we-do-inspection.
Updated
7 December 2018
Our rating of this service improved. We rated it as good because:
- The service showed a good track record in safety. There had been no never events, one serious incident and the incidents reported had mainly resulted in low or no harm and themes had been responded to. Staff understood their responsibilities to raise concerns and report incidents and to be open and honest when things went wrong. Managers investigated incidents and shared lessons learned.
- Systems and processes in infection control, medicines management, patient records and the monitoring, assessing and responding to risk were reliable and appropriate to keep patients safe.
- Consultant cover had increased and changed to block working, to promote continuity of care, multidisciplinary staffing levels were in line with the Guidelines for the Provision of Intensive Care Services (GPICS) standards. Nurse staffing levels and skill mix were planned and reviewed to keep people safe.
- The service provided mandatory training in key skills and role-specific skills and the number of critical care staff who completed this, met the trust targets of 95% and 85%, respectively.
- There was a system in place to ensure all nursing and medical staff had an up to date appraisal and 99% of staff had received an appraisal compared to the trust target of 85%.
- Staff of different kinds worked together as a team to benefit patients. Multidisciplinary staffing, including physiotherapy and pharmacy were appropriate for the size of the unit, in line with GPICS recommendations.
- Patient outcomes were in line with similar units. The service compared local results with those of other services to learn from them.
- The unit’s non clinical transfers and delayed discharge rates were in line with or better than similar units. The out of hours discharge to the ward rate was in line with or better than similar units.
- The outreach team provided a follow-up clinic to support critical care patients following discharge from hospital, in line with the Guidelines for the Provision of Intensive Care Services (GPICS) standard.
- Staff cared for patients with compassion at all times. Feedback from patients and families was consistently positive. Patients and relatives told us staff treated them well and with kindness, that they felt well-informed and staff communicated with them in a way they could understand.
- Staff provided emotional support to patients to minimise their distress; they encouraged families to complete patient diaries, which were used for reflection in follow-up clinics and staff co-ordinated a monthly patient and family-led support group to help people come to terms with their experience of critical care.
- We observed a strong, visible person-centred culture inspired by the nursing and clinical leadership.
- The service engaged patients and families to plan and improve services. The unit had shown a dedication to listening to and involving patients and families. This was reflected in changes to the physical environment, the draft service strategy, the introduction of ‘care packs’ for relatives unexpectedly staying overnight, memory boxes and ongoing support for patients and families after discharge and in trying times.
However:
- The service did not prescribe oxygen for patients in line with national guidance.
- The service was not yet fully compliant with all the Guidelines for the Provision of Intensive Care Services (GPICS) standards.
- The number of staff in the service with a post registration qualification in critical care was 39%, which was not in line with the GPICS minimum of 50%. This had reduced since the last inspection. Managers acknowledged this was due to staff turnover resulting from the service reconfiguration in September 2017 and had a plan in place to mitigate and improve this over two years.
- Patients were not always discharged to a general ward within four hours of the decision to do so. This was not in line with GPICS standards, however there had not been any mixed sex breaches.
- There was a need to strengthen governance arrangements and ensure outcomes and learning from management meetings are shared with staff, including the MDT, to promote service improvement.
Updated
13 October 2017
Nurse and consultant staffing levels for the specialist palliative care team were at full complement and reviewed daily to keep people safe at all times. Any staff shortages were responded to quickly and adequately. Specialist palliative care nurses were available and each ward had an end of life link nurse.
We saw evidence that compliance with infection control and environmental cleaning standards were monitored regularly and maintained in the mortuary.
Risks to people, who use services were assessed, monitored and managed on a day-to-day basis. Staff used a community-wide electronic patient record system accessible to the multidisciplinary team caring for the patient including hospital staff, community staff and most GPs. They also had access to EPaCCS (Electronic Palliative Care Coordination System). which enabled the recording and sharing of people’s care preferences and key details about end of life care.
End of life care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. There was a comprehensive audit programme in place against national standards for end of life care.
The trust included a session on end of life care in the core mandatory training programme for ward nursing staff. The service was planning to introduce the Gold Standard Framework to hospital staff on eleven wards in 2017.
For those palliative care patients who were already known to the service and admitted to the hospital for care and treatment, 93% were followed up by contacting the ward within 24 hours to assess the need for specialist palliative care assessment.
There was a 24-hour seven-day rota for palliative care consultant cover and this was accessed by nursing staff in the hospital when palliative care specialist advice was required out-of-hours. Access to specialist palliative care nurses was Monday to Friday at the time of inspection, but recruitment was underway to expand to a seven-day service.
We observed a caring and compassionate approach from palliative care team members and ward nursing staff during their interactions with patients and family members. We saw how family members were supported in understanding and managing symptoms by being involved in discussions with members of the specialist palliative care team during their assessment of the patient in the hospital. Chaplaincy and drop in services were also available.
The trust was working to create a local end of life care strategy with the clinical commissioning group and other stakeholders. There were clinical networks in place linking the hospices, hospital and community services to ensure effective communication as the patient moved between services.
The quality of leadership for end of life care had improved since the last inspection. Structures, processes, and systems of accountability, including the governance and management of joint working arrangements were clearly set out, understood and effective. The leadership was knowledgeable about quality issues and priorities within end of life care, understood what the challenges were and took action to address them. Risk issues such as achieving rapid discharge were escalated to the relevant committees and the board through clear structures and processes.
However:
Staff we spoke to were not all familiar with the Duty of Candour and when it was implemented.
An end of life care plan had been introduced, but there was no regular audit to determine what percentage of end of life inpatients had the care plan in place. We were unable to assess the level of performance in achieving fast track discharges for end of life patients due to lack of evidence; no audit work had been done to measure performance in this area since the last inspection.
The weekly specialist palliative care team (SPCT) multidisciplinary meeting included SPCT nurses and palliative care consultants but no other discipline such as allied health care professionals, pharmacy, or the chaplaincy.
People were supported to make decisions about resuscitation but, where appropriate, their mental capacity assessment was not always recorded.
There was no regular internal performance reporting to directorate or board management to demonstrate improvement in areas such as quality of care, achieving preferred place of death, referral management and rapid discharge of end of life patients.
Updated
13 October 2017
We observed the treatment of patients to be compassionate, dignified, and respectful throughout our inspection.
There were systems in place to identify themes from incidents and near miss events. The division held regular emergency surgery and elective care business unit meetings where serious incidents were discussed, investigations analysed, and changes to practice identified.
During 2015/16, the surgical division prioritised 33 level one clinical audits covering a range of specialties. Outcomes from each audit were reported to the trust’s quality panels and directorate operational team meetings.
Between December 2015 and November 2016 the average length of stay for surgical elective patients at trust level, as well as at Pinderfields General Hospital, was lower than the England average at 3.1 days and 2.6 days respectively, compared to 3.3 days for the England average.
For the period Q4 2014/15 to Q3 2016/17, the trust cancelled 726 surgeries. Of the 726 cancellations, 1% were not treated within 28 days. The trusts performance has been consistently better than the England average for the period. Across the trust, there were 54,683 surgical admissions from December 2015 to November 2016. Readmission rates had reduced and improved.
There were clear and embedded governance processes in place to monitor the service provided. A clear responsibility and accountability framework had been established. Leadership at each level was visible. Staff had confidence in the new leadership and felt they were be listened to. Complaints were responded to in a timely manner and learning was taken forward to develop future practice.
However:
National Early Warning Score (NEWS) audits in March 2017 showed that 59% of observations were recorded which was down from 67% in the previous audit cycle.
The qualified nursing staff levels required across all surgical wards at Pinderfields General Hospital was 335.9 whole time equivalent (WTE) for March 2017. The number of qualified staff in post were 309.87 WTE. The areas with the largest staffing vacancies were in theatres (16.2 WTE), the plastics and burns surgical services (6.23 WTE) and gate 33 (4.17 WTE).
Nursing staff had not met all mandatory training targets. Medical staff did not reach the 95% target for any of the trusts core training, including safeguarding.
Between February 2016 and January 2017 the trust’s referral to treatment time (RTT) for admitted pathways for surgical services had been worse than the England overall performance.