University Hospital North Durham

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as good. We assessed 5 quality statements. Staff assessed people comprehensively, so the care and treatment provided met their needs. This included both their mental and physical health and any personal circumstances that needed to be considered. Care was delivered within a strong culture of evidence-based practice. Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff discussed people’s needs with them, and they were involved in how care and treatment was planned. They were confident they had been listened to and understood. Staff asked them for any updates, such as whether pain was being controlled, or if they had any additional needs. People said staff considered their wellbeing to give the best possible outcomes. Patients who were waiting were offered refreshments. People we spoke with told us their privacy and dignity were respected by staff.

Staff explained how they used tools to assess patient needs such as mobility, nutrition and hydration, risk of falls, pain management and activities of daily living. This included tools for people who had cognitive impairment such as dementia, and interactive tools for understanding pain experienced by children and people who were unable to communicate. Staff assessed and acted on risks to patients of avoidable harm. Staff worked with other specially trained professionals to support people with additional needs.

We saw staff used effective tools to support good clinical practice with people who had difficulties with communication. This included tools for people who had cognitive impairment, and interactive tools for understanding pain experienced by children. We saw staff assessed and acted on risks to patients of avoidable harm. Staff worked with other specially trained professionals to support people with additional needs.

Records we saw were up to date and showed comprehensive assessments were undertaken leading to effective ongoing care.

Staff gave people clear information about their care and treatment needed to support both their physical and mental health. Staff met people’s nutrition and hydration needs. They told people if they were being assessed for possible surgical procedures and needed to be ‘nil by mouth’ for their safety.

Staff used the trust’s systems to follow the latest guidance and evidence-based practice. The trust kept its database of guidance up to date. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures. They used effective tools for screening malnutrition and dehydration and acted on any indicators of concern.

The trust’s intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current best practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

Patients felt comfortable speaking to staff about their treatment and received information when they requested it. Their care was coordinated, and everyone involved in their care worked well with them. We observed good quality, kind and compassionate interactions between staff and patients. Staff were always present and available for patients. Information was displayed on ward notice boards relating to care, advocacy access, mental health and feedback on care.

Staff we spoke with explained how they accessed support and information needed to provide good quality person centred care. Staff worked well with external partners involved with patients.

External partners, such as GPs, community nurses and social workers were involved to enable continuity of care and support for discharge.

There was a multidisciplinary approach to care and treatment. Staff accessed appropriate expertise. For example, there were acute frailty multidisciplinary teams and clear criteria in place for acute frailty team review. Staff referred directly to the frailty coordinator. There were specific criteria in place for SDEC referrals.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients felt staff saw them as individuals and their care was personal to them. Patients were kept informed throughout their treatment and plans of care were discussed.

Staff we spoke with told us treatment plans were evidence based and monitored for outcomes. They were based on national guidance. Staff monitored and assessed patients’ needs accordingly.

Staff had access to and followed a wide range of policies and treatment guidelines which were stored electronically. Policies and procedures were based on best practice from National Institute Clinical Excellence (NICE) and the Royal College of Emergency Medicine guidelines (RCEM). The department took part in RCEM audits and benchmarked performance against best practice and other regional emergency departments. Improvement work was continuous and incorporated in both direct support and formal education sessions. The department amalgamated all improvement work, for example, relating to the deteriorating patient, sepsis and fluid balance, into a system improvement plan, which was overseen and monitored by the Medical Director. Effectiveness was monitored through scheduled audit cycles. There were action plans to address areas for improvement.

The department took part in RCEM audits and benchmarked performance against best practice and other regional emergency departments. Data we reviewed for ED performance to June 2024, relative to regional and national data, showed the trust was not an outlier. This concurred with the NHS England latest Summary Emergency Department Indicator Table (SEDIT) and Summary Acute Provider Indicator Table (SAPIT) data, (up to April 2024), which showed the department was in ‘middle of the patch’ in terms of performance and indicated the trust was not an outlier. Improvement work was continuous and incorporated in both direct support and formal education sessions. The department amalgamated all improvement work, for example, relating to the deteriorating patient, sepsis and fluid balance, into a system improvement plan, which was overseen and monitored by the Medical Director. Effectiveness was monitored through scheduled audit cycles.

People understood their rights around consent to the care and treatment they were offered. People received information about care and treatment in a way they understood and had the appropriate support and time to make decisions.

Staff gained consent from patients for their care and treatment in line with legislation and best practice guidance. When patients did not have capacity to consent, staff made decisions in their best interests and documented them.

Staff had access to the trust consent policy and understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (1983), Mental Capacity Act (2005) (MCA), Deprivation of Liberty Safeguards, and the Children Acts (1989 and 2004). Staff knew who to contact for advice. We saw examples where staff had completed relevant MCA documentation and followed appropriate guidance. Information documented was accurate and legible.