University Hospital North Durham

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We rated responsive as good. We assessed 7 quality statements. People received person-centred care and did not experience discrimination. Staff listened to and involved people. They worked hard to provide equity in access to care and treatment, experience and outcomes. There was continuity of care and staff made reasonable adjustments where required. Staff listened to people’s concerns to improve the service. People received information and advice that was accurate and provided in a way that they understood.

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.

People we spoke with told us that they felt they were at the centre of their care and treatment and were involved in planning and making shared decisions about their care and treatment.

Staff we spoke with told us they took in to account patient’s individual needs and preferences. They told us they undertook risk assessments to identify specific needs such as nutrition, hydration, mobility and pressure area care. Staff made reasonable adjustments to help patients access services. The department had access to the Big Word service to support patients, loved ones and carers with face-to-face interpreting and translation needs. Staff explained how they accessed multi-faith chaplaincy services when requested by patients and their carers.

We saw positive interactions between staff and patients with complex needs to ensure they remained settled in the department. Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs There were also link workers available to provide additional support and advice to staff for supporting patients with learning and mental health difficulties.

People received care and treatment from a service which understood the diverse health and social care needs of the local communities. There was continuity in people’s care and treatment because services were flexible and joined-up. Peoples individual needs and preferences were considered, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. We saw that patients who attended the department frequently, were treated with compassion and had management plans in place.

Staff we spoke with told us the department was considered ‘everyone’s responsibility’. For example, they described a collaborative team approach with ward colleagues and said there had been a ‘mind-shift’ in terms of helping the department manage flow when it was experiencing high volumes of patients. Staff worked closely with a range of partners, through local, regional and national working groups to share learning and best practice with respect to services for those with dementia and to work on joint pathways such as those with the local mental health trust where appropriate. The UEC group engaged with the Integrated Care Board (ICB) as part of the clinical advisory group for the North East ICB. The service worked with care homes to avoid unnecessary hospital admissions and provided advice to see GPs (where appropriate) rather than come into the UEC department. The service had improved provision of care to patients from local prisons. Prison staff were able to contact a central number to bypass UEC department and arrange for patients to attend at a specific time. Psychiatric liaison staff now had special access to the EPR system so they could document in the patient UEC record, in addition to their own mental health service notes. This helped to promote consistency of information sharing and continuity of care between the services.

The service had formal agreements with other NHS trusts and tertiary centres to facilitate seamless transfers of care where required. There were effective processes in place to manage care and treatment of frequent attenders and homeless people. Discharge letters were generated electronically and sent out within 24 hours of discharge. However, some IT systems between the UEC and some GPs did not always interface. However, the trust continued to work on improvements to the EPR and was actively working with GPs to find out what information they could access, and what they required. Discharge information was also provided by post and telephone if required.

People could access information and advice that was accurate, up-to-date and provided in a way that they could understand, and which met their communication needs. For example, the service made reasonable adjustments and supported with accessible information. Patients were offered alternative formatted letters and documents, such as large print, braille, easy read and email. People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared within the EPR, in accordance with the Accessible Information Standard. People could expect information to be tailored to individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who did not speak English as a first language and for deaf people who used British Sign Language. The trust website had a translation button which changed the website content to several different languages. There were buttons to make the font size larger and a button to change the contrast to make font appear sharper against the background. The trust had a process in place to facilitate patient’s access to their own records, should they wish. Patients had access to information leaflets regarding medication and treatment plans if they required them.

Staff we spoke with told us they had received General Data Protection Regulation training (GDPR) and could explain their duties regarding confidentiality and data sharing. Patient records were held on a secure EPR system which was accessed by individual staff log in. Staff we spoke with explained they asked people if they had any information or communication needs, which was then captured on the EPR. The told us they shared information about people’s information and communication needs with other providers of NHS and adult social care, when patients had given consent or permission for them to do so. If staff required support, advice was always available from the Learning Disabilities Liaison Team.

Special needs regarding information and communication were captured in the EPR we reviewed for example, we saw reference to hospital passports, and ‘’This Is Me’’ documents, which involved the patient, family and carer, to ensure individual information and communication needs were met. The trust had a printable accessible information poster and leaflet within its policy. We observed appropriate conversations between medical staff, patients and family members about treatment plans and options. We saw there were private family rooms where staff could take families and carers, when delivering bad news. We saw a wide variety of resources including leaflets, and interpreter services were available to ensure the patients understood their care and treatment, if required.

Staff had access to GDPR policy and equality and diversity policy on the intranet. The trust Accessible Information Standard Framework was under review at the time of our assessment and due to be ratified in July 2024. Staff could ask for advice from the trust Caldicott Guardian. A Caldicott Guardian is a senior person responsible for protecting the confidentiality of people's health and care information and making sure it is used properly.

People we spoke with told us they knew how to give feedback about their experiences of care and support, including how to raise any concerns or issues and could do so in a range of accessible ways.

Learning from complaints and concerns was seen as an opportunity for improvement, and staff gave examples of how they incorporated learning into daily practice.

Staff understood the trust complaints policy and knew how to handle complaints and concerns. Managers investigated complaints, identified themes and shared feedback with staff and learning was used to improve the service. Staff involved the trust patient experience team and named family liaison officers were allocated where required. Complaints we reviewed were responded to appropriately. People were kept informed about how their feedback was acted on. Where improvements were required as a result, people had the opportunity to be involved in shaping the solutions.

People we spoke with told us did not experience discrimination or inequality. People with additional needs did not feel they were disadvantaged. This included making reasonable adjustments for people with disabilities, those with communication difficulties or cognitive impairment. People were listened to when they wanted to share their experience. We observed no episodes of corridor care. The department was fully accessible to people with disabilities or who used a wheelchair.

Improvement had been made in terms of access and flow, although some challenges remained, which impacted on wait times in the department for some patients. Senior leaders we spoke with were sighted on this and the NHSE data we reviewed reflected an improving picture. The trust ranked 21st in national urgent and emergency care most improved performance for the period 2023/24. Regarding 4 hour waits, the service achieved its internal plan for 2024/25 to date and its trajectory was on track to achieve 78% compliance by the end of March 2025. The trust had identified that since September 2023 to April 2024 the percentage of patients spending 12 hours or more in the department from arrival to departure (admission, transfer or discharge) compared to all type 1 and type 2 attendances was high. However, we saw there was a clear escalation process in place, patients were assessed and triaged timely and escalated as appropriate to their clinical needs. We saw there was a long waits improvement action plan in place. Staff worked hard to remove any barriers to access for patients. There was a strong inclusive culture which prevented discrimination and inequalities, supported by training and guidance. Focus groups reflected on the needs of the community and how to give everyone equal access to care and treatment. Staff listened to people who had concerns or complaints and sought ways to improve the service.

People could access the service when they needed. The department was open 24 hours a day all year round. Adults and children were cared for including those seeking treatment for mental ill health. The service worked with other healthcare professionals to provide a timely service for different healthcare needs and serious conditions needing specialist input. There was a rapid decompression of ED protocol and a trigger tool. Staff we spoke with could articulate the process. We did not see this initiated during our assessment.

The service complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes. We saw staff treated all patients with respect. They safeguarded patient dignity and engaged with all patients in a person-centred way and adjusted their approach according to the patient’s individual needs.

Leaders we spoke with demonstrated they understood the local demographic. They were alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational processes and culture or from individuals. They proactively sought out ways to address these barriers to improve people’s experience, act on information about people's experiences and outcomes and allocate resources and opportunities to achieve equity. People’s care, treatment and support promoted equality, removed barriers or delays and protects their rights. For example, staff we spoke with told us that prisons could contact a central number to bypass the UEC department and arrange for patients to attend at a specific time. Staff we spoke with were mindful of their duties in respect of legislation, including the Human Rights Act 1998, Mental Health Act 2007 and the Mental capacity Act 2005. The trust had reviewed the results of the fifth round of the National Audit of Dementia published in the summer of 2023 and had implemented action plans where scope for improvement was identified. Key learning messages were cascaded to department staff through a quarterly dementia newsletter and through the trust network of 85 dementia champions, who covered not only dementia but also learning disabilities.

People were supported to make informed choices about their care and plan their future care while they had the capacity to do so. When people wanted to express their wishes about cardiopulmonary resuscitation, they were supported to do so and were able to change their mind if they wished. We saw when patients in the department were assessed as approaching the end of their life, and treatment was changed or withdrawn, professionals communicated and managed this openly and sensitively so that people had a comfortable and dignified death.

Staff we spoke with explained how they supported people to make informed choices about their care and plan their future care. They understood and worked in accordance with NICE best practice guidance around decision making and mental capacity. Staff we spoke with demonstrated a clear understanding of the trust do not attempt cardiopulmonary resuscitation (DNACPR) policy and ReSPECT documentation. The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment.