The Care Quality Commission (CQC) has downgraded the overall rating of Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust after finding improvements were needed in some of its services following inspections in August and September.
CQC carried out unannounced focused inspections of urgent and emergency care services, medical wards, surgical wards, diagnostic imaging and maternity services at Bassetlaw District General Hospital and Doncaster Royal Infirmary. At Montagu Hospital, inspectors looked at urgent and emergency care services, medical wards and diagnostic imaging. Inspectors also looked at diagnostic imaging at Retford Hospital. These inspections took place due to concerns received about the quality of care being provided.
Following this inspection, as well as the trust’s overall rating dropping from good to requires improvement, as have the ratings for how effective, responsive and well-led the trust is. Safe remains rated as requires improvement and caring remains as good.
Bassetlaw District General Hospital and Doncaster Royal Infirmary’s overall ratings have both dropped from good to requires improvement as did their ratings for being effective, responsive and well-led. Safe remains rated requires improvement and caring remains as good.
Montagu Hospital has dropped from good to requires improvement overall. The ratings for effective, caring, responsive remain rated as good. Safe and well-led have dropped from good to requires improvement.
Retford Hospital remains rated as good overall, as do the ratings for how caring, effective, responsive and well-led it is. Safety is rated as requires improvement.
The full ratings for each of the services can be found in the report and below.
Linda Hirst, CQC deputy director of operations in the north, said:
“Following our inspection of Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, we found a trust leadership team that was relatively new in place but were working to build and embed a cohesive and united team.
“During the inspection we received several whistleblowing concerns from staff, who didn’t feel respected, listened to or valued. This was particularly prevalent in those areas where there were greater pressures due to challenges with staffing, financial restraints, and increasing care demands.
“One of those areas was maternity. Some staff told us there were challenges regarding staffing levels, because low morale was causing stress related sickness absences. The Bassetlaw birthing unit in particular faced increased demand with less staff, which meant they couldn’t always provide the best care to people.
“In urgent and emergency care, the waiting areas quickly became overcrowded with people having to stand or wait by the entrance and doorways because of the limited space. However, the service had secured funding to enhance waiting areas to reduce crowding and provide a safer environment.
“Also, in the Doncaster Royal Infirmary emergency wards, people were nursed in an area where intimate discussions and treatment could potentially be overheard and seen by others. We also found people in one of the bays could overhear the medical staff board round, which discussed people’s names and diagnoses. This was a risk to people’s privacy and dignity.
“In medical care, the service didn’t always have enough nursing and support staff to keep people safe. Staffing requirements were calculated by ward managers but when we visited we saw that planned and actual staffing didn’t always match.
“Despite these challenges we saw caring staff in all of the services we looked at. In urgent and emergency care, staff provided as much information as possible to people in their own language. They also ensured there were face-to-face interpreters.
“We did see improvements since our previous inspection in the area of diagnostic imaging, where we found safer care in three out of the four hospitals inspected.
“We have given our initial feedback to the trust’s leadership team and told them where we want to see improvements. We will continue to monitor the trust to make sure these improvements happen, so people receive the safe care they deserve.”
In maternity inspectors found:
- There weren’t always enough midwifery staff on duty in the right areas
- Community staff weren’t all suitably trained to manage home birth emergencies
- There was no record of daily checks being undertaken on emergency boxes. The cord prolapse box, pre-eclampsia box and the sepsis box stated that an emergency medicine was missing from each box on 19 July, but these had still not been replaced at the time of the inspection
- People in the maternity day assessment unit described personal discussions being overheard by others these took place around the beds in the unit
- When people were discharged home their details were added to the ward discharge book. Daily checks of discharges ensured this information was shared with the mothers GP, community midwife and health visitors.
In urgent and emergency care inspectors found:
- There weren’t always enough staff on duty in the right areas
- Not all staff had completed mandatory or safeguarding training
- Leaders didn’t have oversight of medicine management. It was difficult to understand how these issues hadn’t been identified internally because they would be part of audit and governance process
- Staff understood and respected the personal, cultural, social and religious needs of people and how they may relate to care needs. A chapel and multi faith room was available for all patients and visitors, with access to a chaplaincy and prayer room.
In medical wards inspectors found:
- Not all staff had completed mandatory or safeguarding training
- There weren’t always enough staff on duty in the right areas
- Not all equipment was safety checked
- Staff understood and respected the personal, cultural, social, and religious needs of people and how they may relate to care needs. Staff we spoke with gave examples of adapting care to meet the needs of people with religious beliefs.
In surgical wards inspectors found:
- Not all incidents or risks to the service were reported consistently or appropriately
- Not all equipment was maintained or stored in line with trust policy or national guidance
- People received specialist support from staff such as dietitians and nutrition assistants who were available when needed. People requiring this extra support were regularly reviewed. When modified diets were needed, assessments of people’s requirements were detailed above their beds.
In diagnostic and imaging inspectors found:
- Not all staff knew the emergency procedures that are in place for people who were at risk of deterioration
- There wasn’t always a resuscitation trolley available to staff in case of emergency
- Staff responded promptly to any sudden deterioration in a person’s health. The trust had clear policies and guidance in place for managing medical emergencies.