Scarborough Hospital

Updated 30 June 2023

York and Scarborough Teaching Hospital NHS Foundation Trust provides a comprehensive range of acute hospital and specialist healthcare for approximately 800,000 people living in York, North Yorkshire, Northeast Yorkshire, and Ryedale.

Scarborough Hospital is the Trust’s second largest hospital. It provides acute medical and surgical services, including trauma and intensive care services.

Updated 30 June 2023

Updated 8 October 2015

There were enough nursing staff to meet the needs of children and families because some beds were closed. Children’s services did not have all the necessary individual risk assessment tools in place so staff were not able to conduct a robust, individualised risk assessment when required. Training records submitted by the trust prior to the inspection showed varying levels of training uptake by members of staff, but not all were achieving the 75% compliance set by the Trust.

Children, young people and parents told us that they received compassionate care with good emotional support. Parents felt informed and involved in decisions relating to their child’s treatment and care. Staff of all grades told us that children’s services were offered very limited CAMHS (Child and Adolescent Mental Health Services) support for children with mental health needs by other providers; the children’s directorate risk register also noted this.

The service was responsive to children’s and young people’s needs and was well led. The service had a clear vision and strategy.

Updated 28 February 2018

Our overall rating of this service stayed the same. We rated it as requires improvement because:

• We rated safe and caring as good, and effective, responsive and well led as requires improvement.
• The service had not taken action on some of the issues raised in the 2015 inspection. For example, the unit still did not have a clinical educator which was not in line with the guidelines for the provision of intensive care services (GPICS) standard and the service had not undertaken patient or relative surveys or any public engagement. At the time of this inspection, it was still not clear what critical care would look like across York and Scarborough hospitals, as the service strategy had not been finalised.
• The risk register was not reflective of all the risks in the service. There was no record of the date the risks were added to the risk register, the date the risk should be reviewed and the controls and mitigating actions recorded were limited and did not always appear to address the cause of the risks.
• The rehabilitation after critical illness service was limited and was not in line with GPICS or the National Institute for Health and Care Excellence (NICE) CG83 rehabilitation after critical illness. The service did not have access to patient and relative support groups.
• Staff were not always supported to maintain and develop their professional skills. The number of nursing staff who had an up-to-date appraisal was worse than the trust’s target. The service did not meet GPICS recommendations for the number of nurses that had a post registration award in critical care nursing.
• Senior staff acknowledged that service improvement and innovation was limited on the unit and the pace of change was slower at Scarborough than in critical care at York Hospital.

However:

• The service had taken action on some of the issues raised in the 2015 inspection. For example, medical staffing was now in line with GPICS, mandatory training rates were better than the trust target and there had been a focus on cross-site working which had improved.
• Systems and processes in safety, infection control, medicines management, equipment, patient records and the monitoring, assessing and responding to risk were reliable and appropriate.
• Care and treatment was planned and delivered by a cohesive multidisciplinary team in line with current evidence based guidance.
• All the feedback from patients and relatives was positive about the way staff treated them.

Updated 8 October 2015

We saw that end of life care services were safe, effective, caring and responsive, with elements of outstanding practice in terms of being well led. We observed specialist nurses and medical staff provided specialist support in a timely way that aimed to develop the skills of non-specialist staff and ensure the quality of end of life care. Staff were caring and compassionate and we saw the service was responsive to patients’ needs. There was good use of auditing to identify and improve patient outcomes.

The trust had a clear vision and strategy for end of life care services. There was consistent leadership including the development of a number of initiatives, such as non-cancer end of life care and the development of training to improve advance care planning discussions, including those relating to DNA CPR.

Updated 30 June 2023

Updated 16 October 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated it as requires improvement because:

• The service was not consistently assessing the clinical risk inherent in its waiting lists where patients were waiting beyond their expected appointment date for new and follow up appointments.
• Although ophthalmology could describe the type of clinical validation (Clinical Prioritisation) for patients waiting for appointments, this was inconsistent across the trust and some specialities had not clinically validated their waiting lists. This meant there was limited oversight of clinical risk in waiting lists across the specialities. Clinical validation was not consistently documented on the risk registers for outpatients.
• The information provided by the trust regarding overdue appointments showed this performance had deteriorated between April 2019 and June 2019. Although the trust provided information stating recovery plans and trajectories were being developed, these were not in place at the time of the inspection.
• There had been two serious incidents relating to patient appointment delays in the ophthalmology department. The trust provided the root cause analysis for one of the incidents and this highlighted the backlog of follow up patients. This had an action plan attached.
• People could not always access the services when they needed to receive the right care promptly. Waiting times from referral to treatment were not in line with national standards across all specialities and there were a high number of cancelled clinics for non-clinical reasons.

However:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The design, maintenance and use of facilities, premises and equipment kept people safe.
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff kept detailed records of patients’ care and treatment.
• The service provided care and treatment based on national guidance and evidence-based practice. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Updated 16 October 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service provided mandatory training in key skills to all staff and had systems to ensure everyone completed it but completion by medical staff at the site was poor.
• We found gaps in records we reviewed of patients’ care and treatment. What was recorded was clear but not always dated and timed with designation and general medical council (GMC) number indicated. Records were mostly stored securely and easily available to all staff providing care.
• The service did not always store medicines safely. Ambient room temperatures were not monitored in rooms where medicines were stored.
• Appraisal completion figures for both nurses and medical staff were low, and clinical supervision was not conducted regularly. Medical staff appraisal rates were worse than the previous year.
• Medical staff did not meet the trust target for completion of training on the Mental Capacity Act and Deprivation of Liberty Safeguards.
• The trust did not follow a two-stage consent process and most consent forms were signed on the day on the procedure.
• The hospital showed continued, variable performance against referral to treatment times (RTT). Some admitted pathways for surgery was consistently worse than the England average.
• Patients were cancelled at short notice due to patient flow issues and lack of available post- operative beds.
• Some leaders were new in post following the recent operational review, completed in March 2019. Leaders, under a new care group structure, were working to understand and manage the priorities and issues the service faced.
• Leaders operated within new governance structures and processes, which needed time to be finalised and embedded.
• Senior management were not always visible for both patients and staff.
• The trust was embedding the values and vision through induction and at appraisal. However, it was noted that appraisal rates, particularly for medical staff were low.
• Staff we spoke with said morale was variable, and some expressed concerns about being moved to backfill other wards.
• Although the papers were titled ‘clinical governance minutes’, they were very limited and focused mainly on audit, mortality and complaints. The meetings were attended by doctors only.
• It was clear from the minutes that the structure and content of these governance meetings were still under development.

However, we also found that:

• The service had enough nursing and medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed staffing levels and skill mix, and gave bank, agency and locum staff a full induction. There were improved nurse and medical staffing levels since our last inspection.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The majority of staff had training on how to recognise and report abuse, and they knew how to apply it.
• Staff completed and updated risk assessments for the majority of patients and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service controlled infection risk well. They kept equipment and the premises visibly clean.
• The service followed best practice when prescribing, administering and recording medicines. Patients received the right medication at the right dose at the right time.
• The service provided care and treatment based on national guidance and best practice. Staff protected the rights of patients’ subject to the Mental Health Act 1983.
• Staff gave patients enough food and drink to meet their needs and improve their health. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
• Key services were available seven days a week to support timely patient care.
• Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. We saw emotional support being provided to patients, families and carers to minimise their distress.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

Updated 30 June 2023