Report to:

 

Health and Adult Social Care Policy and Scrutiny Committee

Date of Meeting:

 

22 November 2022

Subject:

 

CQC Inspection Update – York and Scarborough Teaching Hospitals NHS Foundation Trust

Director Sponsor:

 

Simon Morritt – Chief Executive

Author:

 

Caroline Johnson – Deputy Director of Quality Governance

 

Status of the Report (please click on the appropriate box)

 

Approve   Discuss   Assurance    Information    A Regulatory Requirement     

 

 

Trust Priorities

 

  Our People

  Quality and Safety

  Elective Recovery

  Acute Flow

 

Board Assurance Framework

 

  Quality Standards

  Workforce

  Safety Standards

  Financial

  Performance Targets

  DIS Service Standards

  Integrated Care System

 

 

Summary of Report and Key Points to highlight:

The Trust have received two inspections by the CQC in March and October 2022. Following the inspection, the Trust was issued with a section 29A warning notice due to concern the trust did not have effective systems to ensure patient risk assessments were completed contemporaneously and the care provided to mitigate risk was in line with the assessment in relation to nutrition and hydration, pressure area care and falls prevention.

 

A further unannounced inspection from the CQC took place from 11 October 2022. The inspection focussed on Urgent & Emergency Care, Medical Services, and Maternity Services across York Hospital and Scarborough Hospital. The inspection lasted 2.5 days with inspection activity ongoing throughout October and November, followed by well led interviews between 22-24 November 2022.

 

Positive feedback was received as follows:

 

Nutrition & Hydration: Improvement in systems to ensure patients received nutrition and hydration on medical wards were noted.

 

NEWS2 and Risk Assessments: Improvements in scoring, observations, and escalation of NEWS2 and risk assessments on medical wards were noted. A positive impact had been seen with the roll out of Nucleus, thus freeing up time to care for patients.

 

Emergency Care (Scarborough): Robust systems for managing demand within Scarborough Emergency Department was noted with clear systems for managing the ambulance waiting queue.

 

Areas for improvement were noted during the inspection, some of which required immediate attention from the Trust. As a result of the areas noted for improvement, immediate safety actions were implemented which have been further strengthened since the inspection. The immediate safety actions taken by the Trust have been communicated to the CQC to demonstrate safety and responsiveness.

 

The draft report for core services is expected to be received during November 2022. The well led inspection should be completed by the end of November 2022 with the draft report release date unknown at this time.

 

Recommendation:

·        Note the positive findings highlighted during the CQC inspection.

·         Note the areas assurance from the immediate safety actions implemented within the Trust following the identification of areas for improvement.

 

 

 

 

 

CQC Inspection Activity Report

 

1.   Introduction and Background

 

On 30 March 2022, the CQC had undertaken an unannounced focussed inspection at York Hospital. The inspection focussed on Medical wards and the fundamental basics of care delivery. The inspection lasted 1.5 days, spanning across seven wards.

 

Since this inspection the CQC have undertaken a further unannounced inspection 11-13 October 2022. The inspection focussed on Urgent & Emergency Care, Medical Services, and Maternity Services across York Hospital and Scarborough Hospitals. The inspection lasted 2.5 days with inspection activity ongoing throughout October and November, followed by well led interviews between 22-24 November 2022

 

The purpose of this report is to provide the Health and Adult Social Care Policy and Scrutiny Committee with the findings of the March inspection and assurance in relation to actions taken to address concerns raised. The formal report from the October inspection is not yet available, however, the preliminary feedback will be included in this report.

 

2.   March 2022 Inspection Findings

 

On the 3 May 2022 the CQC issued the Trust with a section 29A warning notice due to concern the trust did not have effective systems to ensure patient risk assessments were completed contemporaneously and the care provided to mitigate risk was in line with the assessment in relation to nutrition and hydration, pressure area care and falls prevention.

 

The warning notice required the Trust to demonstrate improvements by the end of August 2022 and a full inspection was scheduled to take place within three months of August 2022. An unannounced inspection has since occurred on 11 -13 October 2022 and the Trust remains in the inspection phase until completion of the well-led review 22-24 November. 

         

A comprehensive action plan has been implemented to address concerns, and delivery is overseen via a twice monthly Quality and Regulatory Assurance Group which reports through the governance structures to the Board.

 

Audits of the fundamentals of care delivery have been undertaken and positive improvements have been seen between audits. A key aspect of the improvement work has been the implementation of our electronic clinical record system Nucleus across all wards. This has replaced the paper record system and provides greater oversight and assurance of the fundamentals of care delivery.

 

In their feedback letter following the recent unannounced inspection the CQC noted the following improvements:

 

·        Nutrition and hydration on medical wards: We have seen improvements in systems to ensure patients receive nutrition and hydration on the medical wards at York and Scarborough.

·        NEWS and risk assessments on medical wards at York: We have seen improvements in scoring, observation and escalation of NEWS and risk assessments on medical wards and noted the positive impact the introduction of the ‘nucleus’ system has had on releasing nurses time to care for patients.

·        Management of demand within the Emergency Care Department at Scarborough. We have seen robust systems in place to manage demand within the department including clear systems of managing the ambulance waiting queue.

        

3.   Initial Feedback Received from the October 2022 Inspection

 

The Trust remains in the inspection phase pending the well-led review which takes place between 22-24 November, however the CQC have provided some initial feedback.

 

They have raised concerns regarding the following:

 

·        The observation and management and documentation of the care of patients within the emergency department at York. This was particularly within the majors waiting room, ambulance queue and ready for transfer corridors.

·        The use of midwives as scrub nurses in theatres which impacts upon staffing on the labour ward.

·        Processes in relation to the closure of the maternity unit due to staffing pressures and the impact this has upon service users not being able to access the service.

·        Environmental issues in the Emergency department at York and the maternity theatres in York

·        Medicines management both in maternity and with the emergency department at York including the management of controlled drugs.

 

Immediate action has been taken to address concerns raised and assurances were provided to the CQC. The Trust has produced two improvement plans in

relation to Emergency Care at York Hospital and Maternity Services, both of which have been shared with the CQC.

 

4.   Next Steps

 

The draft report for core services is expected to be received during November 2022. The well led inspection should be completed by the end of November 2022 with the draft report release date is currently unknown. There has been no further enforcement activity to date, although inspection activity is still ongoing. Upon receipt of the draft report, further improvement plans will be created and monitored through the pre-existing governance structures.

 

 

Date: 6 November 2022