Torbay Hospital

Updated 21 February 2024

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Torbay Hospital.

We inspected the maternity service at Torbay Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

Torbay Hospital provides maternity services to the population of Torquay and South Devon.

Maternity services include antenatal clinics and a day assessment unit, a consultant led delivery suite and a mixed antenatal and postnatal ward (John Macpherson ward).

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

Our rating of this hospital stayed the same. We rated it as Requires Improvement because:

• Our rating of Requires Improvement for maternity services did not change ratings for the hospital overall. We rated safe as Requires Improvement and well-led as Requires Improvement.

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited the day assessment, antenatal clinics, delivery suite, obstetric theatres, and the antenatal and postnatal ward.

We spoke with 9 midwives and 6 women and birthing people. We received 5 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 3 patient care records, 3 Observation and escalation charts and 3 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 3 November 2023

Updated 2 July 2020

Updated 7 June 2016

We have judged the overall critical care service to be good. The safety, effectiveness, responsiveness and leadership of the service were all good. Caring was outstanding.

• Patients were kept safe from avoidable harm. Staff worked in an open and honest culture that encouraged incident reporting and learning. Generally good levels of nursing, medical and allied healthcare professional staffing ensured patients received care care. Staff adhered to infection prevention and control policies and protocols.
• Treatment by staff was delivered in accordance with best practice and recognised national guidelines. There was a holistic and multidisciplinary approach to assessing and planning care and treatment. Patients’ needs were comprehensively assessed and outcomes were recorded and monitored. Staff were skilled, experienced and worked as part of an effective multidisciplinary team.
• Patients were truly respected and valued as individuals. Feedback from people who had used the service, including patients and their families, had been overwhelmingly positive. Staff went above and beyond their usual duties to ensure patients experienced compassionate care and that care promoted dignity. Innovative support for patients was encouraged and valued by staff, patients and visitors.
• The critical care service responded well to patients’ needs. Patients were treated as individuals, and there were strong link nurse roles for all aspects of patient need. There were few complaints about the department, but where a complaint was received it was dealt with in a timely and compassionate way.
• There was a clear vision and strategy, with staff being actively involved in the development and delivery. Staff, patients and their families were actively engaged with to identify areas of good practice, as well as areas that could be improved. There was a high level of staff satisfaction in a supportive, open ‘no-blame’ culture. The leadership drove improvement and staff were accountable for delivering change. Innovation and improvement were celebrated and encouraged.

However:

• The unit did not meet current standards for a modern critical care unit and had been recognised by the trust as not being fit for purpose. However, staff worked well within the environment to keep patients safe from avoidable harm and the building of a brand new unit had started.
• Staff had alimited understanding of the requirements of the Mental Capacity Act 2005, and the Deprivation of Liberty Safeguards (DoLS).We could not be assured that patients who required an authorisation under DoLS were having this requested by the unit.
• Bed pressures in the rest of the hospital affected timely discharges from the unit, but the numbers of these were below (better than) the NHS national average. Elective (planned) surgery was impacted on by bed availability in critical care. There were limited facilities for visitors and the unit did not meet the modern critical care building standards. However, a new critical care unit was being built and once opened would provide much improved facilities.
• Governance arrangements required some improvement. In particular a holistic formal review of safety information on a more regular basis was needed, as was the regular review of mortality.

Updated 3 November 2023

Updated 17 May 2018

Staff providing end of life care included ward nurses and doctors, the chaplaincy, ward housekeepers, porters, administrative staff and allied health professionals. End of life care was also provided by a hospital specialist palliative care team and cancer nurse specialists for patients needing difficult symptom management. A palliative care service was provided by the trust to support the management of pain and other symptoms and provide psychological, social and spiritual support. The objective of the palliative care service was to achieve the best quality of life for patients and their families. Support was provided to help patients live as normal routine as possible until death and to offer support to help the family cope during the patient’s illness and in their own bereavement.

Our rating of this service improved. We rated it as good because:

• End of life care at Torbay hospital had become a more integrated service which had seen significant improvement of the care provided to its patients nearing their end of life.
• Since our previous inspection a more comprehensive audit programme had been undertaken and from the results we could see where change had been made leading to improvements.

However:

• There were still areas that remained an issue, such as the recording and sharing of spiritual needs and the lack of care planning. The trust had identified these as areas needing to improve, however actions taken so far had not been sufficient to address them.

Updated 21 February 2024

Updated 3 November 2023

Updated 2 July 2020

• Compliance with mandatory training modules was not meeting trust targets. The design, maintenance and use of facilities and premises meant there were some risks to patients and prevented effective cleaning. There were some risks to the spread of fire from poor health and safety practices in relation to fire doors.
• Some staff did not consistently understand the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 and the Children Acts 1989 and 2004. Preoperative assessments were valid for six months prior to the patient’s surgery and surgery was often performed when this assessment had expired.
• There were times when patients did not feel well-supported or cared for or their dignity was not maintained. We spoke with a number of patients who either felt they were given different information by different staff, or did not feel included in conversations about their care.
• Patients could not always access services when needed to receive treatment within agreed timeframes and national targets. Reduced activity and insufficient theatre capacity had resulted in underperformance in admitted patient pathways. Some patients stayed longer in hospital than they needed to, often because care packages to support patients in the community were not always available or timely. There were high numbers of cancellations for patients having elective surgery. When patients had their operations cancelled at the last minute, managers did not make sure they were all rearranged as soon as possible and within national targets and guidance.
• The service did not have a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. There was no current strategy for Coastal Integrated Service Unit. The service did not have a mental health strategy appropriate for patients with mental illness that the trust board approved and reviewed annually. There were some governance processes, but these were not effective in gaining full assurance for improving or developing the service. Meeting minutes lacked enough detail and had limited insight to provide the reader with enough information to understand what was discussed and agreed.

However:

• The service used systems to identify and prevent surgical site infections. Staff used equipment and control measures to protect patients, themselves and others from infection. Staff completed and updated risk assessment for each patient and removed or minimised risks. The service mostly had enough medical, nursing and support staff with the right qualifications, skills, training and experience to provide the right care and treatment. Staff kept detailed records of patients’ care and treatment. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers ensured staff were fully competent for their roles. Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.
• The day surgery team had won prizes at the International Association of Ambulatory Surgery (IAAS) Congress. First prize was awarded to the day surgery emergency team and second to the day case hip replacement service for presenting projects based on their work which had transformed patients’ lives, improved their experience in hospital, reduced waiting lists, improved the efficiency of trust clinical processes, and reduced costs.
• Staff were discreet and mostly responsive when caring for patients. Staff took time to interact with patients and those close to them in a respectful and considerate way. Staff made sure patients’ privacy and dignity was always respected.
• The service relieved pressure on other departments when they could treat patients in a day and was recognised for work on hip replacement surgery. The service treated concerns and complaints seriously, investigated them and learned lessons from the results.
• Leaders had the integrity, skills and abilities to run the service. Staff felt respected, supported and valued. The management and oversight of the risk register was clear. Staff were committed to continually learning and improving services.

Updated 7 June 2016

Updated 3 November 2023