Bridlington Hospital

Updated 16 October 2019

Bridlington Hospital is one of three main hospitals forming York Teaching Hospitals NHS Foundation Trust. The hospital received its first patients in March 1988 and was officially opened by the Duchess of Gloucester in May 1989. In July 2012 Bridlington Hospital, along with Scarborough and North East Healthcare NHS Trust became part of York Teaching Hospital NHS Trust. In April 2007 York Teaching Hospital NHS Foundation Trust was granted its licence as a Foundation Trust.

It offers a range of medical, surgical, end of life and outpatients and diagnostic services for people across the Bridlington and East Driffield area of East Yorkshire. The hospital has one rehabilitation wards, one surgical ward and two day units. The Community Midwife Team is based at Bridlington Hospital. This is one of four community Midwifery teams for the East coast, only the Bridlington team is based here, the other three are based respectively in Malton, Whitby and Scarborough. The hospital also has a minor injuries and GP access centre, a GP MacMillan wolds unit, a ward and a renal dialysis unit that are run by other providers.

The trust also provides a range of other acute services from York and Scarborough hospitals to people in the wider York area, the north eastern part of North Yorkshire and parts of the East Riding of Yorkshire.

The CQC has carried out a number of inspections of the trust; the last comprehensive inspection of the acute services was in October 2015 with focused inspections carried out in February 2018. In February 2018 the overall trust was rated with effective, caring and responsive as good, and safe and well led as requires improvement. We rated the trust as requires improvement overall and requires improvement for well-led.

In February 2018 Bridlington hospital was rated with effective, caring and response as good and safe and well led as requires improvement giving an overall rating of requires improvement.

At Bridlington Between 18 and 20 June 2019 we carried out unannounced inspections of Medicine, Surgery and Outpatients at Bridlington Hospital.

At the time of inspection Bridlington hospital had approximately 51 inpatient beds, 22 day case beds and zero children’s beds.

At this inspection we spoke with around a total number of 27 patients and relatives, 34 staff and reviewed 18 patient records.

The trust services are commissioned by the following Clinical Commissioning Groups (CCG’s), who commission the majority of the trust’s services, and also local authorities.

• Vale of York CCG
• Scarborough & Ryedale CCG

• East Riding of Yorkshire CCG

• City of York Council

• North Yorkshire County Council

• East Riding of Yorkshire Council

Updated 16 October 2019

Our rating of services improved. We rated it them as good because:

• We inspected medical care and rated the service as good which was an improvement from previous ratings. The rating for safe, effective and responsive improved to good. The rating for good stayed the same. The rating for well led stayed the same as requires improvement.
• We inspected surgical services and rated the service as good which was the same as previous ratings. The ratings for safe improved to good. The ratings for effective, caring, responsive and well led stayed the same as good.
• We inspected outpatient services and rated the service as requires improvement. We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. The ratings for caring was good. The ratings for safe, responsive and well led were requires improvement. The effective domain is not rated.

Updated 16 October 2019

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

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service controlled infection risk well. Staff used infection control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• 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. Managers regularly reviewed and adjusted staffing levels and skill mix and gave bank staff a full induction.
• Staff gave patients enough food and drink to meet their needs and improve their health. The service could made adjustments for patients’ religious, cultural and other needs. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held meetings with them to provide support and development. Staff had a good understanding of consent, mental capacity and deprivation of liberty safeguards.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• 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.
• Staff were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work. The service had an open culture where patients, their families and staff could raise concerns without fear.

However:

• Patients’ records of their care and treatment were not always completed in line with professional record keeping standards or trust policy.
• Staff reported delays in the delivery of some equipment and safety equipment was not always replaced when broken.
• The ward did not have a tool for assessing patients’ pain where their communication may be impaired, for example for patients who were confused or suffering with dementia. This was an action in the dementia strategy but had not been carried out yet.
• Staff did not always assess patients’ mental capacity to make informed decisions about their care and treatment in a timely way and these assessments were not always documented in the patients’ notes.
• Leaders and teams used systems to manage performance however the new care group performance dashboards were still under development. Senior managers were aware of service risks, but we were not assured local risks were recorded or acted upon. The trust had plans to cope with unexpected events.
• Leaders operated within new governance processes. Staff had recently been appointed at all senior management levels and clarity about their roles and accountabilities was still developing.

Updated 8 October 2015

We saw that end of life care services were safe, effective, caring, responsive and well led, Specialist nurses and medical staff provided specialist support in a timely way. Staff were caring and compassionate and we saw the service was responsive to patients’ needs. There was good use of auditing and action had been taken against the issues identified. The trust had a clear vision and strategy for end of life care services.

However, do not attempt cardio-pulmonary resuscitation (DNA CPR) forms were not always reviewed when patients arrived at Bridlington and District Hospital and mental capacity assessments and decisions were not always documented clearly.

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.

• Although the resuscitation trolley was checked regularly as required in the outpatient department area A and area B, there were two dates that did not have recorded daily checks and there were checks not documented in outpatient area C.

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 good because:

• 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 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. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
• 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.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• The service worked in partnership with clinical commissioning groups (CCGs) and other providers across clinical networks to deliver both elective and non-elective surgical treatments, in a way that met the needs of local people.
• The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
• The trauma and orthopaedic specialty were referral to treatment (RTT) rates were above the England average (percentage within 18 weeks) for admitted pathways within surgery from March 2018 to February 2019.
• At our previous inspection we had concerns about the arrangements for when the resident medical officer (RMO) was off-site. At this inspection, the trust had completed a risk assessment and a documented procedure was available as a daft, awaiting ratification.
• Bridlington had become one of a few hospitals in the country able to provide hip replacements for selected day case patients.
• Ward sisters and matrons were visible on the ward, which provided patients and visitors with opportunity to express their views and opinions.

However, we also found that:

• Leaders operated within new governance structures and processes, which needed time to be finalised and embedded. The leadership team met regularly to discuss the performance of the service.
• 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.
• The service did not always store medicines safely. Ambient room temperatures were not monitored in rooms where medicines were stored.
• Managers appraised nursing staff’s work performance. However, they did not hold regular supervision meetings with them to provide support and development.
• Appraisal rates for medical staff were included in compliance rates for Scarborough hospital, which were below trust targets and 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 service treated concerns and complaints seriously, however, they were not always investigated promptly.