James Paget Hospital

Updated 31 May 2023

Pages 1 and 2 of this report relate to the hospital and the overall rating of that location, from page 3 the ratings and information relate to maternity services based at James Paget University Hospitals NHS Foundation Trust.

We inspected the maternity service at James Paget University Hospitals NHS Foundation Trust 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.

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 the James Paget University Hospitals NHS Foundation Trust remains good. However, our rating of this hospital location went down. We rated it as requires improvement because:

• Our ratings of the Maternity service changed the ratings for the location overall. We rated safe as inadequate and well-led as inadequate and the overall rating for maternity services went down to inadequate.

How we carried out the inspection

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 6 December 2018

A summary of our findings about this service appears in the Overall summary.

Updated 18 December 2019

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

• Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

Updated 18 December 2019

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Nursing staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However,

• The service did not have enough nursing staff with the intensive care qualifications to meet the faculty of intensive care medicine (FICM) guidelines. Managers regularly reviewed skill mix and encouraged nursing staff to obtain the qualification where possible.
• There was a lack of support to the critical care unit from physiotherapy staff and pharmacy staff. This meant patients did not always get the right amount of multidisciplinary team input.
• The service did not have a defined strategy to enable staff to deliver the vision.
• Staff did not always evidence the completion of mental capacity assessments when they suspected patients lacked capacity to make informed decisions.
• Staff were not aware of the freedom to speak up guardian (FTSUG)

Updated 18 December 2019

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 31 May 2023

Updated 18 December 2019

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Certain clinics were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. Staff focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not always resolve complaints within specified timescales.

Updated 18 December 2019

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

• The service had enough staff to care for patients and keep them safe. Staff mainly had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Although patient records were not always stored securely. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Not all national time to treatment targets were met.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 18 December 2019

• The urgent and emergency service had enough staff to care for patients and keep them safe. Staff were trained in the necessary key skills, knew how to protect patients from abuse, and managed safety well. Staff controlled infection risk well, assessed and monitored patient risks and mostly kept good care records. Staff generally managed medicine storage and administration well. The service managed safety incidents well and learned lessons from them, however, there were occasions when incidents were not reported in a timely way. Staff collected safety information and used it to improve the service.
• Staff provided good evidence based care and treatment, gave food and drink and pain relief when patients needed it. Senior staff monitored the effectiveness of the service and made sure staff were competent. All staff worked well as a team to treat patients, provide advice on leading healthier lives, and support them to make decisions about their care.
• All staff showed compassion and kindness in their interactions, and respected peoples’ privacy and dignity. Staff respected peoples’ individual needs and provided emotional support to patients, families and carers and supported them to understand and make decisions about their care and treatment.
• The service planned and worked with others to provide care to meet the needs of local people. Staff took account of peoples’ individual needs, and made adjustments to help patients access services and for people to give feedback. People could access the service when they needed it and although waiting times from arrival to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards, they were better than or similar to England average. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff although they did not meet the complaints response targets.
• Leaders and staff understood the service’s vision and values and knew the issues the service faced. Leaders were visible and approachable and there was a positive open culture throughout the service. Staff felt respected, valued and supported to develop their skills. The service had systems for identifying and resolving risks although ownership of risk was at a corporate level. Leaders operated effective governance processes, throughout the service and with external and partner organisations. Staff were clear about their roles and accountabilities and engaged well with patients and the community to plan and manage services. All staff were committed to continually improving services.