Goole & District Hospital

Updated 22 March 2024

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at Goole Hospital.

Northern Lincolnshire and Goole NHS Foundation Trust provides a range of maternity services for women at three acute hospital sites.

We inspected the maternity service at Goole 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.

The Goole Hospital provides maternity services to the population of East Riding. There are high levels of deprivation with North East Lincolnshire being one of the 20% most deprived areas in England and 26% of children living in low income families.

The maternity service at Goole is a small standalone birthing unit which offers a home from home low risk midwifery-led unit, run by community midwifery teams and offering antenatal clinics, and an on-call childbirth service for women and pregnant people who want a step up from a home birth. The unit had one delivery room with a birthing pool. There are no other inpatient obstetric or neonatal services onsite. The unit therefore supports low risk women and birthing people who want a birth in a ‘home away from home’ setting. Those considered high risk are transferred to Scunthorpe General Hospital (the consultant led unit) for delivery.

A weekly obstetric clinic is available for women at Goole District Hospital who meet high risk criteria and need consultant led care closer to home.

Between October 2022 and October 2023, 6 babies were born at Goole and District Hospital midwifery led unit (MLU).

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.

This location was last inspected under our full comprehensive inspection programme in November 2019. The overall rating was good.

Our rating of this hospital stayed the same. We rated it as Good.

How we carried out the inspection

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

We visited the Goole midwifery led unit (MLU).

We spoke with 4 midwives and 1 midwifery support worker. We were unable to speak with any women, birthing people, birthing partners or relatives. We received no responses to our give feedback on care posters which were provided to the service to display and share with people during the inspection.

We reviewed 3 patient care records and 2 medicines records. We also interviewed key members of staff, medical staff and the senior management.

Following our onsite inspection, we spoke with senior leaders who were responsible for the leadership and oversight of 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 7 February 2020

We previously inspected medical care services at this site under this trust and overall rated it as requires improvement with requires improvement in safe, effective and well-led, and good in caring and responsive.

At this inspection we rated the services as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• 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 and agency staff a full induction.
• The service managed patient safety incidents well. Staff recognised incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patient’s consent. 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.
• 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. The service included patients in the investigation of their complaint.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. 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.

However:

• Compliance rates for mandatory training for medical staff were poor. The 85% target was not met for any of the ten modules. We saw the trust had an action plan to improve compliance. The plan was medical staff would be compliant by November 2019.

Updated 2 December 2022

Updated 15 April 2016

We found the minor injuries unit at Goole and District Hospital to be good for the effective domain. We did not rate the service in relation to the other four domains.

Evidence-based care and treatment was provided although some of the guidelines were past their review dates; work was taking place to action this.

We found the unit fully supported all grades of staff in their development. There was good multidisciplinary working. However, there was no service level agreement with the local mental health trust as to how long it would take them to come and assess a patient.

Given that this was a small unit in a small hospital there was good access to services seven days a week. Staff we spoke with showed a good knowledge of consent procedures, the Mental Capacity Act, and the associated Deprivation of Liberty Safeguards.

We were told of a recently conducted mental health audit. Apart from this, there was no further evidence presented to us regarding the measurement of patient outcomes.

Updated 22 March 2024

Updated 2 December 2022

Updated 7 February 2020

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

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• 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 and agency staff a full induction.
• The service managed patient safety incidents well. Staff recognised incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patient’s consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• 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. The service included patients in the investigation of their complaint.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. 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.

However:

• In theatres some equipment had gaps in its checking regime. While staff explained this was due to theatres being closed on those days, the system for recording this needed to be improved.
• In theatre recovery and prior to transfer back to a ward, staff were not totalling their observation scores to create a national early warning score (NEWS) score, for use by ward staff. This did not appear to comply with the trust’s policy. We raised this with staff and were told the issue would be addressed.
• Even though it was clear the trust was going through a further period of change, it was noted that a clearly defined plan, with approved budgets and milestones, to realise the ambition for surgery at the Goole site, was still in progress.
• While the overall governance system functioned, we did find instances in the evidence we reviewed that suggested governance needed tightening up. For example, in theatres at Goole, the new form used in theatres recovery was released for use by staff even though key information was missing from the form. In theatres, NEWS totals were not being calculated for sharing on handover to ward staff. This was arguably in non-compliance with the trust’s own policy in this area. In ward areas, for instance, one surgical healthcare team were not completing the space provided on the consent form for re-consenting the patient on the day of the procedure.
• While staff did have access to information to manage their service, various sources of information we reviewed suggested that data management and reliability were an issue for the trust.
• For the surgery division at the Goole site, we saw little evidence of learning, continuous improvement and innovation.