Castle Hill Hospital is one of the main hospital sites for Hull and East Yorkshire Hospitals NHS Trust. The trust operates acute services from two main hospitals: Castle Hill and the Hull Royal Infirmary. The community services operated by the trust were not assessed as part of this review. The trust serves a population of 660,000 and provides a range of acute services to the residents of Hull and East Riding of Yorkshire as well as a number of specialist services to North Yorkshire, North and North East Lincolnshire.
Castle Hill Hospital has 610 beds and provides acute medical and elective surgical services, including cardio-thoracic, breast, ear, nose and throat (ENT) and oncology services. Critical care is provided in two units, which support the cardiology and cardio-thoracic services. There are no accident and emergency services at this hospital: these are provided at Hull Royal Infirmary.
We found that the hospital was facing significant challenges due to the shortage of staff and insufficient capacity to deal with the increasing number of admissions. The shortage of nursing and medical staff, particularly junior doctors was impacting on the care patients received, leading to delays in assessment and treatment. There was a winter plan in operation, whereby additional beds had been opened on one ward, to alleviate pressure on bed space across the trust. Despite this, the high volume of admissions resulted in patients being moved around the hospital and across to Hull Royal Infirmary, often through the night. The hospital was not meeting all nationally set targets such as referral-to-treatment times in some specialties and backlogs had built up. A large number of outpatient appointments had been cancelled.
Staff were working hard to ensure the safety and welfare of patients, including working additional hours. We found that doctors were covering a number of areas in addition to their normal allocation and did not always have the necessary competencies for the speciality. Some staff reported that they were put under pressure to undertake additional workload and meet performance targets.
Patient feedback about care was generally positive and staff were reported to be caring and compassionate.
There were systems to manage and monitor the prevention and control of infection, with a dedicated team to support staff and ensure policies and procedures were implemented. All areas visited were clean.
There were systems in place for assessing, monitoring and addressing risk, with lines of reporting to the trust board. However, many staff told us that they did not have the time to report incidents, and there was little shared learning across divisions.
The trust was aware of the challenges over staff shortages and the high volume of admissions and had taken steps to address these. However, recruitment had proved difficult and had led to a high usage of locum staff. We saw some good examples of local leadership and highly motivated staff, but this was not consistent across the hospital. Staff felt generally supported by local leaders but not engaged with the executive management team.
We found the hospitals in breach of Regulations 9 (care and welfare), 10 (governance), 13 (medicines,) 22 (staffing) and 23 (staff support) for the regulated activities of treatment of disease, disorder or injury and diagnostic and screening procedures.