Calderdale and Huddersfield NHS Foundation Trust

Updated 20 June 2018

Calderdale and Huddersfield NHS Foundation Trust is an integrated trust. It provides acute and community health services. The trust serves two populations; Greater Huddersfield which has a population of 248,000 people and Calderdale with a population of 205,300 people.

The trust operates acute services from two main hospitals; Calderdale Royal Hospital and Huddersfield Royal Infirmary. The trust also provides community services in the Calderdale area. The trust has approximately 800 beds and 6,000 staff.

The trust saw over 102,000 inpatient admissions between January 2017 and December 2017. There were also over 427,238 outpatient attendances in the same period. There were over 150,000 accident and emergency attendances, 5,361 babies delivered and 1,632 patient deaths in the same period.

The trust provides urgent and accident and emergency services at both the Huddersfield Royal Infirmary and Calderdale Royal Hospital. The accident and emergency departments at both hospitals provides a 24 hour, seven day a week service. Huddersfield Royal Infirmary is a designated trauma unit.

The trust has critical care units at Huddersfield Royal Infirmary and Calderdale Royal Hospital. Both units provide combined intensive care and high dependency care. There are 19 inpatient beds but the services have a maximum capacity of nine level three and four level two patients.

The trust provided a full range of maternity services for women and families at both hospital sites and in community settings. Huddersfield Royal Infirmary has a six-bed midwifery-led birth centre for women considered low risk. Maternity services at Calderdale Royal Hospital include two postnatal wards, antenatal area, labour ward and antenatal clinic which included a maternity assessment area. The community midwifery teams also provide antenatal and postnatal care in women’s homes, clinics, children’s centres and general practice locations in the Calderdale area.

The children’s service is located at both hospital sites; however, the majority of children’s services, which include inpatient medical, and surgery take place at Calderdale Royal Hospital. Children's outpatient and child development services, a children's diabetes Team and a community children's nursing Team are also available.

The community inpatient service (community place) is a step down facility for those people who are medically fit for discharge and who are waiting for some social support on discharge. It is a joint initiative between the trust and the local authority. The trust closed this service in April 2018.

Calderdale integrated sexual health service was established in 2015 and provides a fully integrated level three sexual health service to the population of Calderdale. The service is based at Broad Street Plaza in Halifax. There are two satellite clinics based in Todmorden and Brighouse.

We inspected the trust in March 2016 and rated the trust as requires improvement. We rated safe, effective, and well led as requires improvement; caring and responsive were rated as good. We rated the Huddersfield Royal Infirmary and Calderdale Royal Hospital as requires improvement and community services as good. We found the trust was in breach of regulations and issued requirement notices in regard to Regulation 12: Safe care and treatment; Regulation 17: Good governance and Regulation 18: Staffing. The trust put action plans in place, which have been implemented and monitored by CQC.

Updated 20 June 2018

Our rating of the trust improved. We rated it as good because:

• We rated effective, caring and well-led as good and safe as requires improvement.
• At this inspection, we inspected six core services and rated five of them as good and one as requires improvement overall.
• In rating the trust we took in to account the current ratings of the services we did not inspect. We inspected and rated the maternity core service separately from gynaecology; therefore the previous rating for the combined services was not used.
• We rated well-led for the trust overall as good and this was not an aggregation of the core service ratings for well-led.

Updated 20 June 2018

Updated 20 June 2018

Updated 15 August 2016

Overall we rated this service as good because:

• We found this was a service where the patient was put first and holistic care was delivered.

• The service had a system in place to report incidents and staff were able to use this.

• Staff were able to give examples of where they had learned from incidents and how improvements had been implemented.

• Staff sickness levels were lower than the trust target and staff morale was high.

• Staff delivered evidence based care and treatment and followed appropriate national guidance.

• We observed kind and compassionate care being delivered by knowledgeable staff and patients told us they were happy with the service they received.

• There were fully integrated multidisciplinary teams that worked effectively in a variety of settings. A seamless service was provided with a combination of health and social care input.

• There was a range of services offered and patients did not have to wait long for care and treatment.

• There were a low number of complaints received by the service.

• There was a well-managed risk register with action plans and control measures in place.

• Despite a recent significant change in the trust structure and management arrangements staff told us they felt well supported and that managers were approachable.

However:

• Mandatory training levels were below the trust target.

• We found there had been some staff shortages but the service had managed this well.

• Some documentation required updating and standardising across the service.

• There was a lack of comprehensive performance data within the community services. This was impacting on their ability to properly measure effectiveness and responsiveness of the services within the division.

• Complaint responses and lessons learned were not always shared with staff in an effective or meaningful way but plans were in place to improve this.

• Community equipment was not well managed therefore staff were not aware of what equipment was available or if it was safe to use.

• Staff felt that senior managers in the trust did not fully understand the pressures on staff who worked in the community.

Updated 15 August 2016

• The trust had established risk reporting structures in place. Incidents were investigated and reported in line with policy. We saw evidence of the service sharing learning with staff. Staff were knowledgable and experienced in safeguarding children and recognising risk. There were safeguarding systems in place to protect children and young people from harm.

• Staffing levels were appropriate for services provided and were in line with commissioned levels. There had been problems of recruitment in childrens therapy services. The risks had been mitigated by temporary actions.

• Staff had received mandatory training at trust level of expectation. There was a broad understanding of the duty of candour and some staff had received training.

• Staff practiced evidence based care and treatment. There was good evidence of multi- disciplinary working within the trust and with external agencies. Staff were aware of the principles of consent and we observed them practising it in their work. There were clear and accessible routes into other services. Some staff reported that the transition between health visiting services and school nursing was not as smooth now that this service was under the umbrella of a social enterprise company.

• The trust was meeting recognised targets set by NHS England for this year and it’s Commissioning for Quality and Innovation (CQUIN) target for breastfeeding post delivery. However this figure decreased significantly on discharge from maternity care. The service had identified this issue and mitigating actions were being taken to address them.

• There were good appraisal rates throughout the service and systems in place to identify dates of reappraisal.

• We spoke with children and their families, and observed care taking place. We found evidence that staff practiced compassionate care and provided emotional support. People who used the service told us that they felt involved with their care. They had understood the care and advice offered to them.

• The trust planned and delivered services that met peoples needs and were responsive to the changing needs of the population. We saw evidence of innovation in care to meet the needs of the local population and hard to reach groups. This included one health visitor who services for parents who misused substances. This service took into account equality and diversity needs and that of vulnerable groups.

• There was access to translation and interpreting services and staff said that they had knowledge of the trust’s interpreting policy. Staff were aware of local links into services for new migrants and lesbian, gay, bisexual and transgender (LGBT) community.

• Services were easily accessible for children and their families. There was flexibility in how these were provided to suit individual need. There were minimal complaints about the service and these had been dealt with in a timely manner.

• There was a clear vision for the service that was child and family focussed and demonstrated innovation. There were systems in place linking governance, risk management and quality measurement at service and board level. Staff said that they were aware of these and that all levels of management, including the chief executive were visible and accessible.

• Although the community management level was currently interim pending re-configuration, this had not affected staff morale. Staff told us that they worked in an open culture and were given the opportunity to develop individually and as teams. There was evidence of engagement with both the public and staff members. We saw evidence of staff and public feedback. This was used to drive and improve services.

• There were many examples of innovative practice aimed at increased access to services for children and their families. These were evaluated to ensure that staff understood and could learn from both successes and failures.

Updated 20 June 2018

This was our first inspection of this service. We rated it as requires improvement because:

• Risk assessments not carried out routinely to ensure patients received appropriate care and treatment on the unit.
• Some patients, families, and carers told us their needs were not recognised or monitored while on the unit.
• There was insufficient clinical oversight and staff were not equipped to identify and manage deteriorating patients.
• Not all staff had the skills they needed to carry out their role effectively and in line with best practice. Staffing did not always meet defined minimum staffing levels.
• We were not assured that governance systems were effective in escalating potential risks and issues, or that learning from incidents was embedded.
• The issues we raised had not been identified within the provider’s own monitoring or audit systems. These were similar to issues identified following a previous serious incident on the unit which meant the service had not put in sufficient measures to ensure patients received high quality, safe care.
• Patient information was not always consistently recorded and staff did not always have access to the information they needed. There were inconsistencies between information recorded in electronic and paper based patient records.
• Staff did not always recognise, report or record incidents and not all incidents were effectively investigated. This meant opportunities for learning from incidents were missed.
• The leadership model was confusing, roles and responsibilities were not clear and there was insufficient clinical oversight of patients.

However:

• Most patients, families, and carers gave positive feedback about the service and felt staff communicated with them effectively.
• Managers and healthcare professionals worked collaboratively with partner organisations and other agencies to arrange onward care for patients in their own homes e.g. carrying out home visits to assess individual needs.

Updated 15 August 2016

Overall we rated the service as good. We rated the end of life service in the trust as good for safe, effective, caring responsive and well-led. The service understood how to identify safety concerns and risks to patient safety. Incident reporting was embedded in the service and learning from incidents was shared across the service to ensure improvements were made.

Medicines were effectively managed and improvements from incidents were used to improve care and treatment of patients.

Patients could access services out of hours staff worked well with GP practices to ensure patients who were receiving end of life care and their relatives were cared for and supported in the last days of life.

Staff worked within multi-disciplinary teams to allow co-ordination of care and there were meetings held with every GP practice in the area where the team provided end of life care.

There was a 24 hour telephone service and referrals to the service were acknowledged within 10 minutes of referral and contacted by telephone within one hour of the referral. Patients and their relatives were contacted by the service within 3 hours.

There was a clinical educator post within the service to co-ordinate and provide training and staff had access to specialist training. Staff had one to ones with their manager and yearly appraisals. Staff understood their roles and responsibilities for providing end of life care.

Care was provided based on national guidance such as The National Institute for Health and Care Excellence (NICE). The trust had developed and was implementing an Individual care of the dying document (ICODD) which was based on the five priorities of care document in the community.

The service had developed an end of life dashboard and they monitored patient outcomes. Information about patient care and outcomes were shared with the trust and commissioners of the service to continue to improve patient care.

The service had a vision for the service which was understood by all staff and staff felt the service was well managed and patient care was a priority for all staff.