St Luke's Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed key questions within safe and rated it as good. We found a positive learning culture; evidence of safe systems, pathways and transitions.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During the assessment we spoke to several patients and relatives on the two care of the elderly wards across the assessment service group. This included wards F5 and F6. No concerns were raised, and we observed compassionate care and treatment. Patients we spoke to told us they felt included in their care planning. Patients were positive about their experience and interactions with staff, they told us they felt confident and comfortable to raise concerns, though none of the patients we spoke with had needed to raise concerns during their stay. Friends and family feedback reviewed was positive overall and there was evidence of actions taken by the Trust to improve following feedback.

There was a culture of safety and learning from incidents within the organisation. This was based on openness, transparency and learning from events that have either put people and staff at risk of harm, or that have caused them harm. Incidents and complaints were investigated and reported. During inspection we saw examples of differing patient complaints and incidents with harm. Staff were able to explain the investigation process, actions taken, and lessons learnt. Staff gave examples of honest conversations with patients and family members to support duty of candour both verbally and in written form. Staff were able to raise concerns and to proactively identify and manage risks before safety events occurred.

During inspection we saw examples of differing patient complaints and incidents with harm. Staff were able to explain the investigation process, actions taken, and lessons learnt. Staff gave examples of honest conversations with patients and family members to support duty of candour both verbal and in written form. We saw examples of incidents with lessons learnt and action taken as a result of investigation. Staff had access to raise concerns to proactively identify and manage risks. There was a governance process in place where complaints, incidents and risk were reviewed. The Trust officially transitioned to the national Patient Safety Incident Response Framework (PSIRF) from 1st December 2023. The policy and plan was approved by the Trust board of directors, and Bradford District and Craven Health and Care Partnership in November 2023.

Patients we spoke to told us they knew what was happening in their care and what was happening next. Patients we spoke to had been involved in discharge planning.

Staff told us there were risk assessments in place and that they understood the processes and need to complete these. Staff we spoke to were aware of processes and pathways for transfer of patients between the St Lukes wards and the wards at Bradford Royal Infirmary. Staff told us that patients would only be transferred to the wards at St Lukes if they were stable and met the criteria for the ward. We saw some staff were based within bays to provide regular observations and monitoring of risk such as falls. We saw evidence of falls alarms in place.

There were transfer processes in place and admission criteria for patients admitted to Wards F5 and F6. Nationally recognised risk assessments were in place including mobility, nutrition and falls and were reviewed regularly. If patients deteriorated there was a pathway in place to seek advice from advanced nurse practitioners or the medical team and patients could be transferred to the Bradford Royal Infirmary site if necessary to meet needs. We saw some staff were based within bays to provide regular observations and monitoring of risk such as falls. We saw evidence of falls alarms in place. We heard that the discharge planning processes would begin to take place once a person was admitted to the ward.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

During the assessment we spoke to several patients and relatives on wards F5 and F6 (care of the elderly step down wards). No concerns were raised, and we observed compassionate care and treatment. Patients we spoke to told us they felt included in their care planning. Patients we spoke with were positive about their experience and interactions with staff, they told us they felt confident and comfortable to raise concerns, though none of the patients we spoke with had needed to raise concerns during their stay. Some patients told us they felt there was not always enough staff on duty to care for patients requiring additional support. Friends and family feedback was reviewed which was positive overall and there was evidence of actions taken by the Trust to improve following feedback.

Managers regularly reviewed staffing levels and skill mix and efforts were made to increase staffing levels for each shift. However, this did not always provide established safe levels of staffing. The service did not always have 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. Patients were placed at risk of deteriorating mental health, infections and de-conditioning as a result of longer stays in hospital due to limited therapy resource. We also heard that patients might be kept on the wards longer than usual because of a delay of 8 to 12 weeks to access the community therapy stroke team. During assessment staff told us escalation requests were often not supported due to the lack of staff available. The two wards often supported one another, night shifts were often difficult to staff for registered nurses. There was an escalation plan in place to escalate and request additional resource from the acute site. The trust had successfully recruited overseas nurses and newly registered nurses to cover vacancies, however, these staff were junior and inexperienced and required support and mentorship throughout induction, Objective Structured Clinical Examination (OSCE) training and apprenticeship training. The trust had recruited additional clinical practice educators to facilitate additional learning needs for newly recruited staff. However, most staff we spoke to said it was difficult to offer consistent mentorship and training opportunities to junior staff due to patient numbers and patient acuity.

We assessed wards F5 and F6. Ward F6 did not meet planned verses actual staffing levels for registered nurses. Planned verses actual staffing boards evidenced this and managers corroborated there was often gaps in staffing rotas. Both wards were step down wards for care of the elderly patients. Both wards were nurse led unit for patients who had been stepped down from acute care wards from the acute site. On inspection we observed staff working hard to complete tasks for patients, however, we were not assured that staff had the time to always provide person centred care that met individual patient needs and acuity. Patients on the ward were frail elderly patients at high risk of falls. Some patients had dementia and or intermittent confusion and required additional support with daily tasks.

Managers regularly reviewed staffing levels and skill mix and efforts were made to increase staffing levels for each shift. However, this did not always provide established planned verses actual levels of staffing required to care for patients. The two wards inspected had differing levels of patient acuity, some requiring 1:1 support due to risk of falls, dementia, confusion etc. The service had a range of steps and processes to mitigate staffing risks. We assessed two wards at Bradford St Lukes (wards F5 and F6. Ward F6 did not meet planned verses actual staffing levels for registered nurses. Planned verses actual staffing boards evidenced this and managers corroborated there were often gaps in staffing rotas. Both wards were step down wards for care of the elderly patients. Both wards were nurse led units for patients who had been stepped down from acute care wards from the acute site. On inspection we observed staff working hard to complete tasks for patients. There was a process in place to compare staff numbers and skill mix alongside actual patient demand in real time, to base informed decisions. The trust had a clear process in place for escalation requests. There were registered nurse vacancies on ward F6. Mandatory training compliance on all wards inspected met the trust target of 90%. The division provided data which evidenced compliance rates met the trust target rate. Staff appraisal compliance was well managed and was in line with the trust target of 90% on all wards we assessed. Staff at all levels had opportunities to learn, and poor performance was managed appropriately.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were supported to access the medicines that they were prescribed in a timely manner. We were told that medicines reconciliation was undertaken before transfer, for the people we looked at medicines reconciliation had been completed however there were discrepancies in the method of recording. It was possible for staff to provide medicines information leaflets in other languages and for those who required medicines to be dispensed in multi compartment devices this was facilitated by the pharmacy.

There was no clinical pharmacy service to both medical wards however staff told us they knew how to contact pharmacy for clinical queries. Requests for inpatient medicines were sent electronically to the Bradford site pharmacy and these were received in a timely manner. Staff told us that there were sometimes delays with stock orders for medicines due to the paper based ordering process. We were told that the discharge process could be lengthy and ward staff felt that this impacted discharge. The hospital used an external pharmacy provider which had a turnaround time of 48 hours. In addition, once the prescription had been authorised, staff had to physically take the prescription to the dispensary which meant time off the ward. Staff we spoke with had heard of some devices aimed at assisting with administering critical medicines on time however they were not able to show us this on the ward.

Medicines were stored securely on the wards we visited. Room temperatures and fridge temperatures were recorded on most days. Staff knew what to do if they were out of range. CD registers we looked at had no pharmacy CD checks and staff we spoke with were not aware of this being undertaken by pharmacy staff.

The trust used an electronic prescribing system to prescribe and administer medicines. There was a range of in date medicines policies in place to support staff in medicines management. One of the wards we visited told us they completed weekly medicines audits which were given to senior staff however this was not consistent across both wards.