Scunthorpe General Hospital

Updated 17 December 2024

Date of assessment: 14 October 2024. Scunthorpe Hospital provides a range of NHS hospital services. This assessment looked at urgent and emergency care due to concerns raised regarding the management of risk, which we rated as requires improvement. See our previous reports to get a full picture of all other services at Scunthorpe Hospital. The rating of Scunthorpe Hospital remains requires improvement. In our focused assessment of urgent and emergency care we found that the management of risk was good but this did not impact on the overall rating of Urgent and Emergency care.

Updated 8 October 2024

We undertook a focused assessment looking at one area of concern. We found that all staff were able to articulate how they would undertake the recognition and escalation of the deteriorating patient. We reviewed patient records which documented the completed process in full with no errors or omission. Senior leaders were able to articulate how they maintained oversight of all processes that related to the management of the deteriorating patients admitted to urgent and emergency care.

Updated 2 December 2022

Updated 7 February 2020

Our rating of this service went down. We rated it as requires improvement because:

• Some concerns we told the trust it must address at our last inspection in 2018 were not actioned by the leadership team. For example, staff did not receive the mental health training which we told the trust it must provide, following our last inspection in 2018.
• There was limited assurance staff consistently completed and updated mental health risk assessments for each child and young person with mental health issues and removed or minimised environmental risks. This was because they had not received appropriate mental health training.
• The service still did not always have enough nursing or medical staff with the right qualifications, skills, training and experience to comply with national guidance.
• Mandatory training compliance by medical staff had dropped since our last inspection in 2018.
• Local audits for sepsis, hand hygiene and paediatric early warning scores (PEWS) provided limited assurance. This was because sepsis tools were not always completed, departments did not consistently submit hand hygiene data and improvement was still required in clinical record keeping.
• Staff did not always keep detailed records of children and young people’s care and treatment.
• Some staff we spoke with were unaware of the child abduction policy on the intranet and did not know when it was last tested.
• Mental capacity training data for medical staff indicated poor compliance.
• Senior leaders were not always visible.
• The service had a vision for what it wanted to achieve but no clear strategy to turn it into action.

However, we also found that:

• There was improved mandatory training compliance by nursing staff since our last inspection in 2018.
• Safeguarding training compliance had improved since our last inspection in 2018.
• Appraisal compliance had improved since our last inspection in 2018.
• The service provided care and treatment based on national guidance and evidence-based practice.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit children, young people and their families.
• Staff treated children, young people and their families with compassion and kindness and respected their privacy and dignity.
• People could access the service when they needed it.
• Staff felt respected, supported and valued.
• All staff were committed to continually learning and improving services.

Updated 7 February 2020

• We found that the Guidelines for the Provision of Intensive Care Services (GPICS) standard which states 50% of all nursing staff should hold a post graduate qualification in critical care nursing was met. Data showed that 55% of staff had the appropriate qualification.
• The service managed patient safety incidents well. Staff recognised and reported 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 used systems and processes to safely prescribe, administer, record and store medicines. During our inspection we found stock medicines within the unit were handled safely and stored securely. Controlled drugs were appropriately stored with access restricted to authorised staff.
• Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. Data submitted at the time of inspection showed that nursing staff working on HDU and ICU at Scunthorpe General Hospital had achieved an appraisal rate of 100% against a trust target of 85%.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Multidisciplinary team working was in line with GPICS recommendations. Physiotherapy staff confirmed that in line with GPICS recommendations they were able to provide the respiratory management and rehabilitation components of care.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. The information provided by the trust showed 94.3% of nursing and 88% of medical staff were compliant with MCA training. This met the trust target of 85%. We found the processes for sepsis and delirium screening was undertaken on the unit.
• 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. We saw that there were measures taken to reduce noise in the main unit. There had been implementation of sleep bundles (soft close bins, eye masks, ear plugs, clocks which show night and day etc). There was an electronic ear which changed colour when the volume was too high.
• People could access the service when they needed it and received the right care promptly. The decision to admit to the unit was made following a discussion between the critical care consultant and the consultant or doctors already caring for the patient. From the notes we reviewed all the patients had been reviewed by a consultant within 12 hours of admission. This met the GPICS standard.
• We were provided with the most recent ICNARC quarterly quality report. This showed that between April 2018 and 31 March 2019 the percentage of care post eight-hour delay rate was 1.5% this was significantly better than similar units which had an average of 5.5%.
• 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. From June 2018 to June 2019 the trust received only one complaint.
• Leaders had the skills and abilities to run the service. They were visible and approachable in the service for patients and staff. Leadership of the service was in line with GPICS standards. From discussions with the leadership team it was clear they understood the current challenges and pressures impacting on service delivery and patient care. The frontline leadership differed on each site.
• There was a strong and embedded ward management team. Staff we spoke with reported feeling very supported by their team and managers and stated they were able to escalate any concerns.
• HDU and ICU continued to function as one unit with full inter-unit working.
• Staff felt respected, supported and valued. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

However:

• The service did not have enough 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. We found the same situation with regards to medical staffing as at the previous inspection, in that it was not in line with GPICS standards. Not all care was delivered by intensivists, and on call consultants had other areas of responsibility.
• The medical staffing rota did not provide continuity of care for patients as a different consultant attended each day. This was not in line with GPICS standards.
• The percentage of staff assessed as competent to use the ventilators across the critical care division was 91% as of September 2019. All staff had received theory training on the use of ventilators with three remaining staff members to complete the competency statement.
• We were advised that staff were moved from the ward to work on other areas on a frequent basis. We observed that when this occurred it resulted in the co-ordinator no longer being in a position to provide supernumerary support. This does not meet with GPICS standards.
• Intensive Care National Audit and Research Centre (ICNARC) data showed there had been six unit acquired infections in the ITU / HDU between 1 April 2018 and 31 March 2019. This was worse compared to similar units (2.6 against 1.1 unit acquired infections in blood per 1000 patient bed days). Just over 81.4 percent of nursing staff had completed infection control training. This did not meet the trust target of 85%.
• The service did not always provide care and treatment based on national guidance and evidence-based practice. Information from the July 2019 governance meeting minutes showed that the division were not meeting compliance against all the National Institute for Health and Care Excellence (NICE) guidance, with a few outstanding. However, the minutes were not specific to which NICE guidance this linked to.
• The service provided mandatory training in key skills to staff but had not ensured everyone had complete it. The 85% target was not met for three of the nine mandatory training modules for which qualified nursing staff were eligible.  
• Not all staff had training on how to recognise and report abuse. In addition, the 85% target was not met for one of the three safeguarding training modules for which qualified nursing staff were eligible.  
• Not all services were available seven days a week to support timely patient care. We saw from patient records daily consultant led ward rounds took place, however these were not always led by a consultant intensivist due to the lack of these consultants within the trust. This was not in line with GPICS recommendations.

Updated 2 December 2022

Updated 2 December 2022

Updated 2 December 2022

Updated 2 December 2022

Updated 2 December 2022