Darlington Memorial 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 rated safe as good. We assessed 8 quality statements. There was a positive learning safety culture where events were investigated, and learning was shared and embedded to promote good practice. Staff we spoke with appeared committed to understand what safe meant to patients, families and partners. Staff we spoke with were open and honest when things went wrong, and they had the opportunity to learn and gain experience. Staff provided safe care and treatment. Staff had training on how to recognise and report abuse and they knew how to apply it. Risks to patient safety were assessed. The environment was safe, well maintained and met people’s needs. Leaders adjusted staffing levels when needed to keep the department and people safe. Staff were trained and competent and had the right skills to meet people's needs. Staff maintained high standards of infection prevention and control and demonstrated safe medicines management.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who used the service, their relatives, and carers we spoke with, told us they knew how to raise a complaint or concern.

Staff and leaders we spoke with were aware of NHS England best practice guidance: Learn from Patient Safety Events (LFPSE). They told us they were encouraged and supported to raise concerns, and felt confident that they would not be blamed, or treated negatively if they did so. Staff had a good understanding of how to use incident reporting systems and what to report. Staff were aware of the key themes which had arisen from recent complaints and incidents and felt confident to raise issues and concerns when they arose. Senior members of staff and leaders were involved in reviewing complaints and incidents. Safety huddles and patient experience meetings provided staff with a forum in which incidents and complaints were discussed. Information provided by the trust evidenced that concerns about safety were listened to, safety events were investigated and reported thoroughly, and lessons were learned, to continually identify and embed good practices.

In autumn 2023 the trust transitioned to the NHS England’s Patient Safety Incident Response Framework (PSIRF). This meant the trust focused on effective learning and compassionate, meaningful engagement with those affected when incidents occurred. Staff accessed up to date policies linked to relevant best practice guidance. We saw effective systems to raise concerns both formally and informally. Incident reports were analysed, and urgent actions taken by leaders to manage or remove risks. In addition, staff and leaders participated in thematic reviews when themes or trends emerged in reported incidents. There was a central log of National Patient safety Alerts, which were shared with staff and actioned as appropriate.

Patients could access emergency support at any time of day or night. Patients were satisfied there was a joined up, collaborative approach to safety that involved them and their loved ones. Patients we spoke with told us their wait for triage had been timely. They understood their pathway of care and had been informed throughout. Frail elderly people, fit for discharge but not able to get prompt transport, were looked after and monitored in the department until it arrived.

Staff adhered to safe systems and processes to deliver care. Staff completed risk assessments, and any identified risks were managed appropriately. Staff we spoke with explained how patients were triaged by trained triage nurses, and demonstrated how they used the National Early Warning Score (NEWS) tool for adults and Paediatric Early Warning Score (PEWS) for children. The tools enabled staff to identify deteriorating patients quickly and escalate them appropriately. Trust data we reviewed for time to initial triage assessment within the national standard of 15 mins, had improved slightly, with performance at 82.2% in June compared with 81.6% in May 2024. Patients could be streamed to the medical and surgical same day emergency care (SDEC) departments and urgent treatment centre (UTC). SDEC service was operational 7 days a week, 8am - 8pm. All adult patients aged 18 and above were considered for suitability and seen by a senior decision maker. Clear exclusion criteria were in place. Patients could also be referred to the acute frailty team and gynaecology team pathway where required. Staff completed risk assessments for each patient on arrival and reviewed these regularly. Staff followed sepsis-six guidelines to manage adults and children with suspected sepsis.

The service had 24-hour access to mental health liaison and specialist mental health support. There was a good working relationship with the local mental health liaison teams. The local ambulance trust staff met regularly with the service and discussed safe systems of care.

There was a twice daily nursing handover safety huddle where staff allocation was facilitated by the shift coordinator and recorded on the shift report. Key messages were also discussed and included current changes and issues that staff needed to be aware of. For example, staffing, waiting times compliance, safety checks, safeguarding, pre-admission alerts, transport and discharges. The reports were stored electronically on the trust shared drive. There was a full-capacity protocol on the intranet and all staff were familiar with it.

Patients we spoke with told us they felt safe, supported and able to approach staff if they had any concerns or felt unsafe. Staff supported them to manage risks and acted where needed to keep them safe and offer support.

Staff we spoke with knew how to identify adults and children at risk of, or suffering, significant harm. Staff understood how to protect children, young people and their families from abuse and the service worked well with other agencies such as police and local authority safeguarding teams, to protect them. Staff had training on how to recognise and report abuse and they knew how to apply it. We saw evidence of actions and learning from patient safety and safeguarding incidents. Staff we spoke with identified a named safeguarding and PREVENT lead. PREVENT is a national programme that aims to stop people from becoming radicalised or supporting terrorism. All staff we spoke with knew how to make a safeguarding referral and who to inform if they had concerns. Staff attended regular patient safety and safeguarding meetings where important information and lessons learned were shared. They described a partnership approach aligned to strategic areas for safeguarding with external stakeholders, such as the local authority.

Staff had access to safeguarding and chaperone policies, which referenced appropriate legislation and best practice guidance. We saw appropriate flags (identifiers) were applied to the electronic patient record (EPR) to identify people who were at risk, and the appropriate safeguards and referrals were put in place. Safeguarding information was displayed throughout the department.

Patients we spoke with told us they felt safe and supported whilst they were in the emergency department. They could approach staff if they felt their health was deteriorating and they were confident staff would respond to their concerns. Where personal items had been removed or restricted to manage immediate risk, this was explained to them in a way they understood.

Staff we spoke with described the processes that were in place to assess and identify patients at risk and how they assessed and documented mental capacity. Staff had a person-centred approach and involved patients, where possible when completing risk assessments, which were reviewed regularly. Staff had completed mandatory training including training to manage risk and incidents. They attended a thorough shift handover. Patient risk was managed through observation levels dependent on level of risk. We saw patient observations were completed efficiently and correctly.

Partners, such as psychiatric liaison and drug and alcohol teams reported they worked well with department staff. They received appropriate handovers, which included admission reason, whether patients had given consent, any medical or mental health history known, length of time in the department and any behaviours exhibited or known. Security staff employed by an external provider were available in the department 24 hours a day and assisted staff to de-escalate potentially challenging situations and escalate any safety concerns to medical staff.

Staff had access to policies for handover of patients from the ambulance service, paediatric fast-track and management of sepsis procedures. Staff showed us how they assessed and identified patients at risk using management plans for deteriorating patients. Staff followed trust policies and procedures when they needed to keep people with mental health needs safe from harm. For example, there was a risk assessment in place to protect people at risk of suicide or self-harm.

People we spoke with told us the department was clean and comfortable and not too crowded. There was a separate area for children and their families which was safe and secure and there were toys to keep children occupied. People were seen quickly and checked on regularly. Patients using toilet facilities could alert staff with call bells if needed.

Staff had access to all the equipment they needed and guidance or instructions for using it. Staff used their training in moving and handling to support their own safety. The department was kept safe by specialist estates staff who regularly assessed environmental risks and ensured all equipment was serviced and maintained correctly.

Staff had good oversight of the department and people were kept safe while waiting to be seen or receive treatment. The facilities were well maintained and fit for purpose. All equipment used with patients was in good working order and used safely. Corridors were clear of obstructions. Fire exits were not blocked, evacuation routes were signposted and all fire extinguishing appliances were labelled.

Planned preventive maintenance and electrical appliance tests were completed and recorded centrally. The department’s fire safety equipment and emergency systems such as call bells, were tested and maintained appropriately.

The service had enough nursing and support staff to keep patients safe. People we spoke with told us they felt there were enough staff with the right skills and experience to look after them safely. They said the staff were well trained and competent with the care and treatment they provided. People were listened to and given good advice and information.

The service had enough medical staff to keep patients safe and the medical staff matched the planned numbers on the day. Overall, the service had a good skill mix of medical staff on each shift and this was reviewed regularly. There was 24 hour consultant cover available across the emergency department for both adults and paediatric patients, which exceeded the 16 hours of cover recommended in the Royal College of Emergency Medicine (RCEM) guidance. The number of nurses and healthcare assistants matched the planned numbers, and the service had enough nursing and support staff to keep patients safe. Leaders kept staffing numbers at a safe level with a suitable skill mix. They increased numbers as much as possible when the department had higher numbers of people attending for emergency care. They used bank staff when necessary, and ensured they were familiar with local systems and processes.

Staff were noticeably busy and worked well under pressure when the department had higher numbers of patients or when people required close supervision. There was a good degree of support and mutual respect among staff working in the department. We observed effective and cohesive teamwork.

There was a suite of policies relating to safe recruitment, including Disclosure and Barring Service (DBS) checks, and all new starters received a comprehensive induction. Medical staff were supported by named supervisors and nursing staff received restorative supervision as required. However, the trust did not audit or track individual compliance. The trust appraisal compliance target of 90% was exceeded by medical staff and was almost met for nursing staff. The trust target for core essential training was 90%. Whilst nursing staff exceeded the target for all courses, the target was not quite met by medical staff, regarding fire safety training. The trust recognised the barriers to compliance, for example, recent national industrial action and operational pressures had impacted on staff availability to complete training. Trajectories were set to reach compliance by the end of March 2025, and we saw these were regularly reviewed and monitored to keep them on track. Medical staff exceeded the trust target for role specific training, such as advanced trauma life support, child and adult resuscitation and acute illness management. All triage nursing staff were fully compliant with triage assessment training. Managers used a recognised safer nursing care tool (SNCT) to accurately calculate required staffing and reviewed the numbers and skill needed for each shift in accordance with SNCT national guidance. Staff vacancy rates for the period June 2023 to May 2024, decreased month on month and sickness rate for the previous 12 months was 6.5% full time equivalent.

People we spoke with told us that they found the department to be clean, tidy and clutter free. Domestic staff were visible within the department. No concerns were raised around infection prevention and control.

Staff adhered to the trust infection prevention and control policy and exceeded the trust target of 85% for infection prevention and control training compliance.

Clinical areas we saw were clean and had suitable furnishings which were clean and well-maintained. For example, upholstered couches and patient seating were impermeable and could be wiped clean. We saw disposable curtains labelled with the date they were last changed. Cleaning records we saw were up to date and demonstrated all areas and equipment were cleaned regularly. Clinical waste was disposed of safely. We observed staff complied with ‘bare arms below the elbows’ policy, in accordance with national institute for health and care excellence (NICE) guidance. We observed staff washed their hands and used hand sanitising gel between patient interactions. This was also confirmed by patients we spoke with. Staff used personal protective equipment (PPE) such as gloves, aprons and visors where required

Staff had access to hospital infection prevention and control policies on the intranet. Staff followed infection control principles including the use of PPE. Infection control and hand hygiene audits we reviewed showed consistently high compliance rates.

People we spoke with told us staff monitored their pain levels regularly. Time critical medicines were administered timely during their stay in the department. People were appropriately involved in decisions about their medicines.

Staff we spoke with told us how patient’s medicines were appropriately prescribed, supplied and administered in line with local policy, relevant legislation, current national guidance and in line with the Mental Capacity Act (2005). The trust had an electronic system for prescribing and administering medicines. Staff completed medicines records accurately and kept them up to date. Staff followed safe prescribing practices and the trust medicines management policies.

Medicines storage rooms were secured by keypad access and all medicines cabinets, trolleys and fridges were locked in line with the trust policy. Controlled drugs were kept in separate locked cupboards and appropriate checks recorded. We saw records for electronic fridge temperature monitoring, and all were within safe temperature ranges. Intravenous infusions containing additives such as antibiotics, administered to patients, were labelled correctly. There was a piped medical gas system and cylinder gases were stored safely.

Staff had access to medicines management policies on the intranet. Staff were supported by the trust pharmacy team, who also completed periodic medicines optimisation audits with nursing staff. Where areas for improvement were identified, action plans were implemented and monitored.