The Care Quality Commission (CQC) has told York and Scarborough Teaching Hospitals NHS Foundation Trust it must make urgent improvements and served it with a warning notice following an inspection in March.
CQC carried out an unannounced focused inspection of The York Hospital to follow up on significant safety concerns received about the standard of care patients were receiving.
Following the inspection, CQC issued the trust with a warning notice in response to its ineffective systems for managing patient risk assessments, nutrition and hydration, pressure area care and falls prevention.
The service was not rated at this inspection and its rating has been suspended.
The overall rating for York and Scarborough Teaching Hospitals NHS Foundation Trust remains requires improvement.
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Sarah Dronsfield, CQC’s head of hospital inspection, said:
When we inspected The York Hospital, we found that staff treated patients with compassion and kindness but didn’t always respect their privacy and dignity or take account of their individual needs.
Additionally, the service didn’t have enough nursing staff with the right skills, training and experience to keep patients safe and to provide the right care and treatment. It was disappointing that managers didn’t regularly review the situation and change the staffing arrangements to accommodate this.
We found staff didn’t always complete and update risk assessments for each patient or minimise risks to them.
Also, staff didn’t always make sure patients had enough to eat and drink, including those with specialist nutrition and hydration needs. This could put people at serious risk of harm, and we raised this with the trust at the time of inspection.
Due to our findings, we have served the trust a warning notice so its leaders are clear about what changes must be made to improve patient care and safety. We will continue to monitor the service to ensure people are receiving safe care.
- The service did not always have enough staff on wards to allow them to take account of patients’ individual needs, or help patients understand their conditions.
- Staff were unable to deliver fundamental standards of care within a timely way. Also, they were not appropriately or consistently assessing and managing risks to patients.
- Governance systems and processes failed to mitigate the risks identified in relation to nutrition and hydration, pressure area care and falls.
- Although staff had training in key areas including safeguarding, they did not always make referrals when required.
- Staff did not always support patients to make informed decisions about their care and treatment. They did not always follow national guidance to gain patient consent or make decisions in the best interests of those who lacked capacity.
Heather McNair, Chief Nurse, York and Scarborough Teaching Hospitals NHS Foundation Trust, said:
The safety of our patients and wellbeing of our staff remain our absolute priority and we are taking every possible action, and innovating where possible, to mitigate any risk to our patients.
We absolutely recognise the seriousness of the concerns raised by the CQC and since their visit there have been a number of actions taken, including an immediate inspection of every patient’s care on medical wards, including documentation and risk assessments. We also have daily staffing meetings to help identify gaps and any wards which require additional support.
Like other NHS trusts, nurse recruitment continues to be a challenge and we are currently undertaking a nurse staffing establishment review to have a clear understanding of the enhanced required staffing levels on every ward to meet the current clinical demands.
Simon Morritt, Chief Executive, York and Scarborough Teaching Hospitals NHS Foundation Trust, said:
Many of the issues raised by the CQC were known to us, and reflect the extreme pressures facing the Trust, the demands of Covid and associated staff absence, and the well documented recruitment challenges.
The report demonstrates that, when faced with these pressures, it is not always possible to give the standard of care we would want for all of our patients all of the time. We know that there is a long journey towards sustaining improvements across the Trust. Our focus remains on ensuring that all of our hospitals are fit to cope with the growing demand we are facing, and to provide safe, quality care for all of our patients.