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Care Services

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Derriford Hospital, Crownhill, Plymouth.

Derriford Hospital in Crownhill, Plymouth is a Hospital specialising in the provision of services relating to assessment or medical treatment for persons detained under the 1983 act, caring for adults under 65 yrs, caring for children (0 - 18yrs), diagnostic and screening procedures, family planning services, management of supply of blood and blood derived products, maternity and midwifery services, surgical procedures, termination of pregnancies and treatment of disease, disorder or injury. The last inspection date here was 18th December 2019

Derriford Hospital is managed by University Hospitals Plymouth NHS Trust who are also responsible for 13 other locations

Contact Details:

Ratings:

For a guide to the ratings, click here.

Safe: Requires Improvement
Effective: Requires Improvement
Caring: Outstanding
Responsive: Requires Improvement
Well-Led: Good
Overall:

Further Details:

Important Dates:

    Last Inspection 2019-12-18
    Last Published 2019-05-31

Local Authority:

    Plymouth

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

15th April 2019 - During an inspection to make sure that the improvements required had been made pdf icon

We carried out an unannounced focussed inspection of the emergency department at Derriford Hospital on 15 April 2019.

We did not inspect any other core services or wards at this hospital or any other locations provided by the trust. We did visit the day case recovery unit which was being used to provide additional overnight patient accommodation as part of the trust’s escalation plan. During this inspection we inspected using our focussed inspection methodology. We did not cover all key lines of enquiry. We did not rate this service at this inspection.

The trust has one emergency department which provides a 24-hour, seven day a week service. It is a designated major trauma centre providing care for the most severely injured trauma patients from across the south west.

Our key findings were as follows,

  • There were not enough available beds in the hospital to allow emergency patients to be admitted to a ward as soon as this was required. This had resulted in a crowded emergency department with patients receiving care and treatment in unsuitable environments.
  • Initial clinical assessment (triage) of patients did not take place according to guidance produced by the Royal College of Emergency Medicine and the Royal College of Nursing. Self-presenting patients sometimes waited for up to an hour to be triaged. There was a risk serious medical conditions could remain undetected with a consequent delay in treatment.
  • Some records of patient observations were not accurate.

However:

  • Patients arriving by ambulance were assessed and treated quickly.
  • There was a supportive and friendly culture within the department which was centred on the needs of patients.
  • Innovative ideas had been used to prevent unnecessary admission to hospital.
  • The emergency department had a committed and well-motivated leadership team.

We told the trust they must:

  • Reduce crowding in the emergency department so patients do not have to wait on trolleys in unsuitable environments.
  • Complete initial assessment (triage) of self-presenting patients in accordance with standards set by royal colleges.
  • Accurately record first clinical observations made by emergency department staff.

In addition, the trust should:

  • Improve and monitor the speed of response from senior specialist doctors when patients have been referred to them by the emergency department.
  • Regularly monitor operational performance in the emergency department at a senior level and record issues, including how these are being addressed.

Professor Edward Baker

Chief Inspector of Hospitals

17th April 2018 - During an inspection to make sure that the improvements required had been made pdf icon

Our inspection of the trust covered only this hospital. What we found is summarised above under the sub-heading Overall trust.

22nd March 2012 - During a themed inspection looking at Termination of Pregnancy Services pdf icon

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.

14th July 2011 - During a routine inspection pdf icon

The views of all people seen at all locations at Plymouth Hospitals NHS Trust are incorporated in this section of this report. The views for each separate hospital is listed below.

Derriford Hospital

During our site visits to Derriford Hospital and the Child Development Centre, we went to twenty ward and clinical areas in addition to the outpatient clinics at the hospital. We spoke to over 100 patients and visitors. We also spoke with many members of staff.

Most patients said they felt safe and said staff were very kind to them. We had many positive comments about staff. One patient said, ‘The staff are very kind and I shall miss them.’ Another told us that staff were ‘all quite friendly’.

We were told that patients thought their privacy was protected and that they felt staff were respectful during their visit to the hospital. Patients also told us that they had felt involved in planning their care or treatment.

Staffing levels were identified as a problem by patients. Comments included ‘There are not enough staff.’ ‘Things never happen when they [the staff] say they will’. ‘The staff are always smiling when they do come to assist but there just aren’t enough of them.’

Although, on our visit, at least 95 of the 100 patients and visitors, we spoke to told us they felt well cared for, we were informed that sometimes this was not the case. Patients mainly described the response to call bells the main problem with their care. Patients on other wards said were very satisfied with the amount of time they were waiting. Some patients told us they had not been told of why delays in treatment had occurred during their stay. Other patients on other wards described having to be moved in the middle of the night as disruptive.

There was confusion about the different uniforms staff wore. Other patients said the uniforms were very confusing meaning they did not know who to ask for what. One person said ‘It’s enough to make any one muddled’.

We were told that patients were pleased with the way they received their medicines in hospital. Some patients told us that they had to wait for medicines to take home on some occasions, but most patients said that they hadn’t had to wait too long.

The views about the food provided within the hospital continued to vary. Comments included ‘very good’ and ‘excellent’ to ‘awful’ and ‘like school dinners, you either loved them or hate them.’

Patients thought staff worked very hard to keep ward areas clean. Patients and visitors complained to us about the car park, because of the cost and additional stress when appointment times were delayed or were late. Patients appreciated the access to the faith-room facilities, religious services and mobile shop run by the voluntary service.

Patients told us they knew how to complain and that if they had any concerns they would raise them straight away with the staff on the ward. People also knew about the Patient Advisory and Liaison (PALS) team, although confidence was not high regarding the way complaints were currently managed.

Royal Eye Infirmary

We visited all areas of the Infirmary. We spoke with thirteen patients, four of which were children. We also spoke with 6 relatives, 6 parents and 9 members of staff.

Patients said they thought their care and treatment at the Eye Infirmary was very good. We were told ‘The staff care for me beautifully, they are wonderful and excellent’ and ‘The staff are lovely, very reassuring and calming’.

We were told that patients were very satisfied with the information given either verbally or in leaflets (including some in large print) and all were confident that they knew exactly the nature of their treatment. One person said ‘The paperwork received was very good’.

Mount Gould

We visited the clinic areas, at Mount Gould Hospital, that Plymouth Hospitals NHS Trust use. We spoke with four members of staff and four patients. We also spoke with one relative.

All patients spoken with said they were well cared for and the treatment they had received was very good. All comments about staff were positive. Patients felt there were enough staff in attendance. Comments included ‘I waited no time at all’.

One patient said, “I was anxious, but the Dr made me feel so much better, she put me at ease”. This person went onto say that the Doctor had asked lots of questions and was very interested. “I felt very involved in my care”. Another patient said ‘The doctors are lovely.’

Headquarters

Headquarters is a ‘virtual location’ based at Derriford Hospital. It is used to organise community services (mainly maternity). It involves the organisation of midwives working in the community including at peoples homes, local GP clinics and children centres. We visited one children’s centre where we spoke with one midwife, three women and one partner.

All women we spoke with said they had felt respected during the pregnancy, birth and post delivery period. Women explained that they had been given enough information throughout their pregnancy. The feedback regarding care was positive. One woman said ‘Its been nothing but brilliant’. Another woman said ‘My midwives have been lovely, I’ve had the same one most of the way through, it did not matter to me who I saw as they are all lovely.’

Two of the three women and the partner we spoke with said they had not needed to complain. However, none of the women or partner we spoke with knew how to make a complaint.

Tavistock Hospital

We visited the operating department and outpatient department at the hospital. We spoke with 7 patients, 3 relatives and 7 members of staff.

Patients said staff caring for them were respectful about what their needs were. One patient said ‘they really took time to find out about me and put me at my ease.’

Patients all agreed that the care and treatment they received was excellent. Each person said that from the time of entering Tavistock Hospital they were well cared for having everything clearly explained. The positive feedback also referred to reception staff, nurses and doctors.

Kingsbridge Hospital

We visited two departments at Kingsbridge Hospital. We spoke with 3 patients and 5 members of staff.

Patients said they had been given a choice of going to Kingsbridge hospital or Derriford. One patient told us ‘It is more convenient to visit Kingsbridge hospital rather than go into Plymouth.’ All comments about the hospital and care were positive. One patient said ‘I come here regularly for treatment and they are all excellent.’

Cumberland Centre

We visited the x ray department, physiotherapy department and outpatients clinic. We spoke with 4 members of staff, three relatives or escorts and 4 patients.

All comments received about the staff, and the care provided at the Cumberland centre, were positive. Patients told us they thought staff had been ‘Very polite and friendly’ during their care. One person said ‘It is so nice coming here rather than going up to the main hospital.’ Another patient said the care they had received was, ‘Brilliant’ and added that ‘they have cured my pain’.

Liskeard Hospital

We were unable to speak with any patients on the day of our visit to Liskeard Hospital because either clinics were not running that day, or had been cancelled. We were able to read a comment book left in reception in which people visiting the hospital had added numerous comments. All comments read were positive. These include people saying it was the best hospital they’d ever visited and commented about the excellent staff and excellent service provided.

22nd March 2011 - During a themed inspection looking at Dignity and Nutrition pdf icon

During our visit patients told us they felt involved in their care and were very complimentary about the staff. Patients said they felt they had been treated with respect whilst in hospital and not felt embarrassed or uncomfortable during their stay. One person said ‘They are very caring and they listen and answer my questions’.

Without exception, patients told us they thought they had their needs met. Patients told us staff encouraged them to ‘do as much as possible to keep active’. One person said ‘staff check I am OK and then just check on me now again. I find this very reassuring’. Patients talked of feeling involved in their care but also of ‘trusting’ doctors and nurses.

The feedback about the taste of the food was varied, although everyone said there was enough to eat. Some patients said the food was awful, whilst others said it was the highlight of their day. One person said ‘I have an arrangement with the housekeeper to give me a larger portion of potatoes.

One person said ‘Everything was in place’ about their special diet, ‘from the moment I stepped into the ward. I usually have a choice from two or three items each mealtime and fellow patients sometimes say they wish they could have my meals as well’.

16th February 2011 - During an inspection in response to concerns pdf icon

Because we were reviewing practice in the operating theatres we did not speak to many people who use the service. The very small number of people we did speak with, said staff had been very kind and that they had been treated very well.

1st January 1970 - During an inspection to make sure that the improvements required had been made pdf icon

We conducted a follow-up inspection on 11 and 18 December 2018. We did not review ratings as part of this inspection. This inspection was focused solely on the improvements required as detailed within two warning notices. These warning notices were issued to the trust on 13 August 2018, with the requirement to make significant improvements regarding the quality of healthcare by 26 October 2018. The following areas of concern were identified in the warning notices:

Medicines and Pharmacy

  • Significant improvements were required to ensure systems and processes for safely managing medicines were operating correctly both within the pharmacy services and across the trust. These processes also needed to be effectively governed so people were given the medicines they needed, when they needed them and in a safe way.

  • Routine pharmacy input to clinical areas had been frequently limited due to staffing and capacity issues.

  • The delivery of a high-quality service provision was not assured by the leadership, governance and culture.

Diagnostic Imaging

  • Significant improvements were required to ensure patients suspected of having cancer had timely access to initial assessment, test results and diagnosis.

  • The diagnostic imaging service was not meeting internal or national targets for the imaging of patients.

  • Leaders did not have the necessary capacity to lead effectively. This included both service management and modality leadership.

  • There were consistent low levels of staff satisfaction and high levels of work overload. Staff did not feel valued, supported, or appreciated by the rest of the trust.

We found the trust had not fully addressed or sufficiently acted on some of our concerns in the warning notice. The full warning notice and the actions taken needed better executive oversight. The detail of the warning notice had not been appropriately reviewed and acted on. However, we recognised the trust was making some progress and that a cultural shift would take time, which was relevant to both areas inspected.

In Medicines and Pharmacy we found:

  • There was progress in addressing the concerns in the warning notice, although some areas had not been well considered or implemented quickly enough.

  • There was no consistent assurance that patients were discharged with their medicines to take away (TTAs), posing a risk to patient safety.

  • Processes to review TTAs left on the ward following a patient discharge had still not been rolled out. The trust had therefore made insufficient progress in the timeliness of addressing this issue.

  • There were still no safeguards to ensure medicines had been delivered to patients using the trust transport service and patients were adequately counselled on their medicines.

  • The monitoring of refrigerator temperatures on wards across the trust was still not functioning effectively, increasing the risk of unsafe storage of medicines.

  • There was a level of instability in the pharmacy department and a reduced resilience amongst the team. Progress had been made recruiting staff, however, there was a lot of pressure and stress on staff due to capacity and workload.

  • Clinical pharmacist vacancies were reducing; however, gaps were still apparent with specialist pharmacists.

  • The dispensary and supply team particularly felt the pressures of workload because of the vacancies they were experiencing.

  • We were not assured sufficient priority or resources had been allocated by the board to address and rectify issues in pharmacy.

  • There was a lack of capacity with leadership. Adequate support had not been provided to the interim director of pharmacy to ensure a continued presence of support in the department.

  • The current pharmacy department staffing risks were not included on the pharmacy risk register. This was not recorded for the pharmacy leadership team or pharmacy staff.

  • The gap analysis against the Royal Pharmaceutical Society’s Professional Standards for hospital pharmacy did not adequately link to risk management.

  • Culture was improving in the department, but there was still a division, with mixed feelings from pharmacy staff. There were still staff who were upset and felt morale was low.

  • Improvements were needed in the level of engagement provided to pharmacy staff.

  • A more robust check and challenge of the warning notice action plan, through the governance structure, was required to ensure areas of the warning notice had been fully met.

However:

  • The chief operating officer recognised there was still not enough resource to allow the trust to address the full CQC warning notice and the trust action plan. Choices were being made to deliver sustainable solutions, and they were working to get resilience around clinical support in the department. The service model required review and a new workforce model would be developed.

  • The clinical pharmacy service had improved their access to clinical areas for routine pharmacy input. The service had been reinstated on 1 October 2018, reducing several risks identified in our warning notice from a previously restricted service.

  • Governance structures for pharmacy had been changed since our last inspection, although they were not yet embedded to enable us to evidence their effectiveness.

In Diagnostic Imaging we found:

  • Insufficient progress had been made in addressing the concerns in the warning notice.

  • The diagnostic imaging service was still not meeting the seven-day internal target for the imaging of patients suspected of having cancer.

  • In MRI there were still a number of scans breaching the two-day internal reporting cancer target.

  • Some modality leaders still did not have the capacity to lead effectively.

  • We found limited improvement, and some areas of deterioration, with progress on the cultural concerns within the diagnostic imaging department.

  • Staff consistently described a culture from some modality leaders of poor attitudes and behaviours which bullied, belittled and humiliated junior staff. Radiographers felt unable to raise this with their managers or with their freedom to speak up guardians.

  • Some consultants said the workload had not reduced and most reported working harder than at the time of the last inspection.

However:

  • There was improving performance for patients waiting longer than six weeks for a routine scan.

  • There were plans to improve process and efficiency with booking appointments.

  • There was improved management of governance within the imaging department.

  • There had been an internal review of risks on the risk registers and actions were progressing well.

  • Improvements had been made in the management structure for senior staff in the imaging department.

  • The department was now consulted when new appointments and service developments were made throughout the trust.

  • In CT the most urgent scans were reported on in a timely way.

Following this inspection we told the provider it must take some actions to comply with the regulations, and it should make other improvements, even though a regulation had not been breached, to help the service improve. We also served the trust with a section 29A warning notice requiring the trust to make significant improvements within the diagnostic imaging department. Please see details at the end of this report.

Importantly, the trust must:

Pharmacy and Medicines

  • Ensure there is a clear process rolled out trust wide, within wards, pharmacy and transport, to safeguard patients receiving their critical medicines if discharged. Ensuring patients are being appropriately counselled on their medicines.

  • Ensure the trust have assurance and can evidence processes, through review of data, that patients being discharged without their critical medicines receive them in a timely manner.

  • Review staffing establishment and skill mix for the pharmacy department to ensure staffing meets capacity and demand.

  • Review training and competency of staff and ensure staff are not working above their role and competencies.

  • Ensure capacity for leadership and ongoing support is available in the pharmacy department.

  • Ensure risks are identified, recorded and mitigated, with a clear record for this.

  • Ensure there is robust oversight of governance for pharmacy and medicines trust-wide.

Diagnostic Imaging

  • Ensure that 85% of patients suspected of having cancer are scanned within seven days as per the trust target.

  • Ensure the management team addresses poor leadership and manages attitudes and behaviours shown by some of the team.

  • Ensure staff satisfaction improves, and that staff are confident to raise concerns with managers.

In addition, the trust should:

Pharmacy and Medicines

  • Encourage pharmacy staff to consistently report incidents.

  • Confirm all areas within the hospital with refrigerators are recording the minimum and maximum temperatures, along with current temperature, daily.

  • Adapt the ward TTA trust pilot form to ensure a clear auditable trail of TTAs being collected by patients.

  • Explore ways to engage with the pharmacy department to keep staff well informed at a time of unsettlement.

  • Continue to focus on the culture within the pharmacy department.

  • Develop the strategy for pharmacy so there is clear direction for the service, and ensure this is supported by a contingency plan.

Professor Ted Baker

Chief Inspector of Hospitals

 

 

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