Our rating of services went down. We rated them as requires improvement because:

• We rated safe, effective, responsive and well led as requires improvement and caring as good.
• At this inspection we saw improvements in some of the hospital’s services but some services had deteriorated since our previous inspection
• We rated three of the hospital’s five services as good, one as requires improvement and one as inadequate.
• There was limited evidence that staff had the skills, training and experience to provide the right care and treatment. For example, appraisal rates for a number of staff groups were worse than the trust target and mandatory training rates in four of the five services at the hospital were below the trust target of 85%.
• We found examples in medical care and outpatients where there had not been sufficient effective senior clinical oversight to manage risk and respond to urgent or changing patient needs.
• The total number of patients on outpatient waiting lists had increased since the previous inspection.
• Services at the hospital did not have a vision, strategy or business plan. We saw examples where service delivery did not seem to have been addressed, for example, the delayed discharges in medical care and utilisation of the birthing suite.
• The hospital did not engage effectively with patients, staff, and the public to plan and manage services.

However:

• Staff cared for patients with care and compassion and respected patients’ wishes. Staff provided individualised care and involved patients and those close to them in decisions about their care and treatment
• Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff felt well-supported by their local leaders and the culture of the hospital was patient-centred.

We inspected the ward that had four beds identified for stroke rehabilitation care. We found that patients who were admitted to the hospital for stroke rehabilitation received care and treatment that met their needs. The hospital had facilities to enable patients to improve their health and wellbeing.

We found that not all staff we spoke with had up to date certificates in training the trust considered mandatory and other important training relevant to their role. There was limited formal staff supervision and not all staff we spoke with had received appropriate development and appraisal. We found the trust had recognised this and started to address it by completing a training analysis.

We inspected Northern Lincolnshire and Goole NHS Foundation Trust (the trust) from 13 – 16 October 2015. This inspection was to review and rate the Trust’s community services for the first time using the Care Quality Commission’s (CQC) new methodology for comprehensive inspections. It was also an acute hospital focused inspection to follow up our concerns from the April 2014 comprehensive inspection and highlighted through other information routes.

Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection. We therefore did not inspect all the core services at Goole hospital for this follow up inspection. Additionally not all of the five domains: safe, effective, caring, responsive and well led were inspected for each of the core services we inspected. For the 2015 inspection we inspected the effective domain for the emergency and urgent core service (the minor injuries unit). This was because it had not been rated in 2014. We inspected maternity services because of concerns we had received. Diagnostic services were inspected for the first time and we followed up the responsive domain in outpatients from our 2014 inspection.

Overall at the 2015 inspection we rated Goole hospital as good. We rated Goole minor injuries unit (MIU) as ‘good’ for being effective. Maternity services and diagnostic imaging services were rated as ‘good’ overall.

Our key findings were as follows:

• There was good evidence-based care and treatment within the MIU although some of the guidelines were past their review dates; work was taking place to action this.
• Given that this was a small MIU in a small hospital there was good access to services seven days a week.
• Women who chose to give birth at the hospital received two midwives to one woman care during labour and escalation procedures were in place to ensure there were sufficient staff. The unit provided individualised care and patients were treated with privacy, dignity and respect.
• The maternity birthing pool and antenatal clinic were visibly clean.
• The rates for patients who did not attend appointments in outpatients had improved since our last inspection, but clinic cancellation rates were worse, apart from in ophthalmology.
• Outpatients and diagnostic imaging patients received harm-free care and treatment in a clean and well-equipped hospital from staff who had received appropriate training. Although radiology was short of medical staff across the trust, this did not affect patient care.
• Patients in ophthalmology outpatients and radiology told us they were happy with the care and treatment they received. They told us staff were kind, caring and compassionate.

However, there were also areas of poor practice where the trust needs to make improvements at this hospital. Importantly, the trust must:

• seek and act on feedback from service users in radiology in order to evaluate and improve the service.
• ensure it acts upon its own gap analysis of maternity services to deliver effective management of clinical risk and practice development.
• review the rate of cancellations of outpatient appointments and rates of ‘did not attend’ at Goole and take action to improve these in order to ensure safe and timely care and to meet the trust’s own standards of 6%.

Professor Sir Mike Richards

Chief Inspector of Hospitals