Hexham General Hospital is one of the acute hospitals providing care as part of Northumbria Healthcare NHS Foundation Trust. This hospital provides emergency care from an emergency care centre, medical and surgical services, midwifery led maternity services and a range of outpatient and diagnostic imaging services. Hexham General Hospital does not provide critical care, children and young people services and end of life care. Some services had been reconfigured in June 2015 when the Northumbria Specialist Emergency Care Hospital (NSECH) opened. The opening of NSECH had resulted in a new model of care and different patient pathways in emergency, maternity and medical and surgical care.

Northumbria Healthcare NHS Foundation Trust provides services for around 500,000 people across Northumberland and North Tyneside with 999 beds. The trust has operated as a foundation trust since 1 August 2006. Hexham General Hospital has 115 beds.

We inspected Hexham General Hospital as part of the comprehensive inspection of Northumbria Healthcare NHS Foundation Trust, which included this hospital, North Tyneside General Hospital, Wansbeck General Hospital, Northumbria Specialist Emergency Care Hospital, and community services. We inspected Hexham General Hospital on 12 November 2015.

Overall, we rated Hexham General Hospital as outstanding. We rated it outstanding for being caring, responsive and well- led; with safe and effective rated as good.

We rated medical care, outpatient and diagnostic imaging services and surgical services as outstanding; with urgent and emergency services and maternity and gynaecology rated as good.

Our key findings were as follows:

• The opening of NSECH had resulted in a new model of care and different patient pathways in emergency, maternity and medical and surgical care at this hospital. This had resulted in different ways of working for some staff.
• Staff felt fully informed about all the changes which had taken place and were proud of the hospital and the care it provided to the local community and beyond.
• Strong governance structures were in place across the hospital and there was a systematic approach to considering risk and quality management. Senior and site level leadership was visible and accessible to staff. Leadership was encouraged at all levels and staff supported to try new initiatives.
• Managers at all levels understood the challenges of the new model of care and were actively addressing any issues that this had presented, specifically around nursing and medical staffing and patient acuity.
• Staff and patient engagement was seen as a priority with several systems in place to obtain feedback.
• The “Northumbria Way”, which incorporates the trust’s values, behaviours and culture, was evident when we spoke with managers and staff throughout the hospital.
• Staff delivered compassionate care, which was polite and respectful and went out of their way to overcome obstacles to ensure this. All patient feedback was extremely positive.
• There were processes to ensure patients were cared for in the right place at the right time. Patient flow was a priority, and the hospital proactively managed this.
• For all performance measures relating to the flow of patients the hospital was performing the same or better than the England average.
• The transfer of patients between NSECH and the ‘base’ hospitals was still being configured and embedded at the time of inspection and staff were working flexibly to accommodate patient needs.
• The hospital had infection prevention and control policies in place, which were accessible, understood and used by staff.
• Patients received care in a clean, hygienic and suitably maintained environment.
• There was adequate personal protective equipment (PPE) such as aprons and masks available to staff. We routinely saw staff using this equipment during our inspection. Patients told us that staff washed their hands and used gloves and aprons.
• The hospital routinely monitored staff hand hygiene procedures and compliance at the time of inspection was high.
• Between April and October 2015 there had been no cases of methicillin resistant staphylococcus aureus (MRSA) at this hospital.
• Nurse staffing was maintained at safe levels in most areas. The hospital had implemented a ‘Safer Nursing Care Tool’ (SNCT) to assess the staffing requirements across wards.
• The ratio of consultants was better than the England average.
• The hospital utilised advance nurse practitioners to support doctors.
• Mortality and morbidity meetings were held at least monthly and were attended by representatives from teams within the clinical business units.
• Patients were assessed regarding their nutritional needs using the Malnutrition Universal Screening Tool (MUST).
• Nutritional assistants were employed to provide patients with eating and drinking assistance if required.
• Most wards followed the ‘well organised ward’ model to ensure that equipment storage was standardised and consistent across the trust.

We saw several areas of outstanding practice including:

• The hospital had direct access to local authority, community services and care homes to ensure unnecessary admissions were minimised.
• Staff demonstrated an outstanding level of care and compassion towards patients.
• Experienced and cohesive senior management teams across the hospital demonstrated a clear understanding of the challenges of providing high quality and safe care. They had identified and implemented actions and strategies to manage this and this had been done with the involvement of frontline staff.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Complete a comprehensive gap analysis against the recommendation made for the University Hospitals of Morecambe Bay NHS Foundation Trust.
• Ensure that the maternity and gynaecology dashboard is fit for purpose, robust and open to scrutiny.

In addition the trust should:

• Ensure that the clinical strategy for maternity and gynaecology services which is embedded within the Emergency Surgery and Elective Care Annual Plan, sets out the priorities for the service with full details about how the service is to achieve its priorities, so that staff understand their role in achieving those priorities.
• Ensure that levels of staff training continue to improve in the hospital so that the hospital meets the trust target by 31st March 2016.

• Ensure waiting time targets in ultrasound in diagnostic imaging services continue to improve as more staff are appointed.

Professor Sir Mike Richards

Chief Inspector of Hospitals

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 no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.