Pontefract Hospital is part of the Mid Yorkshire Hospitals NHS Trust. This inspection was carried out over one day by a team of inspectors and an Expert by Experience as part of our scheduled programme.

We visited the stroke rehabilitation unit, an orthopaedic ward and the outpatients department.

We found that patients were receiving good care in the areas of the hospital that we visited. Overall patients gave positive feedback on the care and treatment they received. We found that the relocation of the stroke unit had had an impact on how therapy services were delivered, which we consider should be reviewed. We also found that communication about delays in appointment times in outpatients could be improved. We reviewed staffing in the areas we visited and found staffing levels were sufficient. We found satisfactory systems were in place to manage complaints and no evidence to suggest that quality assurance processes were not being implemented, for example, assessing and managing risk.

Pontefract Hospital is part of The Mid Yorkshire Hospitals NHS Trust. This inspection was carried out by a team of inspectors as part of our scheduled programme. We had received information in the form of complaints and statutory notifications since the last inspection which lead us to follow up on reports of poor discharge planning and poor care delivery.

We visited the Accident and Emergency Department, Care Closer to Home and the Day Surgery Unit.

People told us they were spoken to respectfully by staff and that their privacy and dignity was maintained as much as possible.

We spoke with two people who were due for discharge and they told us they had been informed about ongoing help they would receive once they had returned home

Two people in the day surgery unit told us they were provided with information about their care and that their opinions were taken into account when the day surgery was planned.

We spoke with staff who were knowledgeable about their area of expertise and could demonstrate a good understanding and applications of policies and procedures to support effective service delivery. Our observations of staff over all departments visited were that of a competent work force which provided dignity, privacy and respect to patients.

We looked at a number of records including patient records and found them to be relevant to the treatment the patient was receiving, up to date and accurate

• We found that the Pontefract Medical Stroke Rehabilitation Unit (PMSRU) and the Urgent Treatment Centre (UTC) did not always have enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed. Managers could not always match staffing levels to patient need and could not increase staffing when care demands rose.
• We were concerned about patient risk assessment and patient records on the PMSRU. We did not see evidence that patient risk assessments for falls, pressure damage and nutrition were updated weekly or following transfer to the unit. We found that staff kept poor records of patients’ care and treatment. Records were not completed to a good standard and we found incomplete and misfiled notes.
• We saw that staff on the PMSRU did not have always time to give compassionate care to patients because nurse staff levels were low. We noted call bells ringing for more than five minutes and patients were calling out for help. There were not always enough staff to ensure those patients who needed assistance with their meals received it. Some of the housekeeping staff worked additional hours to help with meals when nurse staffing levels were low.
• We had some concerns about clinical audit at the hospital. There was limited evidence of clinical audits taking place in the UTC, so we were unable to gain assurance of positive patient outcomes in the service. In maternity services, we noted significant delays with the local maternity audit programme overall.
• Across the hospital we found that paper copies of patient group directions used for various medicines including ibuprofen and paracetamol and co-codamol had not been reviewed since 2014 and had not been signed by relevant staff.
• In the outpatients service there was a backlog of 18,374 patients waiting for follow up appointments. Although the backlog of patients waiting for follow up appointments had improved slightly since our last inspection we were concerned about the slow pace of clearing the backlog and it was not clear what the trajectories were for clearing the backlog. In addition, the trust could not provide evidence that clinical validation had taken place on all patients in the backlog.

However:

• All the areas we visited in the hospital appeared clean and well organised. Equipment was in good working order and safety tested.
• Staff were aware of the processes to follow to report incidents and safeguarding concerns. Learning from incidents was shared between teams.
• We saw good overall core mandatory training and role specific training completion rates compared to trust targets. Staff could clearly describe safeguarding reporting procedures and felt confident making referrals.
• Care and treatment was based on national guidance.
• Staff were caring, compassionate and treated patients with dignity and respect.