‘Not resting on our laurels’ pledge as Friarage hospital trust makes major improvements

The Friary Hospital, Richmond.

The NHS trust which runs the Friarage and Friary hospitals has moved from ‘requires improvement’ to being rated ‘good’ overall following inspections which revealed a turnaround in its fortunes.

The South Tees Hospitals NHS Foundation Trust had been handed a warning notice by the Care Quality Commission (CQC) last year and ordered to make immediate improvements amid concerns which included patients not always being safely discharged and having enough to eat and drink, something since addressed.

A detailed action plan had been put in place by trust bosses to address a number of regulatory breaches dating back to July 2019 since when the majority of the executive team has changed.

The CQC returned in November last year and also in January to examine critical care services and urgent and emergency care at Middlesbrough’s James Cook University Hospital, along with medical wards at James Cook and Northallerton’s the Friarage Hospital, and how well the trust was being managed overall.

The CQC said the trust, which employs about 9,000 staff and provides services for more than 1.5 million people, could now be rated good in each of five categories covering how safe, effective, caring, responsive and well-led it was, whereas each of these previously required improvement.

However, in terms of individual services inspected, urgent and emergency services at James Cook were moved down from good to requires improvement when it came to their responsiveness.

Medical care at both hospitals was again rated as requiring improvement.

The CQC said overall there had been enough improvement to meet the requirements of the warning notice issued in February last year and for this to be removed.

It said: “In the core services inspected, we found that morale was not perfect, but significantly improved.

“In every observed interaction, staff were kind to each other, and their patients.”

Inspectors found that bosses, who formed part of a “strong and focused” executive leadership team, ran services well, understood the issues faced and made plans to tackle them, and were visible and approachable.

Leaders and teams identified and escalated relevant risks and issues and took actions to reduce their impact, and had plans to cope with unexpected events.

Staff felt respected, supported and valued, and were focused on the needs of people using services and there was an “open culture” where patients, their families and staff could raise concerns without fear.

Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the organisation.

But in terms of medical care there was not always enough nursing staff to care for people and keep them safe, which was deemed to be an issue in terms of surgery at the Friarage and general medical, including older people’s care, and surgery at James Cook.

There was also no clear flagging system for risks associated with people experiencing mental health crises and people couldn’t always access services when they needed it.

Meanwhile, “ongoing challenges with access and flow” in the accident and emergency department at James Cook meant people did not always access the right care promptly.

In December last year only 60.2% of patients were seen within the Government’s four hour wait A&E standard with the number of people attending that month – 10,981 – a new record.

Timely discharges into social care have also added to the problem, although various A&E statistics have shown improvements since the end of last year.

The CQC said despite the pressures, staff worked hard to keep people safe and highlighted the success of a pilot scheme introduced in January last year working with frail patients in a bid to avoid them being admitted to hospital altogether.

The department had also been proactive in trying to address extended waiting times for patients and had introduced various new roles to try and optimise access and flow.

The CQC noted how while the trust provided mandatory training in key skills, compliance was below the trust’s own target.

A separate concern was aired regarding substances hazardous to health, which were not always stored securely in areas where there were vulnerable people.

Both these elements were expressed in a list of ‘must do’ actions for the trust.

Other must-dos included considering ways to ensure optimal nurse staffing levels, making sure staff used systems and processes to safely prescribe, administer and record medicines in line with trust policy and, in terms of surgery, ensuring pain relief is given to patients when they need it with no delays.

Sarah Dronsfield, CQC deputy director of operations in the North, said: “When we returned to South Tees, we found an effective leadership team who had made significant and widespread improvements since our last inspection.

“Our inspectors saw much more effective processes and management of services, which was having a direct positive impact on the quality of care people were receiving.

“For example, these systems were used to identify risks to people and implement actions to reduce the impact of them, meaning they were much safer, and receiving more effective care.

“This was most evident in critical care which was unrecognisable from our last inspection.

“It was most impressive they were able to do this during the COVID-19 pandemic.”

She added: “Staff across all the services we visited were well engaged and committed to continually learning and improving people’s care.

“It was also very impressive that leaders engaged staff to contribute to decision-making, for example to help avoid financial pressures compromising the quality of care.

“However, there are pockets of improvements that still need to be made, particularly around making sure all staff are completing mandatory training to have the skills to keep people safe and provide effective care.

“The trust has worked hard to improve the quality and safety of services they are providing to people and other organisations should look at this report as an example of how to deliver high standards of care.

“Leaders should continue to build on the good work they’ve already done, and apply their learning to other areas in the trust.

“We’ll continue to monitor the trust and return to inspect their other services to ensure people receive care that meets standards they have a right to expect.”

The trust said it had become one of the first acute hospital trusts in England since the start of the covid-19 pandemic to achieve a rating increase from the CQC.

It said since 2019 it had been “empowering” clinicians to make decisions about how resources are allocated and care was delivered, which extends to community services in Middlesbrough, North Yorkshire and Redcar and Cleveland.

The trust recently confirmed a formal group partnership with its counterparts at the North Tees and Hartlepool NHS Foundation Trust, which aims to further improve health services and aid with the recruitment and retention of special doctors and nurses, although it has been at pains to stress it will not amount to a full-blown merger.

Chief executive Sue Page said the organisation would not rest on its laurels and recognised there was more work to do.

She said: “I am incredibly proud of all our staff.

“This achievement is a testament to their dedication and hard work.

“It has been a team effort and I am honoured to lead such a fantastic group of teams and individuals.

“Together they have all achieved something truly special and we will continue to build on this progress for our fantastic patients and service users in the years to come.

“We will not be resting on our laurels.

“There is still lots more work to do, and we are committed to working tirelessly to carry on raising our standards in collaboration with our fantastic partners and communities as we continue to recover together from the huge effects of the pandemic.”