Durham Diagnostics and Treatment Centre

⚠ There was not enough nursing staff, however staffing gaps were filled by bank and agency staff. Nurses staffing was found to be at unsafe levels with a high number of unfilled shifts every month.

⚠ Some mandatory compliance rates fell beneath the trust target of 90%. We were particularly concerned about resuscitation training for medical staff which was 48% and with compliance with infection prevention and control which was 44%.

⚠ Medical staff were not compliant with the trust’s 90% target for all mandatory training modules: resuscitation training compliance was 52% and infection prevention and control compliance was 60%.

⚠ We were not assured there was sufficient oversight of patient safety in the designated mental health assessment room.

⚠ The isolation of patients with suspected influenza was not always in line with trust policy.

⚠ Leaders and teams did not consistently use systems to manage theatre utilisation effectively.

⚠ We found three items of equipment which were out of date for servicing and maintenance.

⚠ The maintenance and use of facilities and equipment did not always keep people safe. We found vital equipment in use, such as ventilators, which appeared to have not been service and maintained.

⚠ The service did not use the trust’s systems and processes to safely prescribe, administer, record and store medicines. We had significant concerns about staff failing to follow the trust’s policy in relation to the safe management of controlled drugs.

⚠ We had concerns that most staff did not recognise the use of mechanical or pharmacological restraint as a reportable incident.

⚠ Whilst staff supported patients with capacity to make informed decisions about their care and treatment, they did not always follow national guidance when patients lacked capacity to give consent. They did not always use measures that limited patients' liberty appropriately. Staff showed limited understanding of the legislation around the deprivation …

⚠ At trust level, there was not sufficient oversight of benchmarking outcomes with other regional services, and this had been an ongoing concern.

⚠ The audit schedule for the (trust-wide) service was not comprehensive. There was no evidence of key audits being carried out from April to December 2019, including record keeping, medicines management and infection prevention and control audits.

⚠ We also saw some risks on the maternity risk register had been ongoing for a considerable amount of time; and one entry had been open since 2006. We saw that there were no specific risks entered on the risk register pertaining to the South Tyneside site.

⚠ Staff did not consistently fully complete the World Health Organisation (WHO) surgical safety checklist for emergency procedures.

⚠ There were inconsistencies and missing checks of emergency equipment (including for the adult resuscitation trolley and difficult airway trolley), and there was no documentation of safety checks of neonatal resuscitaires. We observed missing and out-of-date stock was not always replenished in a timely manner, and saw evidence that staff sometimes …

⚠ We were not assured that the service had enough midwives to consistently provide care and treatment in line with national guidance relating to one-to-one care in labour, and the service did not provide evidence of an internal assessment of safe staffing levels. We saw that 22% of shifts reviewed from …

⚠ No simulations of obstetric emergencies were conducted within the hospital setting, with the exception of birthing pool evacuation drills; and the service had not undertaken a recent baby abduction drill.

⚠ The service’s maternity dashboard was suboptimal, there was not sufficient oversight of benchmarking outcomes with other regional services, and this had been an ongoing concern.

⚠ The audit schedule for the service was not comprehensive. There was no evidence of key audits being carried out from April to December 2019, including record keeping, medicines management and infection prevention and control audits. We were also not assured that the service consistently took the relevant actions required from …

⚠ The service was experiencing midwifery staffing challenges, but this was not always recognised by senior leaders. There was a lack of monitoring of risks in accordance with national guidance in relation to safe staffing of the service. NICE ‘red flag’ recording and monitoring procedures relied on individual reporting by staff, …

⚠ We saw some risks on the maternity risk register had been ongoing for a considerable amount of time; and one entry had been open since 2006.

⚠ The ward environments were not suitable for children and young people with mental health concern.

⚠ The ward environments were not suitable for children and young people with mental health concern, implying insufficient staff training for such an environment.

⚠ Staff had not received any sepsis training.

⚠ There was a risk that staff were not providing care and treatment based on up to date evidence-based guidance because staff on the paediatric wards did not have access to any policies or procedures.

⚠ The service did not have robust arrangements in place for identifying, recording, reviewing and managing risks.

⚠ The service did not have enough nursing staff with the right qualifications, skills, training and experience to meet national guidance. They were not meeting the BAPM guidance for nursing staff.

⚠ The service did not have enough medical staff to meet national guidance. Overnight the middle grade staff provided cover for the paediatric wards, emergency department and the neonatal unit.

⚠ Adult trained staff had not completed any training or competencies to enable them to care for children.

⚠ Nurse staffing was not meeting national guidance. Children and young people were not always cared for by a registered children’s nurse.

⚠ No staff on site had completed advanced paediatric life support (APLS) training.

⚠ There was no formal transfer policy in place for transfer of those children or young people who may deteriorate.

⚠ The environment where children were cared for was not secure and there was a risk that unauthorised adults could enter the area.

⚠ The service did not ensure that tools used to identify deteriorating patients were embedded.

⚠ The service did not comply with Accessible Information Standards by identifying, recording, flagging, sharing and meeting the information and communication needs of people with a disability/sensory loss.

⚠ Robust systems and processes were not in place to identify, manage, mitigate and escalate risks for the service, leading to a lack of clear oversight by senior managers and board members.

⚠ Plans to improve management and leadership capacity within the service were not fully implemented.

⚠ Staff team meetings did not take place on a regular basis.

⚠ The learning disabilities team was isolated, and there was a lack of understanding of the service amongst other teams within the trust.

⚠ Appropriate environmental risk assessment and mitigation for the wards of all ligature risks, including the use of ligature cutters and staff trained to use these, was not provided.

⚠ Patients were not provided with an appropriate system to call staff in the event of an emergency.

⚠ The service did not risk assess for emergency equipment including emergency medication required on the ward for resuscitation in line with the patient group and current national guidance.

⚠ Staff did not receive regular formal clinical supervision in accordance with trust policy.

⚠ Robust systems and processes were not in place to identify, manage, mitigate and escalate risks for the new safe haven unit, and senior managers and board members lacked clear oversight of service risks.

⚠ Plans to improve management and leadership capacity within the service were not fully implemented.

⚠ Staff team meetings did not take place on a regular basis.

⚠ The learning disabilities team was isolated, and there was a lack of understanding of the service amongst other teams within the trust.