North Tyneside General Hospital

Background to the trust Northumbria Healthcare NHS Foundation Trust was authorised as a foundation trust in August 2006. The trust provides community care, mental health services and secondary care for around 500,000 people across Northumberland and North Tyneside. The trust also provides some adult social care services in Northumberland. Services provided include: • Emergency and urgent care services including emergency surgery; • Planned and on-going care and rehabilitation; • Outpatient clinics in a range of conditions; • Elective surgery; • Diagnostic services; • Maternity services; • Children’s services; • End of life care; • Therapies including physiotherapy, occupational and speech and language therapy; • Community services such as district nursing and health promotion; and • Adult social care in Northumberland. The trust has four acute hospital sites, Northumbria Specialist Emergency Care Hospital (NSECH), North Tyneside General Hospital, Wansbeck General Hospital and Hexham General Hospital. All these sites provide a full range of acute hospital services. NSECH opened on 16 June 2015, providing specialist emergency care for seriously ill and injured patients from across Northumberland and North Tyneside. It is England’s first purpose-built specialist emergency care hospital, with emergency consultants on site 24 hours a day, seven days a week, as well as consultants in a range of specialties working seven days a week. The trust also provides a full range of community services, including community hospitals throughout Northumberland and North Tyneside. The trust manages adult social care services on behalf of Northumberland County Council manages seven practices with around 40,000 registered patients in Northumberland and North Tyneside. During 2017/18, the trust provided services for 114,000 inpatients, 3,100 deliveries and 477,000 outpatients and 203,000 accident and emergency attendances. The trust has 911 beds (861 general and acute, 35 Maternity and 15 critical care) and employs 6,900 staff, of which 594 are medical and dental and 1,885 nursing, midwifery and health visiting. The trust is expected to report a surplus for the last financial year of £25.1million from an overall budget of £526 million.

Summary of findings Overall summary Our rating of this trust stayed the same since our last inspection. We rated it as Outstanding

What this trust does Northumbria Healthcare NHS Foundation Trust provides acute services, community care, mental health services and specialised services for people in Northumberland and North Tyneside. The trust operates from four acute hospital sites, Northumbria Specialist Emergency Care Hospital (NSECH), North Tyneside General Hospital, Wansbeck General Hospital and Hexham General Hospital. Services provided include urgent and emergency services, medical care, surgery, critical care, neonatal services, end of life care, outpatients and diagnostics. The trust also provides a full range of community services, including community hospitals and specialist community mental health services throughout Northumberland and North Tyneside.

Key questions and ratings We inspect and regulate healthcare service providers in England. To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so, we rate the quality of services against each key question as outstanding, good, requires improvement or inadequate. Where necessary, we take action against service providers that break the regulations and help them to improve the quality of their services.

What we inspected and why We plan our inspections based on everything we know about services, including whether they appear to be getting better or worse. Between 21 and 23 May 2019, we carried out an unannounced inspection of urgent and emergency services (NSECH), medicine (NSECH and North Tyneside General Hospital) and maternity services (NSECH, Alnwick Infirmary and Berwick Infirmary). We inspected urgent and emergency services because the Northumbria Specialist Emergency Care Hospital had recently opened before our comprehensive inspection in 2015. At that time the trust was in the process of configuring urgent and emergency care services between the new hospital and the base hospitals of Hexham General Hospital, North Tyneside General Hospital and Wansbeck General Hospital. We inspected medicine because the safe domain had been rated as requires improvement at NSECH in our last inspection and there had been several incidents reported recently, including never events. Never events are serious incidents that are entirely preventable as guidance, or safety recommendations providing strong systemic protective barriers, are available at a national level, and should have been implemented by all healthcare providers. Each never event type has the potential to cause serious patient harm or death. We inspected maternity services because the safe domain had been rated as requires improvement at our last inspection well led domain had been rated as requires improvement at our last inspection.

Summary of findings What we found Overall trust Our rating of the trust stayed the same. We rated it as outstanding because: • We rated effective, caring and responsive as outstanding and safe and well-led were rated as good. Four ratings stayed the same as our previous inspection in 2016. • In rating the trust, we took in to account the current ratings of the services that we did not inspect during this inspection but that we had rated in our previous inspection. • We rated well led for the trust overall as good. This was not an aggregation of the core service ratings for well led. • Our full inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website.

Are services safe? Our rating of safe stayed the same. We rated it as good because: • At our last inspection we were concerned about the risk of child abduction on Ward 16 at NSECH. At this inspection this had been addressed across the trust and risks mitigated with security measures were in place at the MLUs. • Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored. • At our last inspection we found some inconsistencies in infection control procedures in maternity services. At this inspection there were no inconsistencies and all infection control procedures and practices were in line with guidance. • At our last inspection we found the storage of emergency drugs on the birthing centre and ward 16 was not in line with the trust’s pharmacy risk assessment. At this inspection we found all emergency medicines and equipment were in place and were checked as part of the routine daily checks. • At our previous inspection we found inconsistencies in the completion of records and which pregnancy pathway women were following. At this inspection records showed pregnancy pathways were clear and risk assessments were completed at each stage of pregnancy. • At our last inspection we noted medical and midwifery staffing figures were worse than national rec