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Care Quality Commission – Sheffield hospitals query inspectors’ report into patient care

Dr David Throssell, Medical Director of Sheffield Teaching Hospitals NHS Foundation Trust
Dr David Throssell, Medical Director of Sheffield Teaching Hospitals NHS Foundation Trust

Hospital chiefs have questioned a report by inspectors which raised a number of concerns about the care of patients in Sheffield.

The Care Quality Commission (CQC) reviewed 20 councils, hospitals and ambulance trusts in different parts of the country in the winter of 2017. Sheffield was chosen because performance was not as good as many other parts of the country on a number of measures.

The Department of Health and Social Care said older people in Sheffield were more likely than most places to be admitted to hospital. They were much more likely to stay an extended time and less likely to stay at home in the longer term once they left hospital.

Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) says its emergency readmission rates were actually below the national average, not higher. Its hospitals and community services are rated by the CQC as providing good quality, safe care

The review raised concerns about bed capacity and patients not being safely discharged but hospital bosses have challenged the findings, saying some particular issues need clarification.

The CQC review said: “Figures showed that hospitals had bed occupancy figures consistently higher than 90 per cent. In the first quarter of 2017/18, bed occupancy was at 95 per cent while the England average was 87 per cent.

“National guidance suggests that optimal bed occupancy levels in hospital are around 85 per cent. Hospitals with an average bed occupancy above 85 per cent risk facing regular bed shortages, periodic bed crises and potential increased numbers of hospital acquired infections.“

But Dr David Throssell, Medical Director of STHFT. said every effort was made to match the number of beds to demand.

He said: “We monitor bed usage and staffing daily to ensure we continue to provide safe care and we have the ability to open additional beds in times of high demand.  

“We were also one of the few NHS Trusts who did not routinely cancel non-urgent operations last winter. We took this decision because we know how distressing cancellations are for patients.”

The review also found that people did not always experience safe discharges home because of a lack of communication, coordination and adequate assessment.

It said: “Significant concerns were raised by people using services, carers, social care providers and the voluntary and community sector. We were told that some people were being discharged home late at night from the wards and the A&E department between 2am and 3am.

“There were widespread concerns regarding the quality and accuracy of discharge information, or about not getting information at all. People did not always get the adequate follow up care they required to remain safe and their medicine information was not always correct resulting in risks of potential ill health.

“People experienced delays being discharged from hospital especially at weekends, due to waiting for medicines, availability of staff and transport issues. They also experienced inappropriate discharges.

“We were told of examples where people were discharged without care packages, medicines and equipment and to inappropriate settings. We received reports of poor joint working with a lack of communication with and involvement of the people, their carers, families and care home providers.

“People and their carers were not always involved in the discharge process, or if they were, this was not always timely.”

Dr Throssell said patients have the right to be discharged if they want to be. “During the review, a number of patient notes were examined by the CQC and they found that a person-centred approach was adopted at the point of discharge from hospital.

“Wherever possible people’s preferences were documented and the right people were involved in conversations about their care.

“However, some records showed these discussions were not always started early enough and this had impacted upon their discharge and length of stay in hospital. We are working hard with the council, other healthcare providers and voluntary organisations to address this.”

Electronic discharge summaries were already sent automatically to patient’s GPs and a copy given to the patient and electronic prescribing has now started at the Northern General Hospital and is in the process rolling it out across the Hallamshire Hospital. This has been shown in many other Trusts to improve information about medication and reduce the potential for error.”

He added: “We had already recognised that as a city we need to make further improvements to some aspects of health and social care for older people, focusing particularly on how we support patients’ transition to their next stage of care or back to independent living after hospital treatment is complete.”

The CQC report can be viewed here https://www.cqc.org.uk/sites/default/files/20180522_local_system_review_sheffield.pdf

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