St Luke's Hospital

Bradford Teaching Hospitals NHS Foundation Trust is an integrated trust, which provides acute, and community in-patient health and children’s services. The trust serves a population of around 500,000 people from Bradford and the surrounding area. The acute services are provided in two hospitals, Bradford Royal Infirmary and St Luke’s Hospital. The trust also has four community hospitals; Westwood Park, Westbourne Green, Shipley and Eccleshill.

The community hospitals are part of the elderly and intermediate care service in the division of medicine at the trust and provide a less acute environment. These services are aimed at avoiding the need for patients to be admitted to an acute hospital for rehabilitation and restoring functional abilities following an acute hospital stay. At the time of the inspection only two community hospitals had in-patient services operating: Westwood Park and Eccleshill.

St Luke’s Hospital provides general medical services for adults and outpatient services for adults and children. The hospital also provides rehabilitation and therapy services.

We inspected the trust from 21 to 24 October 2014 and undertook an unannounced inspection on 4 November. We carried out this inspection as part of the Care Quality Commission’s (CQC) comprehensive inspection programme.

Overall, we rated St Luke’s Hospital as requires improvement. We rated medical care services as good. We rated outpatients as inadequate. We rated the hospital good for being caring and effective but inadequate for safety, and requires improvement for responsiveness and being well-led. The ratings within the report were based on the evidence gathered at the time of the inspection.

Our key findings were as follows:

• We had serious concerns over the very large back log of patients waiting for a review of their outpatient care pathway. There were over 205,000 patient pathways to be reviewed. A patient could have multiple pathways if they are accessing several services for the same referral simultaneously . The trust had taken steps to address this and was validating the information on patients in the back log. However, we had concerns over the length of time it had taken to put in suitable actions and the time it would take to assess the impact on individual patients.

• Following the inspection we requested further information from the trust in accordance with Section 64(1) of the Health and Social Care Act 2008 (HSCA) regarding this backlog. The trust’s response indicated that actions were in place and that the backlog was reducing. The timescale for completing the review of all these patient pathways was March 2015.

• There were no concerns over mortality at this hospital.

• There were concerns regarding the access to out-of-hours medical advice. There was no on-site medical cover provided overnight, on Sundays or on bank holidays and the most senior nurse on the wards during these times was a band 5 staff nurse. This put patients at risk, due to possible delays in accessing treatment.

• Most staff were clear about the vision and strategy for the service. Changes to the risk management processes were in place, but required further embedding in practice. We observed areas of good practice including:

•There were arrangements in place to manage and monitor the prevention and control of infection. There was a dedicated team to support staff and ensure policies and procedures were implemented. We found all areas visited visibly clean.

Care and treatment followed best practice and national guidance.

Patients received appropriate hydration and nutrition. Patients were supported to eat and drink and this was accurately recorded.

The wards at St Luke’s Hospital were suitable environments to provide care. Improvements had been made to make the wards more dementia friendly. Decoration had been improved to aid reminiscence and generate conversation.