Peterborough City Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We rated safe as requires improvement. We assessed 5 quality statements. There was a positive learning safety culture where incidents were reported, investigated, and learning embedded to promote good practice. Staff were open and honest when things went wrong or could be a risk. We observed safe care and treatment. The environment was safe, well maintained and met people’s needs. Leaders ensured that adult areas of escalation had adequate and safe staffing and had the correct equipment available. Reviews of staffing levels were carried out on a regular basis and staff were reallocated to areas of low staffing as required.

Recruitment practices were safe. Staff had training available that was relevant to their roles and responsibilities and support they needed to deliver safe care. However, there was evidence that the paediatric emergency service was short staffed at times for senior nurses and senior medical staff.

Compliance with mandatory training requirements had been a challenge to ensure that staff had the right skills to meet people’s needs and also sepsis screening performance was below the standard required.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were able to raise concerns and report incidents. The concerns and incident reports were taken seriously, investigated and learning shared with colleagues. People or those who represented them were given an apology and an explanation of the event.

The service had effective processes to investigate incidents, identify and share learning. Staff completed a daily review of incidents for immediate review and leaders held a weekly patient safety review panel. Common themes and trends for incidents and complaints were identified for lessons learned and for these to be communicated to staff.

The service held monthly governance meetings to discuss incidents, identify trends, themes and lessons learned. These were carried out collaboratively both within the hospital service with medical services and with another NHS service to share learning and implement improvement.

Staff were confident to identify and report incidents in line with the service’s incident reporting policy. Staff we spoke with had received feedback sometimes on incidents they had submitted. Staff were also able to provide examples of methods used to share learning from incidents such as emails, meetings, and safety alerts.

The service had effective systems to enable staff to raise concerns both formally and informally. Leaders shared lessons learned from incidents through a newsletter, a weekly Friday feedback communication and reflective group meetings.

The service had an up-to-date Patient Safety Incident Response Framework (PSIRF) policy which set out the approach to developing and maintaining effective systems and processes for responding to patient safety incidents and of learning. A Patient Safety Incident Response Plan was also in place, which set out how the service sought to learn from patient safety incidents reported by staff, patients, their families and carers. Leaders analysed incident reports and took urgent actions to manage or remove risks. Incidents were appropriately investigated.

The service had a duty of candour policy, which set out staff roles and responsibilities regarding openness, honesty and transparency if something went wrong with a patient’s care or treatment.

The service also had an up-to-date complaints policy in place. Complaints were investigated and the Patient Advice and Liaison Service (PALS) service also supported responses to complaints. As part of the assessment, we reviewed complaints the service had received. There was some evidence of learning from the complaints such as dealing with delays of treatment and access to pain relief

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

No patients that we spoke with during the assessment told us that they felt unsafe and uncomfortable to raise concerns.

Staff that we spoke with told us they knew how to make a safeguarding referral if they had concerns. The service had a safeguarding team that staff could readily access. Staff we spoke with told us they had completed safeguarding training, and they could refer and review safeguarding referrals on the hospital electronic system.

The service had safeguarding policies and procedures in place. We reviewed care records for children and young people and safeguarding concerns raised by staff and found there was appropriate escalation and action taken to safeguard children and young people. Children’s and young people’s safeguarding processes were thorough and effective. Staff achieved 72% compliance with safeguarding children training level 3 and 91% with level 2 training. However, staff compliance for safeguarding adults training level 3 was 79%, which was below the service’s planned compliance target of at least 90%.

Some people attending the department said they had experienced long waits and were therefore at risk of deteriorating. In June 2024 11.9% of patients were waiting over 12 hours. As part of our assessment, we reviewed the Friends and Family feedback in June 2024 for the trust U&EC services. We found that 75% of patients gave a positive review of the service with a target of greater than 90%. We spoke to one patient who was not aware of their care plan.

Senior leaders met with the medical services leadership team to review common risks such as poor patient flow and length of stay in the service and how to mitigate them. The hospital “back on track” programme was also looking at improving ward processes and discharges to improve the patient pathway, reduce overcrowding and reduce risk in the U&EC.

Staff said within U&EC staff worked well together. Staff had access to a psychiatric liaison team to assist with patients with mental health concerns. The team were co-located within the U&EC department. The psychiatric liaison team would attend a handover meeting every morning. They would aim to see a patient within an hour to evaluate the patients’ needs and provide crisis management. However, there were delays in responding on occasions. For frequent attender mental health patients, a care plan was in place. Every episode is risk assessed independently. During our inspection a patient had recently absconded from the U&EC department without being seen by the psychiatric liaison team. The patient was subsequently located, and we were told by a senior leader that the patient was not seen due to capacity issues in the team. This was a concern for the risk management of mental health patients.

Staff knew about specific risk issues however they were not always dealt with promptly and completely. Staff told us that they carried out safety checks, but this could be difficult to carry out for patients in corridors.

Staff used an ED patient safety checklist outlining the clinical tasks needed for each adult “Majors” patient and for any patient waiting in the “fit to sit” area for more than four hours to improve patient safety and improve the quality of care. The ED patient safety check list had been adapted by leaders to reflect learning from incidents. Data supplied by the service following our assessment showed staff achieved variable compliance against the patient safety check list in the 3 months prior to our assessment, which meant that users were not always being risk assessed in a timely manner.

Although patients sometimes experienced long waits in the U&EC department, patients told us they were well looked after by staff.

In the Care Quality Commission’s 2024 national patient survey the results for the trust U&EC environment and facilities were like other services. People not feeling threatened by other patients or visitors was 8 out of 10 and access to food and drink was 6 out of 10.

Leaders told us that they were aware of the space constraints within some areas of the U&EC department such as the “fit to sit” area. This could then become overcrowded when the ED was busy, and this was an issue they were trying to resolve. Improvements had been made recently to some areas, for example the corridors were more dementia friendly, and the rapid assessment and treatment (RAT) area had increased space and capacity. Despite this improvement we were told by staff of a concern when handover occurs due to the close proximity of other patients in the RAT area.

The premises were modern and well-lit. The initial assessment and “fit to sit” areas were quite small and could become overcrowded especially when the department was busy. The environment was affecting privacy and dignity in the “fit to sit” and the ambulance RAT area. The corridor area was also being used at the time of this assessment. Four patients were being cared for on each side of the corridor in a safe and caring manner. Staff informed us of the criteria for patients to be cared for in the corridor and this was being followed. The environment was generally clean and adequate equipment and facilities were available such as handwashing equipment and personal protective equipment (PPE).

An area had recently been reconfigured to provide a mental health quiet room for children and young people and was waiting for final completion at the time of our inspection. Immediately prior to the assessment a temporary mobile unit had been removed from the external ambulance bay offloading area. This area was found to be heavily contaminated with pigeon droppings. This was likely to contaminate staff and equipment and be transferred to clinical areas causing an infection control risk. Senior leaders took immediate action to resolve the dirty area, and we were given immediate assurance that this area had been satisfactorily cleaned. This area was part of the planned cleaning programme going forward.

We also found that generally the medication cupboards and storage areas were safe and secure. On one occasion the eye clinic room door had been propped open with a clinical waste bin. The medication cupboard containing medicines was open with a key in the cupboard. There was a risk that this area could be easily accessed by someone who was not authorised. We also observed that one of the dirty utility rooms had no lock on the door and there was potential access to chlorine disinfectant tablets by patients.

The service had a procedure for the care of patients in the corridor within the U&EC department. This was in place if the U&EC department was having extreme capacity issues and risks of prolonged ambulance handover delays. Clear patient exclusion criteria were outlined which was being followed during the assessment. The area was busy but was being managed well and had appropriate staffing in place. Dedicated staff had been allocated to manage patients waiting in the corridors and promoted safer care.

During our inspection in 2022 we told the service that it must ensure all staff complete checks on emergency equipment. However, at our most recent assessment we found that the daily resuscitation trolley checks were not always conducted. We found that there were 4 days in the resuscitation area and 8 days in the “majors” area that there were omissions of the daily checks in July 2024. Some out of date equipment was found in the paediatric ED emergency trolley.

Leaders managed safe staffing levels and appropriate skill mix by moving staff across the U&EC department when necessary to fill any areas where staffing was below accepted numbers. Leaders maintained a daily staffing plan which was risk assessed for safe staffing levels. Staff levels had improved slightly recently.

Medical staff rotated to different areas dependant on the acuity and pressured areas within the U&EC. The emergency medicine consultant in charge decided on this allocation daily.

Consultant medical staff were fully staffed and there was good recruitment and retention of all staff. Vacancy rates were 12% for medical and nursing staff in July 2024 compared with around 21% in July 2023.

Staff told us that the paediatric ED was short staffed at times for senior paediatric nurses and medical staff. We were told that due to the lack of senior medical staff at speciality trainee level 4 (ST4) grade there was a risk they would not be able to undertake face to face reviews of suspected paediatric sepsis patients. Leaders were aware of staff concerns about this and the risk was being reviewed at the time of this assessment.

Medical and nursing staff told us they received mandatory and specific training that was relevant to their roles and responsibilities. There were also opportunities for further professional development. During our inspection in 2022 we told the service that it must improve staff mandatory training compliance. At our most recent assessment in June 2024, we found that staff overall compliance with mandatory training was 84% for medical and nursing staff, which was below the trust’s target of at least 90%.

Appraisal compliance was low for nursing staff at 64% in July 2024 and below the trust’s target of 95%. Leaders were taking action to address this by providing protected time to complete appraisals.

During our assessment we observed that nursing and medical staff were busy and worked well under pressure when the U&EC had high numbers of patients. There was a culture of working together as a team to manage the numbers of patients in the department.

The service had a recruitment and selection policy which set out the processes to be followed. There had been an active overseas recruitment programme and there was a dedicated team to support the staff recruited from overseas. Support was being provided for professional duties by mentoring, having Objective Structured Clinical Examinations and assistance to settle into a new community when not at work

The service had processes in place to monitor and review safe staffing levels. On some occasions adult trained nurses with appropriate competencies worked in the paediatric ED to ensure staffing levels were sufficient.

The U&EC service uses the National Early Warning Score (NEWS) 2 scoring tool for assessing sepsis in adults and the Paediatric Early Warning Score (PEWS) for children.

Staff training on sepsis screening and management was below the standard required with 1 year training at 87%- and 3-year training at 68%. During our inspection in 2022 we told the service that it must improve staff sepsis screening. We found that the U&EC service inconsistently undertook sepsis screening and treatment in a timely manner with 73% screening reported for June 2024 against a target of 100%. An action plan was in place to address the shortfalls but had not been completed and reviewed in a timely manner. This had implications for missed opportunities for screening and delays in care.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.