Patients were involved in the care they received and their privacy and dignity was respected.

We spoke with ten patients in different areas of the accident and emergency department (A&E). One patient and their family in the short stay area of A&E told us the staff had treated them with privacy and dignity. They knew they were being assessed and monitored following a head injury and had been told if all was OK after 24 hours they would be discharged. They said “Everything has been explained every step of the way. They are very good.”

They also told us they had had tea and toast at breakfast time but didn’t have anything the night before because of their head injury. They said the staff always knocked on the door before entering their room. The relative said “I think communication is alright here. The staff have all been very nice.”

We visited four wards, ward 2 (acute stroke unit), ward 6 (respiratory medicine), ward 15 (plastic surgery), ward 16 (elective orthopaedics) and the accident and emergency department on this inspection. It was an early evening inspection that started at 1600.

Nearly all the patients we spoke with were satisfied with the care and treatment they had received. Comments included “Everything’s good, I’m well looked after”.

There were also many positive comments about staff. Comments included “I have nothing but admiration for them”,” Couldn’t ask for better.”

However, we did find sometimes patient’s dignity and privacy was not being respected.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

We visited University Hospital of North Durham to check whether improvements had been made to two compliance actions. We visited ward 1 (elderly medicine), ward 3 (acute medical admissions), ward 11a (winter pressures resource), ward 12 (orthopaedic inpatients) and the orthopaedic outpatient clinic.

We spoke with patients, visitors and staff on the wards to see what improvements had been made since our last visit.

One patient told us, “I feel well looked after.” Another person said, “The staff are all very nice and helpful”.

Visitors told us that the longer visiting times were “better” because they could spend more time with older patients. Relatives were also positive about the support and information they received whilst visiting patients

One visitor told us that they had requested to stay with their relative on the ward for the last few nights. They told us that ward staff had provided them with a reclining chair during that time, and that they had been able to make hot drinks whenever they liked in the ward kitchen.

Overall, people had positive comments to make about the meals and drinks. One patient said, “It’s a marvellous place, the food is lovely.”

Another patient told us, “The meals are canny, and I’ve had a lot worse. It takes me a while to eat them because they are big portions, but I manage.”

Another person told us, “The meals have been fine, sometimes it’s a bit too much. I prefer a coloured glass because of my bad sight and they usually remember to give me one.”

Patients told us that there were “plenty of choices” of meals and drinks.

A visitor told us, “There always plenty of tea and biscuits, and she said the lunchtime mealtime was ok and she’s chosen from the menu for tonight’s meal.”

We visited the University Hospital of North Durham on 25 and 26 August 2011. During the two days we were there, we spent time on the following wards: Accident and Emergency including X.Ray, ward 3 Acute Medical Admissions and Ambulatory Care, Ward 7 Child Health, Ward 10 Post Natal, Ward 1 Elderly Medicine, Ward 12 Orthopaedics inpatients and outpatients and Ward 13 Surgery.

Generally the comments we received from patients that we spoke to were positive with many patients being satisfied with the care they received. What we saw during our visit to some of the wards at University Hospital North Durham differed from what some patients told us. Opinions about the food were varied with some people saying that they liked the food and others saying that there was not always something suitable for them to eat.

Our rating of services stayed the same. We rated it them as requires improvement because:

• We rated safe, effective and well led as requires improvement; caring and responsive were rated as good.
• Overall, surgery had gone down one rating to requires improvement overall, urgent and emergency care stayed the same since our last inspection. Maternity services and medical care had improved.
• Within urgent and emergency care, consultant presence in the departments did not meet the RCEM guidance of consultant presence of 16 hours a day. ST3 doctors (those in year three of speciality training) were part of the middle grade rota. This goes against the RCEM guidance that a minimum of an ST4 or equivalent is in the department at all times.
• Within urgent and emergency care, the service did not always manage medicines well.
• Within urgent and emergency care, the department missed key targets for caring for patients promptly. Patients did not always get a face-to-face assessment within 15 minutes of arrival or registration. Patients brought in by ambulance were not always handed over to the department within 30 minutes and this was getting worse.
• Within urgent and emergency care, staff did not record patient care consistently.
• Within medical care services at University Hospital North Durham, members of staff did not comply with hospital policy on the administration of covert medicines. We found evidence of staff providing medication covertly for patients without ensuring capacity assessments were in place.
• Within medical care services, medical and nursing records were not stored securely in all areas we visited.
• Staff did not understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They did not support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
• The hospital did not meet targets for Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training. The knowledge and practice of staff on the wards raised concern over the effectiveness and numbers trained.
• Eleven never events were reported over 13 months from May 2016 to May 2017. Joint working with stakeholders and a trust wide programme of learning had taken place following these never events reduce risks of harm to patients; however, despite this, two further never events occurred after September 2017. There were unacceptable numbers of never events and a strong need to further embed safer practices and learning across the trust.

However:

• In most areas nurse staffing had improved.
• Staff investigated incidents quickly, and shared lessons learned and changes in practice with staff.
• Wards and department areas were clean and equipment well maintained. Staff followed infection control policies that managers monitored to improve practice.
• Staff provided care and treatment based on national guidance and evidence and used this to develop new policies and procedures.
• Staff cared for patients with compassion, treating them with dignity and respect.
• Patients, families and carers gave positive feedback about their care.
• The hospital escalation policy and procedure guidance was followed during busy times.