England’s Chief Inspector of Hospitals has rated Calderdale and Huddersfield NHS Foundation Trust as Requires Improvement following an inspection in March this year by the Care Quality Commission.
The trust has been rated as Requires Improvement for providing services that were safe, effective, responsive and well led and Good for caring. Inspectors rated the services at both Huddersfield Royal Infirmary and Calderdale Royal Hospital as Requires Improvement.
The full report can be found on this website.
CQC’s Deputy Chief Inspector of Hospitals in the north Ellen Armistead, said:
“Our inspection has found variation in the quality of the services provided by Calderdale and Huddersfield NHS Foundation Trust. At both hospitals; A&E, medical care, surgery, outpatients and end of life care were rated Good. However Maternity, critical care, and children and young people’s services were rated as Requires Improvement at both hospital sites.
“We found the trust’s community services to be Good across the board – especially the work being done in the community to reduce A&E attendances and GP callouts by effectively caring for people in their own homes.
“There were some examples of outstanding practice this included the Engagement Support Workers in surgical services who provided engagement, socialization and companionship to patients with dementia or delirium.
“I am sure that Calderdale and Huddersfield NHS Foundation Trust will build on the positives in this report but also focus on those areas for improvement which we have identified. We will return in due course to check their progress.”
Generally, care was delivered according to best practice guidelines, and there was strong multidisciplinary team working throughout the trust that supported good patient outcomes.
Staffing levels throughout the trust were planned and monitored, the trust had some staffing challenges with recruitment to vacancies particularly in A&E , adult community services, children’s services and in some areas of medicine.
The trust had a number of areas where further improvement was required and this included patient flow, safeguarding training, transfer of patients from critical care units and the management of complaints. The governance of the organisation although in place there was a need to continue the work to strengthen this process and embed it into practice.
In critical care at both hospitals there were issues with discharging people back to a ward which resulted in delays. Too many patients in critical care, particularly at Calderdale, were being discharged to a ward at night time.
The clinical decision unit was often not available to the emergency department as patients waiting for beds on other wards remained on the unit for up to a week – even though it did not have the facilities for patients who needed longer than 24 hour care. This was having an adverse effect on flow through the emergency department.
Within the accident and emergency departments, provision for children and young people was limited with only one qualified paediatric staff member on duty across both sites.
CQC raised concerns regarding some aspects of maternity services at the time of inspection. The trust responded to these quickly developing actions to address the concerns and are instigating an independent review of these services which took place in July.
During the inspection of maternity services, inspectors received a number of comments from women who felt they had not being involved in decision making about their care and felt unsupported.
Inspectors, also identified other areas where the trust most improve, including:
- Ensuring that at all times there are sufficient numbers of suitably skilled, qualified and experienced staff in line with best practice and national guidance taking into account patients’ dependency levels.
- Ensuring that patients on clinical decision unit meet the specifications for patients to be nursed on the unit and standard operating procedures are followed.
- Ensuring there are improvements to the timeliness of complaint responses.
Although there were lots of improvements that CQC have asked the Trust to make, inspectors did also see some examples of great care.
For example patients with a dementia and/or delirium were provided with an engagement support worker to socialise and provide companionship as well as cognitive and physical support.
This engagement team supported patients during the day with either group or one-to-one activities which promoted sleep at night. By providing engaging activities during the day, less one to one care was required during the day and night. This also helped to improve the experience of other patients by reducing sleep disruption on the wards.
Inspectors also identified some other areas of outstanding practice, including:
- The development of national early warning score and technology to identify deteriorating patients for prompt intervention. This supported early admission to critical care, and in turn better patient outcomes.
- Within community services, multidisciplinary and multiagency working was integrated in some teams with staff having a good understanding of each other’s roles. This led to a seamless service for patients and there was a collective responsibility to meet patients’ needs in the community.
CQC will present its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
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