Care Quality Commission rates Royal Cornwall Hospitals Requires Improvement

England's Chief Inspector of Hospitals had told Royal Cornwall Hospitals NHS Trust that it must continue to make improvements following its latest comprehensive inspection by the Care Quality Commission.

Overall the trust has been rated as Requires Improvement. Royal Cornwall Hospital at Treliske was rated Requires Improvement, St Michael’s Hospital, Hayle, was rated Good and West Cornwall Hospital, Penzance, was rated Good.

A team of inspectors including specialist advisors and experts by experience spent four days at the trust in January, returning unannounced on three occasions. It was the fourth inspection since CQC introduced its new programme of inspections.

The Chief Inspector, Professor Sir Mike Richards, said:

“Two years ago we found Royal Cornwall Hospitals as a trust which has been under considerable pressure but was clearly heading in the right direction. On this inspection we have noted some improvements, but overall it is disappointing that it has not made enough progress in all areas.

“I am encouraged by the continuing good care we have seen at the trust's two smaller hospitals and by the attitude of the staff, who we found caring and dedicated throughout. After a period of instability, I note that that the new interim leadership team are apparently working well together.

“At the time of the inspection we wrote to the trust asking them to address some immediate concerns we had about the care of stroke patients, delays in cardiology and procedures for warning doctors about the condition of emergency patients. We will continue to monitor these areas closely to ensure they improve.

“More generally if the trust is going to pull itself round, it will need a combined determination of the staff, the leadership team and the commissioners to help the health services throughout the county deliver the level of service that the people of Cornwall are entitled to expect.

“Our inspection provides further evidence that the challenges in community health services and adult social care in Cornwall are having a direct impact on the safety and wellbeing of patients in the Royal Cornwall Hospitals. There are unacceptable delays in people leaving hospital, including those people who are at the end of their lives. This should not be happening. I am looking to providers and commissioners to transform that situation and to do so rapidly”.

Following the inspection CQC asked the trust to address three immediate areas of concern:

• Only half of stroke patients were spending 90 pc of their time on the stroke unit. The trust was told that it must ensure that stroke patients are admitted to the most appropriate speciality ward according to their clinical needs.
• There was a backlog of patients waiting too long for cardiology tests because specialist cardiac beds were being used to accommodate other patients.
• In the emergency department, staff were not always escalating concerns to a doctor as the condition of patients deteriorated.

The inspectors found that nursing staff levels remained a challenge for the trust in medicine, surgery, and operating theatres, where the trust continued to use a high level of bank and agency staff to maintain staffing levels. Although staffing had improved in the emergency department there were not enough consultants to provide cover.

Beds at Royal Cornwall Hospital were under such pressure that the emergency department were unable to admit patients when needed. Patients did not always receive care and treatment in the most appropriate clinical setting or had to wait for special attention. A significant number of patients who had their operations cancelled at short notice were not treated within 28 days of the cancellation.

The inspection team also found a number of areas of Outstanding practice.

Full reports and ratings for all core services including accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, maternity and family planning, children’s care, end of life care and outpatients and sexual health services are available at www.cqc.org.uk/provider/REF

The Care Quality Commission 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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