England's Chief Inspector of Hospitals says some improvements have been made but more work is needed to ensure patients receive appropriate care at Worcestershire Acute Hospitals NHS Trust.
The trust was placed into special measures in December 2015 and has been subject to frequent inspection and rigorous action by CQC during this time.
Between 23 January and 22 March 2018, a team of CQC inspectors visited six of the core services provided by Worcestershire Acute Hospitals NHS Trust across Worcestershire Royal Hospital, Alexandra Hospital and Kidderminster Hospital and Treatment Centre.
The inspection was carried out to check on progress with improvements following the previous inspection in November 2017. It is currently rated as Inadequate overall and remains in special measures.
The trust ratings remain Good for being caring, Requires Improvement for being effective and Inadequate for being safe and responsive. The trust had improved from Inadequate to Requires Improvement for being well-led.
Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, all trust inspections now include inspection of the well-led key question. CQC inspected the well-led key question between 26 and 28 February 2018 which was rated as Requires Improvement.
Inspectors found that the stability of the leadership had significantly increased over the last year with only one executive post interim at the time of the inspection. The leadership team understood the challenges to quality and sustainability faced by the trust. They were able to identify the actions needed to address them and recognised the significant volume of work required to improve the quality of care at the trust and ensure it was sustained.
However, many of the projects were at an early stage and while issues were mostly being recognised and actions put in place to address these, they had not yet consistently resulted in the required improvements.
Although the overall rating for the trust has not changed as a result of this inspection, some services had improved.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“Although we found some improvements had been made across the trust, it was disappointing to find that some areas had not improved and others had declined since our last inspection. Progress with improvements in services has not been fast or consistent enough. More work is needed by the trust and its system partners to ensure that all patients receive satisfactory care.
“Our main concerns are still with urgent and emergency care, surgery and outpatients which are still rated as Inadequate overall.
“The trust was performing worse than the England average for patients waiting over 60 minutes before being handed over to emergency department staff. Not all patients were recorded as being seen by a specialist doctor despite being referred.
“We were, however, pleased with the improvements made in other areas. For example, maternity services at Worcestershire Royal Hospital are now rated as Good overall. The Meadow Birth Centre won a national award in recognition of its outstanding health care environment. Feedback from women who had had their baby in the birth centre was overwhelmingly positive.
“This trust has been in special measures far too long. Further improvements are needed and must be delivered rapidly. We will continue to monitor the situation closely, taking further action as necessary.
“The trust board knows what it must do to bring about sustainable change to its services and ensure people receive the care they should be able to expect.”
Inspectors found that staff spoke positively about the increased stability in the trust’s executive team, and in the focus on achieving and sustaining good patient care. They also said they felt respected, supported and valued and that the new executive team had made a difference to the trust.
However, inspectors highlighted areas where the trust must take action to bring urgent and emergency, surgery and outpatients services up to the required standards.
Not all staff in senior roles had the experience, knowledge, capacity or capability to lead effectively and shortly before the inspection clinical divisions had been reconfigured. There was a risk of instability across management divisions with some posts being filled by interim staff or acting up posts.
The trust had a vision for what it wanted to achieve and objectives to support this, but CQC found that a robust strategy had not yet been developed. A framework for mitigating risks was also in place but this was yet to be embedded enough to be fully effective or to provide assurance regarding improvements to the safety and quality of patient care.
Full details of the ratings, including a ratings grid, are given in the report published on our website.
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Further improvements are needed and must be delivered rapidly
Professor Ted Baker, Chief Inspector of Hospitals