England’s Chief Inspector of Hospitals has called for improvements at Hampshire Hospitals NHS Foundation Trust following an inspection by the Care Quality Commission.
A team of CQC inspectors visited Basingstoke and North Hampshire Hospital in Basingstoke, the Royal Hampshire County Hospital in Winchester, and Andover War Memorial Hospital in June and July 2018 to check the quality of three core services: urgent and emergency care, medical care and surgery. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
As a result of this inspection the trust has now been rated Requires Improvement overall. For caring the trust was rated as Good. For safety, effectiveness, responsiveness and well led it was rated as Requires Improvement.
Following the inspection, CQC used its urgent enforcement powers to impose six conditions on the trust’s registration:
- There must be an effective system in place to assess and monitor the ongoing care and treatment to patients while in the emergency department.
- The trust must ensure that there are enough suitably qualified staff on duty in the emergency department at all times to care for children.
- The provider must ensure that children and young people are cared for in an environment which is tailored to meet and protect their needs.
- The trust must ensure at least one member of staff is available each shift who is trained in advanced paediatric life support.
- The trust must ensure that there are enough qualified, skilled and experienced staff deployed throughout the emergency department. The staffing levels and deployment of staff must be reviewed and adapted as required at regular intervals throughout the day.
- The trust must submit a report to CQC which demonstrates the actions taken to ensure that the conditions listed above are complied.
CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Requires Improvement for using its resources productively.
CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Requires Improvement for using its resources productively.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“Since our last inspection, Hampshire Hospitals NHS Foundation Trust has not sustained the momentum and embeded the improvements that we saw at that inspection. As a result of this, the trust’s overall rating has moved from Good to Requires Improvement.
“I am pleased to note that we did see some outstanding practice and the trust has a strong and engaged workforce, although it is concerning to find that some staff did not feel able to safely raise concerns or that these were not being addressed.
“We have now made it clear to the trust where it must take action to improve and have placed urgent conditions on the trust’s registration to ensure these improvements do take place. We will remove those conditions when we are satisfied that the trust has made sufficient progress to provide the quality of services that its patients are entitled to expect.”
Inspectors found that there were no systems place to address continuous improvement for the quality of services in many departments. The processes that had been implemented were not fully embedded and inspectors could not be sure that patients were protected from avoidable harm.
Not all areas were effectively managing infection risks. Inspectors did observe episodes of poor infection control practice and known infection controlled risks were not always dealt with effectively.
Patients’ privacy and dignity was not always protected. During the inspection there were patients being treated on corridors without access to a patient call bell and they found it difficult to get help from the nursing staff when it was required. Neither did patients have access to screens, closed doors, or curtains to allow for privacy during treatment.
CQC found that the board were not always aware of the risks, issues and challenges in the service. This meant that leaders could not implement actions to address issues and reduce the risk of patient harm.
Managers were not always seen to take action to address behaviour and performance that was inconsistent with the trust’s vision and values. This made staff feel there was a culture in the trust where staff were not all treated equally.
The trust had engaged with patients and the local population including hard to reach groups, to inform service development.
The trust had a clear overarching vision which was ‘to provide outstanding care for every patent’, The trust’s strategic framework stated four organisational goals, which together aimed to deliver the vision.
We have now made it clear to the trust where it must take action to improve
Professor Ted Baker, Chief Inspector of Hospitals