England’s Chief Inspector of Hospitals has found further improvements are needed by North Cumbria University Hospitals Trust following an inspection by the Care Quality Commission in July and August this year.
CQC inspectors looked specifically at urgent and emergency care, medical care (including older people’s services), surgery, maternity and children and young people’s services. Inspectors also reviewed the management and leadership of the trust to answer the question: is the trust well-led?
As a result of this inspection the trust maintains its rating of Good for being caring, although safe, effective, responsive and well led are rated as Requires Improvement. The trust remains rated Requires Improvement overall.
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 combined rating for the trust, taking into account CQC’s inspection for the quality of services and NHSI’s assessment of Use of Resources, is Requires Improvement.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“Since our last inspection, North Cumbria University Hospitals Trust has not been able to consistently sustain the pace of improvements that we had previously seen.
“I am concerned that the patient flow through Cumberland Infirmary and West Cumberland Hospital has deteriorated. Patients were left without treatment for too long in these hospitals’ urgent and emergency departments, which resulted in a number of serious incidents.
“However, patients’ feedback was positive and we saw that staff were providing compassionate care. Everyone was clearly working hard to deliver the best care they could under pressure.
“We do recognise that recruitment remains a long running challenge for the trust and I am satisfied that the leadership team are responding to the concerns we have raised. The trust has come a long way but further improvements are needed.
“We will continue to monitor the trust closely and return in due course to reinspect its services.”
Inspectors visiting Cumberland Infirmary and West Cumberland Hospital found that patients were assessed quickly on arrival to the urgent and emergency departments. However, they experienced long waits for treatment because bed availability across the trust was limited, placing pressure on other departments and preventing patients from being admitted quickly. There had been several serious incidents at West Cumberland Hospital because patients were not being transferred quickly enough to their specialist wards.
Across the trust nursing staff vacancies continued to go unfilled and the trust’s use of locum doctors was high. Staff sickness was also high and several ward shifts were not fully supported, which risked staff safety. Despite the pressures, inspectors noticed an improvement in staff morale within areas of the trust. Staff were seen to be kind, compassionate and caring.
In both Cumberland Infirmary and West Cumberland Hospital mental health assessment areas failed to meet best practice guidelines. The rooms contained inappropriate equipment and a number of ligature risks, that made the rooms unsafe for patient use. The trust took immediate action after these concerns were raised by inspectors.
Penrith Hospital maintained its Good rating, although the rating for being well-led went down to Requires Improvement. The quality of the services was not being audited well enough, and the coordination of medicines management across community midwifery was poor. The inspection noted that a new leadership team had not had enough time to embed new practice.
The trust had responded well to the previous inspection’s findings in children and young people’s services and was now meeting standards recommended by the Royal College of Paediatrics and Child Health. Staffing in the service had improved and the associated risks had been addressed.
Inspectors saw areas of outstanding care. In the urgent and emergency department the trust implemented an innovative advanced care practitioner programme to address the shortage of doctors. The trust was top in the UK following a patient satisfaction survey about kidney care, and the trust was using technology to provide stroke services across the region remotely. Cumberland Infirmary was one of nine disablement services chosen to provide enhanced services to veterans following service in the armed forces.
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Everyone was clearly working hard to deliver the best care they could under pressure.
Professor Ted Baker, Chief Inspector of Hospitals