England’s Chief Inspector of Hospitals has called for improvements at University Hospitals Plymouth NHS Trust following an inspection by the Care Quality Commission (CQC).
A team of CQC inspectors visited Derriford Hospital in April and May 2018 to check the quality of six core services: urgent and emergency services, medical care, surgery, maternity, outpatients and diagnostic services. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
Following the inspection, CQC issued two Warning Notices requiring Derriford Hospital to take urgent action to improve the management of medicines within its pharmacy services and ensure there were significant improvements in the diagnostic services.
Overall the trust remains rated as Requires Improvement for the quality of its services. The trust’s rating for caring remains as Outstanding. The trust is also rated as Requires Improvement for whether its services were safe, effective, responsive and well-led.
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:
“It is disappointing to report that since our last inspection, University Hospitals Plymouth NHS Trust has been unable to sustain the momentum and embed the improvements that we had seen on our previous inspection. As a result of this, the trust’s ratings for being effective and well led have 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 issued two Warning Notices to ensure these improvements do take place. We will continue to monitor those services and we will return in the near future to check progress.”
Within the pharmacy service, there were not enough staff to ensure a safe or basic service. On the week of this inspection, there were between four and six pharmacists to cover the acute hospital, comprising 900 beds. The trust had been awarded external contracts to become the main suppliers of medicines to the community hospitals across Devon and Cornwall, but there had been no corresponding increase in the number of staff required to take on this extra workload. The trust had started to make some significant changes that were already having a positive impact.
Diagnostic services were rated as Inadequate. Patients were waiting too long to gain access to services and there were unacceptable delays with imaging and the reporting of results. There were risks from ageing equipment and an environment that did not always respect patients’ privacy and dignity. Patients were positive about the way staff treated them, although the staff themselves felt demoralised and unable to provide the service they wanted to deliver.
Surgery and outpatients were again rated Good, although both were Requires Improvement for their responsiveness due to failures to meet demand for appointments and procedures against national standards.
Urgent and emergency care remained as Requires Improvement. The A&E department is the largest in the South West of England, and, as the trust acknowledges, is too small to safely accommodate the growing patient demand. Inspectors recognised the strong multidisciplinary teamworking in this busy department.
Maternity services were rated as Requires Improvement overall. Inspectors found there was strong teamwork and staff were caring and compassionate. But there were concerns around equipment and medicines management and how the service was assessed for its quality and safety through governance and risk management. Medical care dropped to Requires Improvement; there were vacancies for doctors and nurses and there were not enough beds to meet the demand of admissions to the hospital. While the systems to promote patient flow should have been effective, increasing demand outweighed available beds. Patients were often staying in hospital longer than they needed to because there was nowhere to send them in the wider healthcare community.
The systems for managing patients with mental health needs were not consistent across the trust and so care varied. There were also a number of vacancies for medical and nursing staff across the medical wards so staffing was not always at safe levels. However, well-led in medical care remained Good.
Ends
For further information, please contact John Scott, Regional Engagement Manager on 077898 75809.
Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here.
Please note: the press office is unable to advise members of the public on health or social care matters. For general enquiries, please call 03000 61 61 61.
We have now made it clear to the trust where it must take action to improve
CQC’s Chief Inspector of Hospitals, Professor Ted Baker