England's Chief Inspector of Hospitals has rated Kettering General Hospital NHS Foundation Trust as Requires Improvement following inspections in November and December 2017.
Leaders at the trust have driven improvements across the trust since CQC’s inspection in October 2017, when the trust was rated as Inadequate, and knew where further work was still required.
Between 7 and 10 November 2017, CQC inspected urgent and emergency care, surgery, maternity, children and young people’s service, outpatients and diagnostic imaging to check if improvements had been made since we last inspected.
A further unannounced inspection was carried out on 24 November 2017 as well as a well-led review from 29 November to 1 December 2017. Inspectors found some improvements had been made and rated the trust as Requires Improvement overall.
The trust is now rated as Requires Improvement for being well-led and safe, where it was previously rated Inadequate. It is also rated as Good for whether services are caring and Requires Improvement for whether services are responsive and effective.
Despite improvements, there is more work the trust needs to do to ensure services meet the standards people should be able to expect. The leaders of the trust have plans to continue to improve services.
We recommend the trust continue to benefit from the external support from being in special measures.
Chief Inspector of Hospitals, Professor Ted Baker, said: "We found a number of improvements had been made at Kettering General Hospital NHS Foundation Trust but there are still several areas where improvements must be made. Leadership of the trust had improved to give a clearer focus on the work needed to improve all services.
"We were impressed how caring staff were across the trust which we rated good in every area. Staff cared for patients with compassion and feedback from patients confirmed that staff treated them with kindness. We saw significant improvements in the outpatients service, was now rated as good overall. Improvements had also been made in the children and young people’s service.
"However, there were services that had not improved since we last visited which the trust needs to address as a priority. Urgent and emergency services and diagnostic imaging were still rated as inadequate overall.
"The radiography service was not providing a safe service for patients. Diagnostic images which had not been reported in a timely manner which meant the service was not managing potential risks to patient safety.
"Clinical teams had been expected to review all inpatient images since 2012 but the guidelines issued by the Royal College of Radiologists had not been followed. There had been no robust monitoring system to indicate the true extent of the backlog of unreported images.
"In addition, the reporting backlog and the staffing shortages in radiology were not on the corporate risk register, which meant the provider had not been monitoring the risks to people and had not taken appropriate action to mitigate these. There were also an insufficient number of radiologists, radiographers, and nurses which affected the efficiency of the department.
"In A&E, whilst we saw some improvement had been made since the last inspection, patients arriving by ambulances were not always clinically prioritised to determine who needed treatment. Observations were not undertaken and treatment was not always carried out in a timely manner.
"The trust failed to meet the national standard for being admitted, transferred or discharged within four hours of arrival between October 2016 and September 2017.
"The recording of time to triage process in A&E also still needed improvement. We observed staff recording time to streaming rather than to triage. There were also some issues in timely sepsis management and management of deteriorating patients.
"We have reported all our findings back to the trust and the trust board knows what it must do to bring about sustainable change to its services so that people receive the care they should be able to expect.
"We will continue to monitor progress at the trust and this will include further inspections."
Inspectors found a number of good practices across the trust. For example, the outpatients service used a systematic approach to continually improve the quality of its services by creating an environment in which excellence in clinical care would flourish. The service had managers at all levels with the right skills and abilities to run a service working to provide high-quality sustainable care. Improvements had been made regarding the security of the paediatric ward.
However, there were also additional areas where the trust must make improvements. The maternity service did not adequately monitor the effectiveness of care so was not able to use findings to consistently improve practice. The service did not take timely action to address problematic areas on their maternity dashboard. For example, induction of labour was flagged as amber or red risk for a whole 12-month period without defined actions taken to improve this.
CQC will return to inspect the trust at a later date to check on progress with the areas highlighted for improvement.
Read the full details of the ratings, including a ratings grid, on the Kettering General Hospital NHS Foundation Trust page.
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We found a number of improvements had been made at Kettering General Hospital NHS Foundation Trust but there are still several areas where improvements must be made.
Ted Baker, Chief Inspector of Hospitals