Chief Inspector of Hospitals finds that Isle of Wight NHS Trust requires improvement

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of services provided by Isle of Wight NHS Trust.

Overall, the Care Quality Commission has rated the trust as Requires Improvement. Acute services provided at St Mary's Hospital, and Community Health services, were both rated as Requires Improvement. Mental Health services were rated as Good.

The trust was inspected by CQC in June under its new inspection regime. The inspection team of 79 people which included doctors, nurses, midwives, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent three days at the trust. Inspectors also returned unannounced two weeks later.

The Isle of Wight NHS Trust is an integrated trust that provides acute, ambulance, community and mental health services to a population of approximately 140,000 people. The full reports and ratings are available here.

Inspectors found that staff were caring and compassionate, and treated people with dignity and respect, although people using community mental health services expressed some concern that they were less involved in their care.

On the whole, patients received the right care at the right time. The ambulance services achieved national response times, patients were seen and treated in the A&E within four hours, people had surgery, diagnostic tests and outpatient appointments within national waiting times. But at St Mary's Hospital, the pressure on beds meant that patients were being moved between wards too often, and weekend discharges were delayed. There were long waiting times for assessment and treatment in community mental health teams.

Staffing levels were too low in some areas, with difficulties recruiting staff to work on the island. There were not enough nurses for children’s care in the A&E, the acute services, community rehabilitation wards, district nursing and older adult mental health wards. The trust faced a similar challenge recruiting doctors, with some services run by locums and this had not provided consistency of leadership or treatment. During the inspection there were several issues which led the inspectors to ask the trust to take immediate action:

• There was some confusion among hospital and ambulance staff over the admission of children in emergency. Children being brought by ambulance to the hospital were not always allocated to the correct emergency area.
• Inspectors were concerned that there were so few doctors and nurses on the stroke unit that the staff on duty were unable to deal with the needs of acutely ill patients.
• In adult community services, recently qualified nurses were expected to work alone at night without the support of more experienced staff. Although the trust responded by placing a senior district nurse on call – this was not working when CQC checked during the unannounced visit.
• Some medicines were not being kept properly by the ambulance service.
• Initially, patients arriving at A&E were being assessed by a receptionist who was not medically qualified. Although the trust responded by bringing in a trained nurse to triage patients, during the unannounced inspection inspectors saw that patients were waiting an hour to be assessed in order of attendance rather than in order of clinical priority.

Following the inspection CQC has issued a warning notice requiring the trust to take action to improve the ways it assesses and monitors the quality of its services.

Inspectors also identified a number of areas of outstanding practice, including:

• The Integrated Care Hub was an excellent example of teams from different disciplines working closely together to ensure that patients had timely access to appropriate services, so avoiding unnecessary admissions to hospital. The call centre provides access to the 999 calls service, NHS 111 service, the GP out-of-hours service, district nursing, adult social care, tele-care services, non-emergency patient transport services, and mental health services.
• The pharmacy service was operational seven days a week, providing an innovative service within multidisciplinary teams to improve patient care. As an example, electronic prescribing had reduced medication errors, and was being used to ensure that patients were assessed for the risk of venous thromboembolism.
• A shared care network for managing children with the most complex and rare conditions had enabled families to be supported and the children treated closer to their homes. It also enabled access to the best possible advice for these families.
• The integrated sexual health service provided access for the full range of population groups on the island, including young people, the homeless and vulnerable adults.
• Mental health services had developed innovative ways to protect vulnerable people such as 'Operation Serenity', involving joint working with the police, to treat people at home or in the community. This had reduced the use of the S136 Place of Safety, and decreased the number of people having to be detained under the Mental Health Act.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“The Isle of Wight NHS Trust stands on its own as the one NHS organisation which provides the full complement of acute, ambulance, community and mental health services. That creates its own demands – but its own opportunities for integrated care.

“We have found some examples of outstanding care. The staff were caring, highly motivated, and treated people as individuals. However people told us how at times low staffing numbers affected their care and treatment and there were also areas of poor practice where the trust needs to make improvements.

“I recognise the challenge that the island faces in attracting and retaining experienced staff. But, the trust must ensure that the clinical leadership of services improve.

“Some staff in the ambulance, community and mental health services considered they had a lower profile compared to the acute service. I'd like to see more effective staff engagement so that service changes and developments are owned by everyone and effectively implemented, to reduce risks to patients and people who use services.

“Some of the issues being faced by the trust now, such as pressures on bed capacity, were those experienced in the wider NHS a few years ago. The trust must prepared for the demands and pressures that, with an older population on the island, will increasingly be felt on the Isle of Wight in the years to come.”

“The trust must improve its arrangements to monitor the quality of care and assess and manage risks. We have served a warning notice to ensure that this improvement takes place within an appropriate timescale.”

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