Chief Inspector of Hospitals finds that Mid Yorkshire Hospitals 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 The Mid Yorkshire Hospitals NHS Trust.

Overall the trust has been judged as requiring improvement. The Care Quality Commission has found that the trust provided services that were caring, however, improvements were needed in the safety, effectiveness, responsiveness and leadership of some services.

Pinderfields Hospital, Pontefract Hospital and Dewsbury District Hospital were each rated as Requires Improvement, although critical care at both Pinderfields Hospital and Dewsbury District Hospital was rated as Good. The trust’s Community Health services were also rated as Good, however Safety across the trust was rated as Inadequate. The full reports are available on the CQC website here.

The trust was inspected by CQC in July under its new inspection regime. The inspection team which included doctors, nurses, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent four days at the trust. Inspectors also returned unannounced to Pinderfields Hospital and Dewsbury District Hospital later in the month.

Inspectors found that most patients were positive about the care they received and staff were thought to be polite, patient and caring. Inspectors also found some examples of outstanding practice, particularly within the children’s community end of life team who demonstrated compassion and commitment to families.

Overall treatment and care was delivered in line with national and best practice guidance. There were arrangements in place to manage and monitor the prevention and control of infection and all areas visited were visibly clean.

However, staffing levels and skill mix were a significant concern across a number of services and locations, particularly within the acute services where staff shortages and movement of staff between areas, had led to a high level of frustration amongst staff.

There was a significant backlog of outpatient appointments, which meant that patients were waiting considerable amounts of time for their appointment. This was reflected in the high number of complaints regarding outpatients, reporting distress and frustration at delays and appointment cancellations.

New arrangements in governance and the management of risk had recently been introduced, but inspectors found these had yet to be embedded and it was too early to assess whether these new initiatives would deliver sustainable improvements in the long term.

As part of their inspection CQC raised concerns with the trust about patient safety and nurse staffing on Gate 20, the acute respiratory care unit at Pinderfields Hospital. In response, the trust implemented a number of immediate actions to address the concerns which included reducing the number of beds on the ward from 46 to 40.

Inspectors identified some areas of outstanding practice, including:

• The multidisciplinary team approach in community services for adults with complex needs.
• The implementation of a link health visitor role in community services.
• The compassion and commitment demonstrated by the staff within the children’s community end of life care team (Jigsaw).
• The support provided to patients following discharge from the critical care unit by the set-up of monthly outpatient clinics.

There were also a number of areas of poor practice where the trust needed to make improvements, including:

• The trust must ensure there are always sufficient numbers of suitably qualified, skilled and experienced staff to deliver safe care in a timely manner.
• The trust must take action to address the backlog of outpatient appointments, including follow-ups, to ensure patients are not waiting considerable amounts of time for their appointment.
• The skills and experience of staff working with children in the A&E departments, special care baby unit and children’s outpatients’ clinics must be reviewed to ensure the trust is meeting national and best practice recommendations.
• The trust must ensure the procedures for documenting the involvement of patients and relatives in ‘Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) are in accordance with best practice at all times.
• The trust must ensure staff are trained and competent with medication storage, handling and administration, and that controlled drugs are administered, stored and disposed of in accordance with trust policy, national guidance and legislation.
• The trust must review the arrangements over the oversight of Gate 20 acute respiratory care unit to ensure there is appropriate critical care medical oversight in accordance with the Critical Care Core Standards (2013).
• The trust must ensure ambulance handover target times are achieved to lessen the detrimental impact on patients.
• The trust must ensure the high prevalence of pressure ulcers is reviewed and understood and appropriate actions are implemented to address the issue.

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

"We saw staff treating patients in a compassionate and sensitive way, and patients and relatives were generally content with the care they received. We also identified some outstanding practice particularly within the trusts community services.

“However, I am very concerned that staff shortages in the trust’s acute hospitals are impacting on the safety and quality of patient care. The backlog of outpatient appointments is also a matter of significant concern, as is the length of time patients were waiting in accident and emergency to be handed over from the ambulance staff.

“While the trust has put systems and processes for improvement in place there is no doubt they have a considerable challenge and we need to see that the trust has taken our findings seriously and that they will make the necessary changes at pace.

“We will be returning for an early re-inspection to check on progress made.”

Ends

For media enquiries, contact 020 7448 9401, during office hours, or out of hours, contact 07917 232 143.

For general enquiries, call 03000 61 61 61.