Chief Inspector of Hospitals finds that North Bristol 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 North Bristol NHS Trust.

Overall the trust has been rated as Requiring Improvement. The Care Quality Commission has found that the trust provided services that were Good for being caring. Improvements were needed for services to be safe, effective, responsive and well led.

During the inspection in November a team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Southmead Hospital, Cossham Hospital, Frenchay, Riverside and Eastgate House. The trust’s community healthcare services for children and young people, including mental health services, were also inspected.

At Southmead Hospital, services for children and young people were rated Good. Urgent and emergency services were found to be Inadequate, while critical care, maternity and gynaecology, end of life care, medical care, surgery, and outpatients and diagnostic imaging were rated as Requires Improvement.

Maternity services at Cossham Hospital, and community health services were rated Outstanding. Outpatients and diagnostic imaging at Frenchay Hospital, and child and adolescent mental health services require improvement. Full reports are available at www.cqc.org.uk/provider/RVJ.

Inspectors found every service to be caring, with staff at all levels committed to providing good patient care and frustrated when they felt they could not achieve this. Patients felt involved in their care, particularly in the maternity services at Cossham and the community services for children and young people.

But the report says that the trust is facing serious performance and financial issues, some of which are putting the safety of patients and the wellbeing of staff at risk.

There were significant issues with the flow of patients through Southmead Hospital. The four hour target for patients attending A&E to be admitted, discharged or transferred was not being met, with some patients remaining on trolley beds in A&E for over 12 hours until a bed became available. Some medically fit patients could not leave hospital until social care or community health arrangements had been made.

Patients needing medical care could not always be accommodated in medical wards. That led to some patients missing out on their review by a doctor as they had become lost in the system.

CQC has formally warned the trust that it must take action to deal adequately with demand in the emergency department, where patients were waiting too long to be assessed and treated.

Overall, inspectors identified a number of areas of outstanding practice, including:

• The dedication and commitment of staff, particularly in the emergency department where they displayed excellent teamwork, although they were struggling to manage under significant demand.
• The involvement of children and young people in their care and in the development of the service, especially the work with Barnado’s.
• Staff at Cossham Hospital were going out of their way to involve women and their partners in their maternity care, and to reach out into the community to promote the use of the unit.
• The introduction of volunteer move makers, who were originally brought in to help patients and visitors in the move to the new hospital. They were so effective that they had become an integral part of the service.

The inspection team identified 14 areas where the trust must make improvements including:

• The trust must take action, working with other organisations as needed, to improve the flow of patients through the hospital, ensuring that patients are cared for in the most appropriate place and are supported to leave hospital when they are ready.
• Patients in the emergency department must be assessed in a timely manner and cared for in a suitable environment.
• The privacy and dignity of patients in the Brunel building must be maintained.
• Staffing levels must be reviewed. There were not always sufficient skilled and experienced staff in theatres, critical care, emergency department, medicine, surgery, maternity services at Southmead Hospital and child and adolescent mental health teams.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“First I must congratulate all the staff and volunteers at Southmead Hospital on the way they have coped with all the upheaval in moving into the new hospital. It was a huge logistical exercise, and since then there has been a large number of snagging issues to sort out. I know that staff morale has been affected.

“While the move has been managed well - there are some longstanding performance and financial issues to resolve which have a direct bearing on patient safety and the wellbeing of the staff.

“There has been unprecedented demand, which has not always been dealt with effectively. Overall bed occupancy is above the level where it can start to affect the quality of care and the orderly running of the hospital. It is a concern that too many people have been waiting too long in the emergency department, or in inappropriate accommodation, because the hospital beds are full.

“These are matters which the trust cannot fix alone. It will need to continue to work in partnership with the local commissioners and local authorities to ensure that people who are ready to be discharged from hospital get the support they need as soon as possible.

“We will return in due course to check that the trust has made the immediate improvements we require. In the longer term I will continue to monitor how North Bristol and its partners manage to deal with those longstanding issues.”

Ends

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