England's Chief Inspector of Hospitals has found improvement at University Hospitals of North Midlands NHS Trust following an inspection in October.
Despite improvements there is more work the trust needs to do to ensure services meet the standards people should be able to expect.
While the trust’s overall rating of Requires Improvement has not changed inspectors found a number of improvements had been made at the trust when they visited between 3 and 11 October.
Inspectors visited the trust’s Royal Stoke University Hospital and County Hospitals as part of their inspection.
The trust is now rated as Outstanding for being caring, where it was previously rated as Good. It is also rated as Good for whether services are effective and well-led, where it had previously been rated as Requires Improvement, and the trust is now rated as Requires Improvement for whether services are responsive, where it was previously rated as Inadequate.
Chief Inspector of Hospitals, Professor Ted Baker, said:
“We found a number of improvements had been made across University Hospitals of North Midlands on our return."
“We were particularly impressed with the progress at the Royal Stoke University Hospital where many of the overall ratings for its individual services have improved. For example, critical care at the hospital is now rated as Outstanding overall as well as for whether that service is caring and well-led. The hospital itself is now rated as Good overall and Outstanding for whether its services are caring."
“At County Hospital we also found improvements including to urgent and emergency and end of life care services which are now both rated as Good overall."
“However we also found there were areas where the trust needed to make improvements."
“There were issues with the trust’s capacity to handle the number of patients coming to the hospital, particularly in the urgent and emergency department. This is a real concern to CQC, but it also depends on the trust receiving rounded support from other agencies such as the CCG and local authority, so that all those across health services are working together. This issue was also highlighted in a Local Systems Review which looked at services in Stoke-on-Trent."
“We also had concerns surrounding staff and their understanding of the Mental Capacity Act 2005 and found there needed to be a more consistent approach around the practice of mental capacity assessments and deprivation of liberty safeguarding assessments."
“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 outstanding practices at the trust.
Survival rates for adult major trauma had been amongst the highest in the country since 2013 and a team from critical care won a national award for monitoring patient outcomes.
In addition, through education and the use of The Purple Bow Scheme - to raise the profile of the end of life service - the importance of providing high quality care in the last stages of life was being prioritised by staff across the trust.
However, inspectors also found areas where the trust must make improvements including ensuring that staff have a greater understanding of mental capacity. For instance, staff must ensure that Mental Capacity Act assessments are conducted for every patient where it is suspected they may lack capacity when completing a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms.
The trust needed to continue to look at sustainable methods to improve patient flow in the emergency department.
Inspectors also found the trust needed to improve safeguarding training for adults and children levels (1 and 2) for medical staff and for nursing staff in safeguarding adults and children (level 2).
CQC will return to inspect the trust at a later date to check on progress with the areas highlighted for improvement.
Full details of the ratings, including a ratings grid, are given in the report published on our website.
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