Chief Inspector of Hospitals publishes his findings on the Heart of England NHS Foundation Trust

14 January 2014

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by the Heart of England NHS Foundation Trust in the West Midlands.

The trust was inspected under radical changes introduced by the Care Quality Commission, which provide a much more detailed picture of care in hospitals than ever before.

As well as good care, during its inspection CQC uncovered a number of concerns and areas for improvement at the trust’s Good Hope Hospital in relation to how its services are assessed and monitored. These have prompted the regulator to issue a warning notice to the trust demanding that improvements in this area are made by 21 February 2014.

What inspectors found

Overall, the report concludes that the Heart of England NHS Foundation Trust is generally providing patients with safe and effective care. For example, patients and their relatives said that staff were caring and kind and this was observed by the inspection team.

The inspection team found areas of good practice, which included:

• The system to highlight patients who are medically fit for discharge promotes multidisciplinary working to discharge patients effectively.
• The work carried out by the end of life care team in ensuring relatives were involved and continued to feel cared for after the death of their loved one.
• The support of the critical care outreach team to other hospital staff while patients were waiting for a critical care bed.

However, there were a number of areas for improvement that CQC found, including a shortage of midwives and concerns regarding staffing in surgical care and wards caring for older people.

Also, there were concerns with how patients were treated once they had been triaged (the process of assessing and prioritising people's injuries and illnesses) at reception in the A&E department. Once the initial triage was undertaken on arrival, patients were not being assessed by a healthcare professional within the recommended 15 minute timeframe.

Furthermore, CQC’s inspectors observed that all A&E cubicles at Good Hope Hospitalwere occupied and some patients had to wait on trolleys in the corridor. On reviewing the care records of two patients, it was clear that they had not been assessed or received any physiological checks while they were waiting.

Also, inspectors witnessed two patients calling out for help in a distressed manner who were ignored by nearby staff as they were busy with other tasks.

The national guidance for clinical practice states that staff should check the emergency equipment daily to ensure it is ready in the event of an emergency. However, CQC found that these checks were not taking place, both in the A&E department and on a nearby ward.

In response, CQC has told the Heart of England NHS Foundation Trust that it must take action to improve in the following areas:

• The care provided in the A&E departments, particularly around the timing and type of initial assessment.
• Clarification with regard to services provided by the A&E department at Solihull.
• Ensuring patients are cared for on appropriate wards and clinical areas.
• In the reduction of the use of agency and bank staff through continued recruitment of permanent staff.
• Documentation relating to patient care.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards said: “Whenever we inspect we will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?

“While most services were delivered safely at the trust, the safety of patients in all the A&E sites, the acute medical unit at Good Hope Hospital and the Critical Care Unit at Solihull must be improved. We were concerned about staffing levels in some parts of the trust. However, the trust had an active recruitment programme and could demonstrate that significant numbers of staff were due to start work in early 2014.

“The trustappeared to have well trained staff but there were concerns surrounding the services at Good Hope Hospital and Solihull A&E and Critical Care Unit. Most people described their care as good, telling inspectors that staff were caring, despite being busy.”

CQC’s Head of Hospital Inspection, Fiona Allinson said: “The concerns CQC found were unacceptable and we have warned the trust it must improve. CQC will continue to monitor the service closely and our inspectors will be returning unannounced to check on whether improvements have been made and standards are being met.”

CQC spent four days at the Heart of England NHS Foundation Trust, including Good Hope Hospital in Sutton Coldfield, Heartlands Hospital, and Solihull Hospital in November. The inspection team included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts. They examined the care provided in accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients.

The reports, which CQC has published today (Tuesday 14 January), are based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

Read the full reports on the Heart of England NHS Foundation Trust page.

CQC will return to the trust at a later date to follow up the findings of this inspection and to report on the trust’s progress in making the required improvements.

Ends

For media enquiries, call Louise Grifferty, regional communications manager, on 07717 422917, or Helen Gildersleeve, regional communications officer, on 0191 233 3379.

The CQC press office can also be reached on 020 7448 9401 during office hours or out of hours on 07917 232 143.

For general enquiries, call 03000 61 61 61.

Notes to editors

1. CQC has presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit was to develop a plan of action and recommendations based on the inspection team’s findings.
2. The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike is implementing his new approach to hospital inspection with 18 NHS trusts across England, which represent variation of care. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model.