Chief Inspector of Hospitals publishes his findings on Hull and East Yorkshire Hospitals NHS Trust

7 May 2014

Chief Inspector of Hospitals publishes his findings on Hull and East Yorkshire Hospitals NHS Trust

England's Chief Inspector of Hospitals has published his first report on the quality of services provided by Hull and East Yorkshire Hospitals NHS Trust.

Both the Hull Royal Infirmary and Castle Hill Hospital at Cottingham have been rated as Requiring Improvement following an inspection in February under the new inspection regime introduced by the Care Quality Commission to provide a much more detailed picture of care in hospitals than ever before. A full copy of the report can be found at:

While end of life care, critical care and maternity and family planning services were rated Good – the inspection team have concluded that all other services at the two hospitals require improvement.

An inspection team of 45 people which included doctors, nurses and midwives, and hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent three days at the hospitals in February. They also visited both hospitals unannounced over two days.

Inspectors found that both hospitals were facing significant challenges due to the shortage of staff and insufficient capacity to deal with the increasing numbers of admissions, particularly patients referred to the hospital as an emergency.

The shortage of nursing and medical staff, particularly junior doctors, was affecting the care patients received, leading to delays in assessment and treatment. Staffing levels and skill mix did not always meet national guidance, although the trust board had agreed to invest in recruiting more nurses, and was in the process of recruiting for doctors’ posts.

At the Hull Royal Infirmary, the accident and emergency department did not have the capacity in terms of facilities and staffing to deal with the numbers of patients attending. There was a lack of appropriate senior clinicians and the children’s accident and emergency department could not provide a dedicated 24-hour service. While a refurbishment programme due to be completed this summer, would increase the size and capacity of the department, in the meantime patients faced long waits, sometimes on trolleys in corridors.

Inspectors acknowledged the trust had a clear vision for the future, with a number of new initiatives to engage staff and patients, and involve staff in the drive to improve services. While the incident reporting system had recently been strengthened, not all incidents were being reported and learning from these was not consistently shared across the trust.

The trust was found to be improving the way it engaged with the public. Among other improvements noted by the inspectors was the introduction of a Pioneer team which allowed staff to develop solutions which would drive improvement throughout the organisation. The end of life team too had developed a package of care to ensure that relatives and carers received the support they needed.

The Care Quality Commission has identified 20 areas where the trust must improve, including:

• The trust must ensure that there are enough suitably qualified and experienced staff on duty, particularly at night and weekends.
• The trust must investigate why some staff feel that they bullied, or feel pressure to undertake additional hours, putting the need to meet targets above patient care.
• Incident reporting must be reviewed to ensure that staff report incidents appropriately and in a timely manner and ensure that staff receive feedback from incidents.
• The patient pathway into the hospital must be reviewed particularly through the accident and emergency department, to ensure that patients are assessed and treated appropriately to meet their needs.
• Patients must have improved access to hospital appointments, with the cancellation of outpatient clinics kept to a minimum.
• Patients’ assessment and treatment must be based on best practice guidelines and delivered at the right time to meet those needs.

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

We know that Hull and East Yorkshire Hospitals NHS Trust has been facing significant challenges with the increasing numbers of patients coming to hospital in emergency. Although staff have been working hard to meet patients’ needs, this has been a struggle at times, with staff shortages which have been was felt across a range of services.

It of particular concern that the shortage of junior doctors was impacting on the care patients received, leading to delays in assessment and treatment. We heard that many patients found that they were moved, sometimes more than once, within the hospital and between hospitals, often through the night.

We know that a new A and E department is due to open in August and it is encouraging that the trust has set its sights on greater involvement of staff, the public and the wider community in its organisational development. Some of these initiatives are still in their infancy - and the challenge now is to ensure that all the trust's staff are properly engaged.

ENDS

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Notes to editors

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. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model. Whenever CQC inspects it 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?

This report describes our judgment of the overall quality of care provided by this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.