Chief Inspector of Hospitals publishes his findings on New Cross Hospital, Wolverhampton

21 November 2013

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by The Royal Wolverhampton NHS Trust at New Cross Hospital.

The trust was one of the first to be inspected under radical changes which have been introduced by the Care Quality Commission providing a much more detailed picture of care in hospitals than ever before.

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts spent three days at New Cross Hospital during September. 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. Inspectors also visited the hospital unannounced on three occasions.

The report which CQC publishes today (Thursday, 21 November) is based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

Overall the report concludes that The Royal Wolverhampton NHS Trust is generally providing patients with safe and effective care. However, there are a number of areas for improvement. There was a shortage of midwives and concerns regarding staffing in surgical care and wards caring for older people.

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:

• Staff were praised by people using the hospital and staff spoke positively about working for the trust.
• The inspection team was impressed with the trust’s response to the never events in theatres and the steps taken to minimise the likelihood of them reoccurring.

CQC has told the trust it must take action to improve in the following areas:

• The hospital needs to improve care for older patients. The inspection found that older people’s care, surgical and dementia wards were not sufficiently staffed, particularly at night.
• The trust has a shortage of midwives and it is taking action but more work is needed to improve staffing levels in the maternity ward.
• The trust needs to ensure it follows its own processes and systems properly. The inspection found processes relating to infection and hygiene control, responding to patient alarms, and following guidelines for treatment of patients with dementia were not always followed.
• Systems and processes intended to help people at the end of their life need to be fully implemented; particularly those relating to documenting decisions made about whether to resuscitate a patient.

The Chief Inspector, 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?

"At New Cross Hospital, we found the trust had implemented a number of systems and processes to improve safety following a slightly higher than expected reporting of ‘never events’ (patient safety incidents which should not happen). We saw that the trust had strong risk assessment and incident reporting practices but staffing levels on older people’s care wards, surgical wards and in maternity services needed to improve.

Is it effective?

"The hospital was seen to have a clear focus on patients and good clinical outcomes. However there were instances where older patients were not receiving effective care, and examples of where systems and processes intended to help people at the end of their life were not fully implemented, so improvement is needed.

Are services caring?

"Overall services were considered to be caring. People were positive about the staff working on the wards, and the care received. There were numerous examples where patients felt cared for. Patients said staff were sensitive to their needs and delivered care in a dignified manner. Strong, positive feedback was received from parents in the children’s care department, and from patients in the outpatient clinics.

Are services responsive to people’s needs?

"The trust performed well against some national targets and surveys, including, patients being seen within four hours in the A&E department and the frequency of cancellation of operations.

But there were deficiencies in the trust’s complaints system and improvements are required to ensure this is more effective. Additionally, in the majority of inspected services, there were no systems in place to respond to the needs of people with learning disabilities and this needs to be an area of focus.

Are services well-led?

"The trust's leadership team has been through a number of changes in recent years but the Chief Executive and the Chief Nurse have been in post for a number of years, which has brought some stability to the leadership team. The trust scored in the top performing 20% for 10 of the 28 indicators on the NHS staff survey, and generally staff had a positive view of its leadership team."

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.

CQC inspectors will return to New Cross Hospital in due course to follow up the findings of this inspection and to report on the trust’s progress in making required improvements.

Ends

Notes to editors

The Chief Inspector, Professor Sir Mike Richards, announced in July that he will lead significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike identified 18 NHS trusts representing the variation of care in hospitals in England. These will be the first hospitals to test the new inspection regime.