Chief Inspector of Hospitals publishes his findings on Royal Bournemouth Hospital

18 December 2013

England's Chief Inspector of Hospitals has published his first report on the quality of care provided at Royal Bournemouth Hospital.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation 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 two days at the Royal Bournemouth Hospital during October. 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.

The report which CQC publishes today 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.

Read the full report on the Royal Bournemouth Hospital page.

Overall the report concludes that children’s care, midwifery, critical care and end of life care services at the hospital were good. Across the hospital, most staff were eager to give good care. Patients were complimentary about the care they received and the professionalism of staff on surgical services.

But the inspection team found that medical care, including older people’s care was inadequate. There were widespread and significant negative views from patients and staff.

A&E, surgical services and outpatients services also required improvements. The seriousness of the impact of poor care on patients outweighed the many positive comments received about the hospital.

The inspectors highlighted one area of good practice:

• Some aspects of end of life care were undertaken very well.

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

• All patients need to have their needs assessed and care delivered safely and in a timely manner by staff who are skilled to do so.
• At all times, patients must be treated with the dignity and respect they deserve and basic care needs must be met.
• The trust must reassure itself and stakeholders that all opportunities to drive quality improvement and quality assurance are taken.
• The trust must ensure that the required number of staff with the correct skills are employed and managed shift by shift, to demonstrate that there are sufficient staff to meet people’s needs.

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 Royal Bournemouth Hospital, we were told about basic nursing care which was not being given to patients on two medical care wards. We heard from five patients who told us they had been left to wet or soil their beds.

"The hospital had a high occupancy rate and there had been ongoing use of escalation beds when a ward or unit was full - even though these beds could not meet patients’ needs properly.

"The trust did not employ enough staff, even though it was fully aware that nearly all its beds were occupied all the time. Some patients were still not receiving the care they needed in a timely manner, and there was an ongoing high risk of this continuing."

Under the new inspections, CQC will always seek to answer five basic questions. The findings are summarised below:

Is it safe?

We found that care was not always safe; both doctors and nurses at times felt unsupported and under too much pressure due to staffing levels and skill mix within the areas where they worked. On some medical wards, including for frail older people, patients were at risk of harm. On surgical wards junior doctors told us the medical staffing level at night was not safe. In outpatients there were a risk of cross infection. However the services that were safe included maternity, critical care, children’s care and end of life care.

Is it effective?

Many parts of the hospital were effectively managed and applied recognised clinical guidelines or national standards which means that recognised best practice was used to deliver treatment that met patients’ needs. The A&E and medical care services were not effective and there is a need to ensure greater external scrutiny of some measures, such as mortality rates.

Are services caring?

Some aspects of care were not met in a timely manner. This was found to be inadequate on two medical care wards in particular and to a lesser extent, across medical services as a whole. Some people in the medical care wards, including older frail people, were left in soiled beds. However, there were many positive examples of caring in areas that included maternity, critical care, children’s care, outpatients and end of life care.

Are services responsive to people’s needs?

Children’s care, critical care and end of life care were particularly responsive to people’s needs. However, improvements in one part of the hospital were not necessarily shared across all services. Some people felt that when they made a complaint, the trust was dismissive of their concerns. This meant that they either chose to have care elsewhere or continued to feel dissatisfied.

Are services well-led?

Many departments and wards had effective leadership. However the A& E department required improvements and medical care services in particular were inadequate in this regard. While there was clear communication between the senior management and the trust’s board, this was less apparent for other staff and this was affecting staff morale.

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 Royal Bournemouth 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

For media enquiries, call the CQC press office 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

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.