Chief Inspector of Hospitals publishes his findings on the Royal Cornwall Hospitals NHS Trust

27 March 2014

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of care provided by Royal Cornwall Hospitals NHS Trust.

• Royal Cornwall Hospital Treliske - Overall rating: Requires improvement
• St Michael’s Hospital, Hayle - Overall rating: Good
• West Cornwall Hospital, Penzance - Overall rating: Good

While many of the services are delivered to a good standard, and while recognising the progress and improvement at the trust over the last two years, Sir Mike’s inspectors conclude that overall the trust requires improvement.

The inspection team found that generally services at the trust’s three hospitals were effective, caring, and well led.   But the main Royal Cornwall Hospital at Treliske needed to improve to be safer and to be more responsive to patients’ needs.

The trust was 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, and hospital managers, trained members of the public, CQC inspectors and analysts spent two days at Royal Cornwall Hospital, Treliske, St Michael’s Hospital, Hayle, and West Cornwall Hospital, Penzance in January.  

They examined the care provided in accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, maternity and family planning, children’s care, end of life care and outpatients.  Inspectors also visited all three hospitals unannounced in one weekend.

The reports which CQC publish today 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.   

Across the trust, the inspection team found areas of good practice.  At Treliske Hospital these included:

• Staff were caring and hardworking, and supportive of the hospital as a whole. There was a strong sense of an improving service.
• The respiratory and oncology wards were recognised for their innovative services and strong leadership which created good outcomes for patients.
• The new A&E department was providing improved observation of patients, and improving their privacy, dignity and confidentiality.
• The stroke service in A&E was recognised for delivering good outcomes to patients.
• The development of the Frailty Assessment Unit was providing elderly patients with the support they needed.
• There were good outcomes for patients in critical care, with mortality rates below the national average.
• The outstanding service provided from a theatre team for people with learning disabilities needing care and support.

Inspectors said that the trust should improve in the following areas:

• Patient records on some wards were incomplete.  There was conflicting and missing information in relation to pressure ulcer assessment and management, and in care plan records or nursing notes, placing patients at risk of not receiving the care they needed.
• Too many operations were being cancelled or delayed due to a shortage of ward beds. Patients were not always being discharged, or admitted to critical care, in a timely way due to a lack of available beds in other areas of the hospital. The trust needs to plan and deliver care safely and effectively, involving the trust’s partners to ensure that pressures and shortfalls in capacity are managed across the wider community.

The Chief Inspector, Professor Sir Mike Richards, said: 

“We know that Royal Cornwall Hospitals Trust has been on a journey of improvement over recent years, with the new accident and emergency  department at Treliske the latest and most obvious outward sign.  

“But they're not there yet.  At Treliske Hospital  the high occupancy level, particularly in medical and surgical beds, has been having an impact on the quality of care, and on the trust’s ability to be responsive to people’s needs.  If they are going to meet those pressures, the trust will need to work in partnership with commissioners and all the other providers, who share responsibility for the effectiveness of health and social care services in Cornwall.

“It was encouraging that the staff we met held such a positive view of recent improvements and were proud to work for the trust.  I am confident that the executive team, with the support of the staff, can deliver the improvements we require on behalf of their patients.”   

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.

Ends

For media enquiries, contact the CQC press office on 020 7448 9401 / media.team@cqc.org.uk 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 2013 that he would lead significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public.