England’s Chief Inspector of Hospitals has found improvements are needed at West Suffolk NHS Foundation Trust following an inspection by the Care Quality Commission.
Between 24 September and 30 October 2019, a team of CQC inspectors visited services across West Suffolk NHS Foundation Trust. A well led inspection at provider level also took place between the 28 and 30 October 2019. As a result, inspectors rated the trust as Requires Improvement overall.
The trust is also rated as Requires Improvement for whether its services are safe, responsive and well-led. Services provided by the trust are rated Good for whether they are effective and caring.
The trust was previously rated Outstanding following an inspection in December 2017.
West Suffolk NHS Foundation Trust provides hospital and community healthcare services in a predominantly rural area to people in West Suffolk and is an associate teaching hospital of the University of Cambridge.
Inspectors found significant concerns and risks to patients within the maternity and midwifery service, which included the failure to track and score observations of some women and new-born babies in order to identify deterioration. These concerns were raised with the trust immediately following the inspection and a warning notice was issued stating that improvements must be made by 31 January 2020.
In outpatient services, systems to identify and track patients on surveillance pathways were not robust, and actions to address this had not been undertaken quickly enough once concerns were known. This resulted in risk to patients using the vascular service, as well as a period of time where the potential risk across other specialties remained unknown.
Chief Inspector of Hospitals, Professor Ted Baker, said:
“Our inspection of West Suffolk NHS Foundation Trust found that improvement was needed, and it is disappointing that their previous rating of Outstanding has gone down to Requires Improvement.
“We had particular concerns about the assessment of risk to mothers and babies in maternity services and have issued a warning notice meaning that improvements must be made by the end of this month.
“We also found that the style of executive leadership did not demonstrate an open and empowering culture. There was an evident disconnect between the executive team and some consultants.
“Safety concerns were not consistently identified or addressed quickly enough, and incidents were not always reported in a timely manner. Wider lessons were not identified or shared effectively to improve patient safety.
“Not all staff felt respected, supported and valued or felt that they could raise concerns without fear of retribution. This has been exacerbated by the way the trust has managed recent issues of concern.
“However, we found that staff worked well together for the benefit of patients across the trust and supported them to make decisions about their care.
“Across services, leaders actively engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. A family centred approach was observed in the community children and young people service.
“The trust has told us they have listened to our inspectors’ findings and its board knows what it must do to ensure it makes the necessary improvements. We will return to check on the progress they have made.”
The trust has been told it must make several improvements, including:
- The trust must take definitive steps to improve the culture, openness and transparency throughout the organisation and reduce inconsistencies in culture and leadership.
- The trust must ensure the culture supports the delivery of high quality sustainable care, where staff are actively encouraged to speak up and to raise concerns, and where clinicians are engaged and encouraged to collaborate in improving the quality of care.
- The trust must ensure that effective process for the management of human resources (HR) processes, including staff grievances and complaints, are maintained in line with trust policy.
- The trust must ensure that processes for incident reporting, investigation, actions and learning improve are embedded across all services and that risks are swiftly identified, mitigated and managed.
- The trust must ensure that they implement a nationally recognised monitoring vital observations tool for women attending triage on labour suite and the maternity day assessment. The trust must ensure they implement a national recognised monitoring vital observations tool for new born babies on the labour suite and F11 ward.
- The trust must ensure outpatients can access the service when they need it and receive the right care promptly in line with national targets.
Inspectors witnessed areas of outstanding practice, including:
- Within community health services for children and young people, physiotherapists were linking with sports gyms in the locality to jointly provide gym groups for five to 11-year-olds and 11 to 18-year-olds with cerebral palsy.
- Within community health services for children and young people, an emotional well-being care pathway had been developed, in conjunction with other services.
- Within community health services for children and young people, multi-disciplinary and multi-agency working was particularly strong.
Full details of the ratings, including a ratings grid, are given in the report published online at: www.cqc.org.uk/provider/RGR
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