England’s Chief Inspector of Hospitals has rated East Cheshire NHS Trust as Requires Improvement following an inspection by the Care Quality Commission.
A team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Macclesfield and District General Hospital, Congleton War Memorial Hospital and the trust’s community services over a period of three days during December 2014. They also made separate unannounced visits as part of the inspection.
Full reports including ratings for all of the provider’s core services are available here.
Overall, the trust's services were rated as Good for being caring, but as Requires Improvement for being safe, effective, responsive and well led.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“When we inspected the hospital and community based services run by East Cheshire NHS Trust, we found that – across the board – staff were working hard delivering compassionate care to people using trust services.
“We also found, however, that improvements were required in some areas particularly in relation to safety of the trust’s community services and services for children and young people.
“We saw that work was needed to improve the leadership and governance at the trust. The trust’s vision and strategy was not always clear and the visibility of the executive team was variable, with a noticeable disconnect between the trust board and staff providing some community services.”
"People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. The trust has told us they have listened to our inspectors' findings and have already taken action where it is required. We will return in due course to check that the improvements we have identified as being needed have been made."
Inspectors found that services were provided by dedicated, caring staff and that patients were treated with dignity and respect. Patients spoke positively about the care and treatment that they received and inspectors saw that patients and their families were involved in decision making regarding their care.
Inspectors were concerned that current governance processes could not ensure that services would be of high quality at all times. While systems were in place for reporting and managing incidents, these were not followed consistently by staff across all services, and when issues were identified, action was not always taken to address the risks.
During the inspection, inspectors raised concerns regarding the decontamination and storage of equipment and the maintenance of a safe environment on some hospital wards. A number of areas showed signs of ‘wear and tear’, which meant that they could not be cleaned adequately and patients were at risk from potential cross-infection.
Inspectors noted that the layout of the children’s ward at Macclesfield District General Hospital made it difficult for staff to observe all areas and that there was no evidence that a risk assessment had been carried out before placing children and young people in the areas which were out of sight. These concerns were raised immediately with the trust, and they took urgent action to address the issues.
While nurse staffing levels were generally adequate on the wards at the time of the inspection, there were not enough qualified and experienced nurses working in adult community services to fully meet patient needs. Inspectors also found that nurse staffing levels within the children’s unit were not always in line with Royal College of Nursing recommendations. The trust was actively recruiting to improve staffing levels.
In some services the trust was not following policies it had in place regarding management of medicines and issues with patient flow through the accident and emergency department at Macclesfield District General Hospital meant that patients often waited for long periods of time before being transferred to a ward.
The inspection found a number of areas where the trust must make improvements, including ensuring that:
- Suitable arrangements are in place to respond appropriately to any allegation of abuse in order to safeguard people against the risk of abuse.
- Robust systems are implemented for the management, storage, administration, disposal and recording of medication, including controlled drugs and oxygen.
- Effective processes are followed for the decontamination and storage of clean and contaminated equipment and for the monitoring of this, particularly in relation to children’s and young people’s services.
- The environment within the surgical wards and maternity services are well maintained and fit for purpose so that appropriate standards of cleanliness can be maintained.
- There are sufficient numbers of nursing and other staff working in adult community services to meet people’s needs.
- Effective systems are in place to identify, assess and monitor risks relating to the health, safety and welfare of both staff and patients. This includes incident-reporting systems and risk management processes for the maintenance of equipment.
The reports also highlight some areas of outstanding practice, including:
- The community dental service was found to be outstanding in its care planning and inspectors observed excellent interactions between staff and patients using the service.
- A new project recently set up by the trust for providing intravenous therapy at home. The team had developed policies and procedures based on best practice from other trusts and in line with national guidance.
- The Parkinson’s nurses, respiratory nurses, physiotherapists and podiatrists networked in specialist groups. They attended regular update meetings where some would present their work to peers outside the organisation.
The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.
On Friday 8 May 2015 the Care Quality Commission 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.
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The trust has told us they have listened to our inspectors' findings and have already taken action where it is required. We will return in due course to check that the improvements we have identified as being needed have been made.
Professor Sir Mike Richards, Chief Inspector of Hospitals