Chief Inspector of Hospitals rates East and North Hertfordshire NHS Trust as Requires Improvement

England’s Chief Inspector of Hospitals has rated the services provided by East and North Hertfordshire NHS Trust as Requires Improvement following an inspection by the Care Quality Commission.

The CQC inspected the core services provided by East and North Hertfordshire NHS Trust between 20 and 23 October 2015.

A team of inspectors, which included a variety of specialists and experts by experience visited hospitals and services provided by the trust and full reports of their findings, including ratings for all of the provider’s core services are available at:

The CQC has rated the trust as Requires Improvement overall. It was rated as Good for being caring, Requires Improvement for being safe, effective, responsive, and well led.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Our inspectors found that some improvements were needed at East and North Hertfordshire NHS Trust.

“The emergency department did not consistently meet the four hour target for referral, discharge or admission of patients. The triage system within the emergency department at Lister Hospital was not sufficient to protect patients from harm or allow staff to identify those with the greatest need. Urgent action was taken to address these concerns after we brought it to the trust’s attention.

“In addition, although there were robust systems in place to manage risks, these were not always effectively implemented. Risks identified in some areas were not always acted upon in a timely manner and opportunities to prevent or minimise harm were missed and feedback was not always provided.

“We have seen, however, that some progress has already been made across some areas and we found many areas of good practice that staff should be proud of.

“We were particularly impressed by the outstanding level of care at the community, children’s and young people’s service and in chemotherapy services at the Mount Vernon Cancer Centre. The trust was very proactive in engaging with the local community and had exceptional engagement with young people.

“We saw some examples of excellence within the maternity service. For example, the foetal medicine service is run by three consultants as well as a specialist sonographer and screening coordinator. The unit has its own counselling room away from the main clinic and continues to offer counselling postnatally.

“Since our inspection we have been monitoring the trust and working closely with the Trust Development Authority and other stakeholders, such as the local Clinical Commissioning Group and NHS England.

“The trust leadership knows what it needs to do to bring about improvement and our inspectors will return at a later date to check on what progress has been made.”

The CQC has told the trust to take action in several areas, including ensuring that:

• All required records are completed in accordance with trust policy, including assessments, nutritional and hydration charts and observation records.
• Effective governance systems are in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients including the timely investigation of incidents and sharing of any lessons to be learned.
• Systems are in place for the triage process to accurately measure patient need and priority in the emergency department.
• The triage process in maternity operates consistently and effectively in prioritising patient needs and that this is monitored.
• All staff complete their mandatory training in line with trust requirements.
• Patients who require urgent transfer from the trust’s Mount Vernon Cancer Centre have their needs met to ensure their safety and that there is an effective process in place to handover continuing treatment.
• There is oversight and monitoring of all transfers.

The CQC inspection team also found a number of areas of outstanding practice, including:

• The trust’s diabetes team, which had won a prestigious national “Quality in Care Diabetes” award in the best inpatient care initiative category.
• The development of an outreach team to deliver proactive ward rounds specifically targeting high-risk patients; including the delivery of smoking cessation and structured education programmes for both the respiratory and diabetic services.
• The day surgery unit had been awarded the Purple Star, which is a recognised award to a service for improving health care for people with learning disabilities.
• The ophthalmology department had implemented a minor injuries service and patients could be referred direct form accident and emergency, their GP and opticians to be seen on the same day.
• The maternity unit offers some services above the requirements of a typical district general hospital such as invasive procedures and diagnostic tests. The unit has its own counselling room away from the main clinic and continues to offer counselling postnatally.
• The radiotherapy service had a strong reputation nationally as a major contributor to clinical trials.
• The cancer centre is one of the top ten centres in the country for research and innovation and care shown to patients undergoing chemotherapy and the community children’s and young people’s service was outstanding.
• Parents said staff did everything they possibly could to support their child and family which exceeded their expectations.

Full reports for the trust will be published on CQC’s website today at the following link: www.cqc.org.uk/provider/RWH

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