England’s Chief Inspector of Hospitals has found improvements are needed at East and North Hertfordshire NHS Trust following an inspection by the Care Quality Commission.
Between 20 March and 25 April 2018, a team of CQC inspectors visited services across Lister Hospital, QEII Hospital and Mount Vernon Cancer Centre. As a result inspectors rated the care provided by staff to be Requires Improvement overall.
The trust is also rated as Requires Improvement for whether its services were safe, effective, responsive and well-led. The trust is rated as Good for whether its services are caring.
Chief Inspector of Hospitals, Professor Ted Baker, said:
“Our visit to East and North Hertfordshire NHS Trust found a number of improvements were needed.
“We found a number of concerns where we felt action was needed and, as a result, issued a warning to the trust telling it that it must make improvements, particularly in surgery and the urgent care centre at QEII Hospital.
“Due to the work that is needed our overall rating for the trust remains unchanged since our last inspection in October 2015 at Requires Improvement.
“While the trust clearly needs to do more to ensure people receive the care they should be able to expect, we found a kind and caring workforce and inspectors found a number of areas of outstanding practice. This included practices in the emergency department at Lister Hospital and at the Mount Vernon Cancer Centre.
“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 in due course to check on the progress that they have made.”
Among the improvements the trust must make are that all executive employment files must be complete in order to comply with the Fit and Proper Persons regulation and there must be effective oversight of incidents so they can be assessed and investigated swiftly, to ensure learning is implemented to prevent recurrences.
Urgent Care Centre at the QEII Hospital must ensure all nursing staff are familiar with the computerised triage system and that they are able to use it appropriately. They must also be trained in assessing all patients, including children, for the risk of sepsis and acute mental health problems.
The trust must ensure medical care staff are fully compliant with all mandatory training,
that medicines are securely stored and there are always adequate numbers of staff on duty to safely care for patients.
In surgery all emergency equipment must be checked as per trust policy to ensure it is safe for use, all patients must be reassessed 24 hours after admission for venous thromboembolism and the service must reduce the number of never events. All staff in surgery must comply with the trust’s infection prevention and control policy, particularly regarding hand hygiene.
Services for children and young people must ensure there is a systematic and effective approach to identify and manage risk and it must ensure that oxygen is correctly prescribed for patients on their medication charts.
Inspectors also found a number of areas of outstanding practice during their inspection.
This included that the emergency department at Lister Hospital had introduced an electronic record system which identified children on the child protection register, notified staff of learning disability needs, highlighted patients at risk of sepsis and notified the department’s leads, and alerted nurses to repeat observations. Nurses inputted patient information into individual handheld devices which communicated with the department’s IT system, allowing continuous and visible patient monitoring.
The responsiveness of the frailty and mental health teams had improved the flow within the emergency department at Lister Hospital since our last inspection in October 2015. The mental health team, rapid assessment, intervention and discharge team (RAID) were available 24 hours a day, seven days a week and responded to referrals within an hour.
Pharmacists from the chemotherapy service attended patients at their clinic appointments with medical staff. They described this as having a positive effect on team working and patient care as they could advise and deal with issues earlier.
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