Chief Inspector of Hospitals rates Gloucestershire Hospitals NHS Foundation Trust as Requires Improvement

England’s Chief Inspector of Hospitals has rated Gloucestershire Hospitals NHS Foundation Trust as Requires Improvement following an inspection by the Care Quality Commission.

A team of inspectors has found that the trust provided services that were caring and well led. But the trust required improvement for providing safe, effective and responsive care.

During the inspection in March the team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Gloucestershire Royal Hospital, Cheltenham General Hospital and Stroud Maternity Hospital. Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RTE.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"I am satisfied that there is a positive and open culture within Gloucestershire Hospitals NHS Foundation Trust. It is a well led, caring, organisation which has made the safety of its patients a priority at all levels.

"During our inspection we found that staff were aware of their responsibilities to report and learn from incidents. I know that designated clinical staff regularly lead reviews of incidents and disseminate the learning from them. The trust has a long-established programme to teach these skills to new doctors.

"While there was evidence of learning from incidents, there was also recognition in some areas that not all incidents, particularly near-misses, were being reported. In relation to safety, there are other significant factors such as the pressure on the emergency departments and the related pressures on the wards to discharge patients. This has led to patients not always being treated on the most appropriate ward for their condition and to overcrowding in both emergency departments.

"It is well known that patients have been waiting too long in A and E. I am aware that this is being investigated, and we will continue to monitor the trust's performance in this important area. I am confident that the trust will work with partners and commissioners to address the areas for improvement that we have identified in this inspection.

“I am particularly grateful to Healthwatch Gloucestershire for the information they provided and the support they gave in helping us to obtain the views of patients and the public.”

The inspectors found every service to be caring, with outstanding critical care at both Gloucestershire Royal and Cheltenham General hospitals. Staff at all levels were highly committed to doing their best for patients. While they displayed a passion for delivering the best care possible, they felt frustrated when they thought this was compromised by the pressure on the hospitals and the wider system.

Both main hospitals were very busy. Bed occupancy was constantly over 91 per cent, above the level at which it is generally accepted that bed occupancy can start to affect the quality of care provided to patients and the orderly running of a hospital. This had placed significant pressures on the staff delivering the services and had affected the care, treatment and wellbeing of patients.

There were issues with the flow of patients into, through and out of the hospitals. The emergency department frequently became overcrowded when demand for services exceeded capacity. The standard that requires 95 per cent of patients to be discharged, admitted or transferred within four hours of arrival in A&E was consistently not being met.

While staffing was at safe levels in many services, there were some exceptions. There were not enough consultants in acute medicine, general and old age medicine and radiology, and junior doctors were needed in medicine and emergency care.

The reports highlight several areas of outstanding practice including:

• Patients living with dementia at Gloucestershire Royal Hospital were able to take part in an activity group involving their relatives that encouraged them to maintain their skills and independence.
• The trust had a mobile chemotherapy unit which enabled patients to receive chemotherapy treatment closer to their homes to prevent frequent travel to hospital.
• There was outstanding care for bereavement in critical care. All staff spoke highly of how they were enabled to care for and support bereaved relatives, or patients nearing the end of their life.
• Mobility in labour was promoted with the Mums Up and Mobile (MUM) programme, which included wireless cardiotocography (CTG) monitoring across the delivery suite.

The inspection found a number of areas for improvement, including:

• The trust must improve its performance in relation to the time that patients spend in the emergency department to ensure that patients are assessed and treated within appropriate timescales.
• The trust must continue to ensure there are enough qualified, skilled and experienced consultants and middle grade doctors in the emergency department at Gloucestershire Royal Hospital 24 hours a day, seven days a week, and to reduce reliance on locum medical staff.
• Delays in ambulance handover times must be reduced, and steps taken to ensure that patients arriving at the emergency departments by ambulance do not have to queue in the corridors.
• Patients with mental health needs who attend the emergency departments out of hours should receive prompt and effective support from trained mental health practitioners.

The four 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 Thursday 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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