Chief Inspector of Hospitals rates Hull and East Yorkshire Hospitals NHS Trust as Requires Improvement

England’s Chief Inspector of Hospitals has rated Hull and East Yorkshire Hospitals NHS 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, but required improvement for providing safe, effective and well led care. Services were rated as Inadequate for being responsive.

During the inspection in May 2015 the team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Hull Royal Infirmary and Castle Hill Hospital. The inspection was carried out in order to follow up on concerns that had been highlighted during a previous trust wide inspection in February 2014. Visiting inspectors looked specifically at surgery and outpatient and diagnostic services at both hospital sites, as well as urgent and emergency care, medical care, maternity and services for children and young people at Hull Royal Infirmary. Neither critical care services nor end of life care services were assessed during this inspection.

Full reports on the services that were reviewed as part of the inspection are available on this website.  

Hull and East Yorkshire Hospitals NHS Trust provides a range of acute services for the residents of Hull and East Riding of Yorkshire area, as well as a number of specialist services to North Yorkshire, North and North East Lincolnshire and outpatients services at locations within the Hull and East Riding of Yorkshire area. The trust serves a population of approximately 600,000.

Inspectors found that staff were caring and compassionate, and treated people with dignity and respect. The majority of patients were positive about the care and support they received from staff, however some patients and relatives on the elderly care wards raised concerns that there was a lack of communication between the nursing staff and patients, particularly around discharge planning.

The trust was working hard to address concerns around bullying and harassment of staff. The trust had appointed an internal anti-bullying Tsar and had introduced a number of schemes focussed on empowering staff and instigating positive cultural changes.

The trust had responded to previous staffing concerns and was actively recruiting to fill posts. Inspectors found that there had been a significant increase in the recruitment of consultant obstetricians and midwives, with the birth to midwife ratio having increased from 1:35 to 1:32 since the last inspection in February 2014. However, there remained a shortage of nursing staff on some medical and surgical wards, and this was impacting on patient care and treatment. There were also staffing pressures in the electrocardiography department at Castle Hill Hospital which meant staff were struggling to carry out cardiac diagnostic tests for patients.

Systems and processes for the management of medicines and the checking of resuscitation equipment on some wards did not always comply with trust policy and guidance. Most patients were receiving a good standard of care. However, on the elderly care wards patients were waiting for staff to assist them with their basic needs. Call bells were not always in reach of patients and there was inconsistent use of the red top water jug system to identify patients that required assistance with nutrition and hydration.

There had been changes to medical pathways of care to improve access and flow, however at the time of the inspection this had not yet resulted in a significant improvement as there continued to be delays in discharge, patient bed moves out of hours and patients being cared for on non-specialty or other specialty wards due to inpatient capacity issues. Patients were often waiting too long for treatment. The national targets for Accident and Emergency referral-to-treatment times were not being achieved.

There were a number of infection control issues across surgical services and in the Accident and Emergency Department at Hull Royal Infirmary. Inspectors identified potential risks of contamination caused by inappropriate storage and ineffective cleaning protocols and hand-washing facilities for clinical procedures were poor.

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

“The quality of the services provided by Hull and East Yorkshire Hospitals Trust was mixed. There were some areas of very good practice. Generally we found services to be caring and saw staff being respectful and compassionate when interacting with patients. There had also been significant progress made by the trust with their work to address the issue of the bullying culture identified at our February 2014 inspection.

“But clearly the trust is under pressure. Some people have to wait too long for their treatment. Bed occupancy has been very high, with poor patient flow through both hospitals, and too many patients having to be accommodated on the non-specialist wards, or simply waiting to be discharged.

“I recognise that there are competing demands for resources, but it is clear that the trust will need to continue to work with partners and commissioners to anticipate and respond to the increasing demand for its services and to address the areas for improvement that we have identified in this inspection.”

“People deserve to be treated in services which are safe, compassionate, effective, and responsive to their needs. We will continue to monitor the trust closely and will carry out an early re-inspection to check that action has been taken and improvements are being sustained.”

The reports highlight several areas of good practice, including:

• The opening of the new emergency department represented a substantial improvement in the facilities for the hospital so that emergency care and treatment was provided in a suitable environment.
• The trust had appointed an internal anti-bullying Tsar (a doctor) to lead the trust’s anti-bullying work. Inspectors received many positive comments about the Tsar and their approach to the role.

The inspection found a number of areas where the trust must make improvements, including:

• The trust must address the breaches to the national targets for A&E and referral-to-treatment times to protect patients from the risks of delayed treatment and care. It must also continue to take action to address excessive waiting times for new and follow up patients with particular regard to eye services and longest waits.
• The trust must ensure that there are at all times sufficient numbers of suitably skilled, qualified and experienced staff in line with best practice and national guidance.
• The trust must ensure the sustainability of the work to address the concerns raised regarding the bullying culture and the outcomes from the NHS staff survey data (2014).
• The trust must ensure that all incidents are investigated in a timely manner, that lessons are learnt and that duty of candour requirements are effectively acted upon and audited.
• The trust must ensure that systems and processes are in place and followed for the safe storage, security, recording and administration of medicines on the medical wards.
• Call bells must be placed within reach of the patient at all times, especially on the medical wards and regular audits must be completed to monitor compliance.
• The trust must review its patient pathways and patient flow through services to reduce the number of patient bed moves ‘out of hours’ (unless for clinical reasons) and ensure more timely discharges of patients.
• The trust must take action to ensure that patients’ nutrition and hydration is maintained in a timely manner; including the effective use of the ‘red top’ water jug system across all medical wards and the accurate recording of fluid balance and food charts for patients.
• The trust must ensure that there is an effective and timely system in place, which operates to respond to, and act on, complaints.

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 Wednesday 7 October 21015 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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