Chief Inspector of Hospitals rates Portsmouth Hospitals NHS Trust as Requires Improvement

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

A team of 56 inspectors has found that the trust provided services that were effective and Outstanding for being caring. But the trust required improvement for providing safe, responsive and well led services.

The team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Queen Alexandra Hospital over seven days during February and March 2015. Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RHU.

Following the inspection, CQC issued two warning notices to the trust requiring immediate improvements to be made in the Emergency Department to the initial assessment of patients, the safe delivery of care and treatment, and the management of emergency care.

Since then, inspectors have returned and recognised that improvements have been made. A further report will be published in due course.

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

"Portsmouth Hospitals NHS Trust has a three-year strategy that aims to deliver high quality patient care, with plans to transform services, reducing admissions to hospital and delivering care closer to home.

"It is clear that many of these priorities were underdeveloped although the trust is still having to deal with the immediate capacity issues.

"Our most urgent concern was the risk to patients arriving by ambulance. We saw severe overcrowding in the accident and emergency department which meant that some patients with serious conditions had waited over an hour to be assessed. Patients were not appropriately monitored and observed and there was a high risk of their condition deteriorating during this time.

"We have taken immediate action to protect patients and we expect Portsmouth Hospitals NHS Trust to ensure that there are lasting improvements.

"Despite these pressures, I recognise that the trust has a culture of compassionate care. Many patients and relatives told us that although staff were very busy, they were supported with compassion, patience, dignity and respect, with time being given to the delivery of personalised care. In particular we found many areas of outstanding and innovative practices in the critical care service.

"However I am concerned that there was a wide variation in the quality and safety of services throughout the hospital. Our inspection has identified those areas where the trust must make improvements. We will return in due course to check that the trust continues to make progress in these areas for the benefit of its patients."

Overall, the inspectors found that outcomes for patients were often better than the national average. Bed occupancy at the trust was 92 per cent, consistently above the level at which it is generally accepted that it can start to affect the quality of care and the orderly running of the hospital. The trust was not meeting the emergency access target for 95 per cent of patients to be admitted, transferred or discharged within four hours. This target had not been met since November 2013. Patients were not always admitted to wards according to their clinical needs, which meant that they did not always receive the specialist expertise and experience they needed.

While nurse staffing levels were regularly reviewed, there were high vacancy levels across the hospital, notably in the emergency department, the medical elderly care wards and the surgical assessment unit, where there were insufficient staff for the number of patients and the complexity of their care and treatment needs. Staff were transferred across units on a shift basis to try to reduce risk, but this affected the availability of expertise and continuity of care.

The reports highlight several areas of outstanding practice including:

• There were many areas of outstanding and innovative practices in the critical care service.The practice of daily safety briefings on the intensive care unit ensured the whole multidisciplinary team was aware of potential risks to patients and the running of the unit.
• The electronic monitoring system used to monitor patients’ vital signs enabled staff to review patient information in real time and the outreach team to monitor patients on all wards and prioritise patients who needed attention. This early warning system which was developed to monitor deteriorating patients had saved more than 400 deaths.
• In the maternity service, there was a telephone scheme for women who had experienced complex or traumatic deliveries to talk about, and have a debrief conversation, with a midwife after they had left hospital. The conversations had led to a reduction in the number of complaints.
• There were good arrangements for meeting the needs of patients with a learning disability, particularly in theatres. Staff used a specialist pain management tool for assessing pain levels in patients who could not verbally communicate their experiences of pain.
• The trust had introduced a volunteer programme for people who wanted to work as a chaplain’s assistant. Through this training programme, the trust had more than 50 volunteers coming to help and support patients.

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

• Patients must be appropriately assessed and monitored in the emergency department to ensure they receive appropriate care and treatment. Ambulance patients must be received and triaged by a qualified healthcare professional.
• There must be a hospital-wide approach to address patient flow and patient care pathways across clinical service centres. Patients’ bed moves must be monitored, with guidance around the frequency and timeliness of bed moves so that patients are not moved late at night, several times and for non-clinical reasons.
• Nurse staffing levels must comply with guidance on safer staffing levels, and there must be adequate numbers of doctors on shifts at all times.
• Staff on all wards must be able to raise concerns above ward level, particularly when this impacts on patient care, and there must be a response to these concerns.

The two 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 2 July the Care Quality Commission will present 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.

Ends

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