England's Chief Inspector of Hospitals has told South Warwickshire NHS Foundation Trust that it must make improvements following an inspection by the Care Quality Commission.
South Warwickshire NHS Foundation Trust was rated as Requires Improvement overall following an inspection which took place in March this year.
The trust was rated as Good for being caring and responsive and rated Requires Improvement for being safe, effective and well-led. The community health services were rated as Good overall.
The trust provides a full range of district general hospital services at Warwick Hospital, community inpatient care at Stratford-Upon-Avon Hospital, Leamington Spa Rehabilitation Hospital and Ellen Badger Hospital. The trust provides neuro rehabilitation to young adults at the Central England Rehabilitation Unit (CERU), based at Leamington Spa Rehabilitation Hospital.
South Warwickshire Foundation NHS Trust also provides a range of health services to a community of approximately 270,000 in South Warwickshire and the surrounding areas.
Ellen Armistead, Deputy Chief Inspector of Hospitals for CQC’s central region, said:
“Our inspectors found that some improvements were needed at South Warwickshire NHS Foundation Trust but we also observed many areas of good care across several departments.
“Patient risk assessments were not fully completed on admission and generally not reviewed at regular intervals throughout the inpatient stay. This included incomplete risk bed rails risk assessments resulting in the use of bed rails without a completed risk assessment.
“The trust had no strategy for end of life care. The end of life care team did not have a direct reporting structure to the board and there was no named non-executive director representing the service. The governance processes for end of life care were not established and the care planning tool to replace the Liverpool Care Pathway was not embedded.
“This is why leadership for end of life care, both at Warwick Hospital and in the community services were judged to be inadequate. The trust had, however, recently appointed a full time consultant with the remit of developing a strategy for the department.
“Our inspection team also observed many areas of good care across the trust. For example, the flow of patients into and through the hospital was well managed with all areas of the trust taking responsibility for this.
“We were particularly impressed by the trust’s emergency department and services for adults which were rated outstanding for being responsive.
“The trust consistently exceeded the Department of Health target for emergency departments of 95% of all patients to be admitted, transferred or discharged within four hours of arrival to the emergency department every month.
“All staff were passionate about providing the best possible service to patients. Patients told us they felt safe and cared for and that staff were respectful of their needs and preferences and took time to understand personal requirements or to explain the care being delivered.
“In addition, there was an extremely positive culture within the trust and staff felt respected and valued. The results of the 2015 staff survey reflected this positive culture with the trust ranked as 'better than average' when compared with all other trusts.
“Since our inspection we have been monitoring the trust and working closely with NHS Improvement and other stakeholders.
“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.”
Across the trust, the inspection team found several areas where improvements must be made, including:
- Risk assessments must be completed appropriately on admission to medical wards and repeated regularly to identify any changes in patient’s risk of harm. This includes bed rail and mobility assessments and nutritional assessments for patients receiving end of life care.
- All staff must receive safeguarding children training in line with intercollegiate document ‘Safeguarding Children and Young People: Roles and competencies for Health Care Staff (March 2014).
- All staff must have a full understanding of the Mental Capacity Act 2005 and their responsibilities and role in the management of patients with capacity concerns. This includes appropriate formal assessment processes and escalation of concerns.
Inspectors also witnessed some outstanding practice across the trust, including:
- The Central England Rehabilitation Unit (CERU) provided neuro rehabilitation to young adults. Staff on CERU had developed and published an assessment tool called Sensory Tool to Assess Responsiveness (STAR). STAR was a tool aimed at providing an accurate diagnosis of prolonged disordered consciousness and establishing any means of communication in the patient. The STAR was used to assess responses to stimulation in visual, auditory and motor modalities, and also records observations of communication and emotion.
- The work of the community nursing service reviewing patients who were insulin dependent diabetics was recognised by Diabetes UK at the Patient First conference in London. Diabetes UK asked if they could work alongside the group and share SWFT good practice. The project had been put forward for the Health Service Journal (HSJ) and Nursing Times Awards 2016.
- The use of reminiscence therapy within the emergency department (ED) for patients with learning disabilities, dementia and mental health conditions was outstanding.
- Processes and procedures had been developed for women on the postnatal ward to self-administer some medication if they opted to do so.
CQC’s inspection team informed the trust of its findings immediately after the inspection so that it could take steps to make any improvements.
Ends
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Our inspectors found that some improvements were needed at South Warwickshire NHS Foundation Trust but we also observed many areas of good care across several departments.
Ellen Armistead, Deputy Chief Inspector of Hospitals, central region