Chief Inspector of Hospitals rates Warrington and Halton Hospitals NHS Foundation Trust as Requires Improvement

England’s Chief Inspector of Hospitals has rated Warrington and Halton 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 effective. But the trust required improvement for providing safe, responsive and well led care.

During the inspection in January and February 2015, the team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Warrington Hospital, Halton Hospital and community healthcare services provided at Bath Street Health and Wellbeing Centre.

Warrington Hospital was rated as Requires Improvement. Halton Hospital and Bath Street Health and Wellbeing Centre were rated as Good.

Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RWW.

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

“When we inspected the services run by Warrington and Halton Hospitals NHS Foundation Trust, we found that – across the board – staff were working hard to deliver compassionate care to patients. We were particularly impressed by the trust’s approach to dementia care.

“However, we also found that improvements were required in several areas. Pressures from high numbers of emergency admissions meant that some patients were being cared for on wards that were not suited to meeting their needs. It had also led to patients being moved from ward to ward, sometimes during the night. This issue must be addressed promptly to ensure that patients’ needs are appropriately met.

“The trust must also continue the work to improve discharge processes and tackle staff shortages. Although the wards and departments were adequately staffed at the time of our inspection, nurse vacancies were covered by bank and agency staff with regular staff also working overtime. This is not a sustainable position in the longer term. I know that the senior managers have acknowledged the importance of these challenges. I believe that trust has considerable potential to improve their services along these lines, and I will watch their progress with interest.”

Inspectors found every service to be caring and effective and patients and their relatives were extremely positive about the care and support they received from all the healthcare professionals. All areas visited were clean and well maintained, and robust infection control practices were adhered to by staff. Staff communicated with and supported people in a compassionate way, and patients and their families spoke positively about their care and treatment

The trust had a vision and strategy with clear aims and objectives, and staff at both hospitals were supportive of the trust’s vision and values.

However, pressures on bed capacity within the hospital were affecting patient care and experience. Some patients were being treated on wards that were not specific to their condition, or best suited to their needs. Patients were often moved before being placed in an appropriate setting and surgical patients were also affected because operations were cancelled if inpatient beds were not available.

Patients were often in hospital longer than they needed to be. Discharge processes were slow at Warrington Hospital and inspectors found high numbers of delayed transfers of care from the intensive care unit to appropriate wards. The trust was taking action to improve discharge processes and the early supported discharge team for stroke patients had resulted in a reduced length of stay and an improved patient experience for this group of patients. Inspectors also identified staffing issues. There was a heavy reliance on bank and agency nurses to maintain safe staffing levels and there were not always doctors on duty to provide timely treatment, particularly out of hours .The trust was actively recruiting nurses and had increased its staffing levels, however this remained an ongoing challenge.

Inspectors identified a number of areas of outstanding practice, including:

• The purpose built and highly effective ward for patients living with dementia which was well equipped and well-staffed. Patients with dementia were assessed and admitted to the ward based on the severity of their dementia and managed sensitively and compassionately.

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

• Medical staffing must be sufficient to provide appropriate and timely treatment and review of patients at all times including out of hours.
• The trust must take action to improve the levels of mandatory training compliance and the number of staff appraisals
• Improvements must be made to patient flow throughout the hospital to ensure that patients are cared for on the appropriate ward for their needs and reduce the number of patient bed moves, particularly in the medical division.
• Medicine stocks in the outpatient department must be accurately recorded and checked

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 Friday 3 July 2015 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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