England's Chief Inspector of Hospitals has recommended a special measures extension for Worcestershire Acute Hospitals NHS Trust after a Care Quality Commission (CQC) inspection resulted in it receiving an overall rating of Inadequate.
The trust was first placed into special measures in December 2015 and this inspection was to see what progress had been made.
CQC inspected the trust from 22 to 25 November 2016, with unannounced inspections at Worcestershire Royal Hospital, the Alexandra Hospital and Kidderminster Hospital and Treatment Centre on 7, 8 and 15 December 2016.
The trust was rated as Inadequate overall. It was rated as Inadequate for being safe, responsive and well-led, Requires Improvement for being effective and Good for being caring. Worcestershire Royal Hospital, Kidderminster Hospital and Treatment Centre and Alexandra Hospital were all rated as Inadequate overall.
Following this inspection CQC issued a warning notice as significant improvements were required in relation to staffing levels, governance, investigation of clinical incidents and culture. Inspectors have been back to review progress against this and the report is likely to be published in late July.
Professor Sir Mike Richards, the Chief Inspector of Hospitals, said:
“We found a number of serious problems when we inspected the services run by Worcestershire Acute Hospitals NHS Trust. Rather than getting better, our latest inspection shows a noticeable decline in ratings."
“The trust has been in special measures since December 2015 with little evidence of improvement to date which is why I have recommended an extension of special measures as a new executive team has recently been put in place."
“During our December inspection, we rated the trust inadequate for safety, responsiveness and being well-led. This is extremely concerning, both in terms of the quality of care that people can expect from the trust, and for what it says about the trust’s ability to improve. This situation must not be allowed to continue and we are considering, along with partner agencies, the best option available in order to improve services rapidly for the local population.”
Since May 2016 the trust has regularly breached the 12 hour target for patients remaining in the emergency department and many continued to be cared for in the corridor at Worcestershire Royal Hospital.
Staffing levels within the emergency department were not planned and reviewed in line with national guidance. There were not enough consultants there to meet the Royal College of Emergency Medicine’s workforce recommendations.
There was no privacy and little confidentiality for patients being cared for on trolleys in the corridors of the emergency departments at Worcestershire Royal Hospital and the Alexandra Hospital. Petients were sometimes waiting by external doors in cold conditions or out of staff view.
Patient risk assessments were not fully completed on admission and generally not reviewed at regular intervals throughout the patient’s stay in hospital and records were not always stored securely. This occurred in various hospital services including the emergency department, medicine, surgery and critical care.
In addition, aging and unsafe equipment was used in the radiology departments across the trust that was being inadequately risk rated.
Professor Richards continued:
“The trust has been over reliant on the CQC inspection regime to identify areas for improvement and often shifts its focus to address these areas and loses sight of other issues.
“Over the last two years the trust has been subject to rigorous and frequent regulatory action. This activity demonstrates the trust’s continued poor governance arrangements and the over reliance on the assistance of others to highlight areas that require significant improvement.
“CQC has met with the trust’s executive team who were aware they faced significant challenges that despite previous enforcement action by CQC, had either not been addressed or improvement not sustained. They believe that cultural and behavioural change is key to driving and sustaining the required improvements.
“Generally, staff were hard-working, passionate and caring and because of the quality of staff interactions with patients, we rated the trust as good for caring. Many staff, however, were clearly frustrated that they were not able to effect change due to poor communication between ward, divisional and executive levels.
“It is clear that the trust cannot solve these important issues on its own, and will require continued support for the foreseeable future. Others with a responsibility for health services in the area need to help address the problems the trust cannot deal with on its own. In these circumstances, it would not be appropriate to recommend that the trust leave special measures, which is why I am recommending a temporary extension.”
CQC has told the trust it must make improvements in a number of areas, including:
- Patient documentation, including risk assessments, must always completed accurately and routinely to assess the health and safety of patients.
- The trust must improve performance against the 18 week referral to treatment time, with the aim of meeting the trust target
- Flow in the hospital must be maintained to prevent patients being treated in the emergency department corridors for extended periods of time
- Patient privacy, dignity and confidentiality must be maintained at all times. For example, patients staying overnight in the gynaecology assessment unit.
- The trust must improve performance against the national standard for cancer waiting times. This includes patients with suspected cancer being seen within two weeks and a two week wait for symptomatic breast patients.
- There must be access to 24-hour interventional radiology services.
- Patients under child and adolescent mental health services must receive care from appropriately trained staff at all times.
- There must be an appropriate mental health room in the emergency department to care for patients presenting with mental health conditions that complies with national guidance.
- There must be a robust system in place to ensure that all electrical equipment has safety checks as recommended by the manufacturer
- The trust must ensure that there is clear oversight of the deterioration of patients and that this is documented appropriately.
Full reports are available on our website.
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