Chief Inspector of Hospitals recommends Hinchingbrooke Health Care NHS Trust remains in special measures following Care Quality Commission inspection

England's Chief Inspector of Hospitals has recommended Hinchingbrooke Health Care NHS Trust remains in special measures following a Care Quality Commission inspection.

A previous inspection, in September 2014, led to the trust being rated ‘Inadequate’ overall and placed in to special measures. It was also inspected to check on progress at the trust in January 2015. At the time of CQC’s previous inspections the trust was privately managed, but in April 2015 it reverted to being managed by the NHS.

The latest inspection, carried out in October and November 2015, found a number of improvements had been made since CQC’s last inspection, although further work needs to be done. The trust has now received an overall rating of ‘Requires Improvement’ but it is recommended the trust remains in special measures so it can continue to get the support it needs to make sustainable changes.

Hinchingbrooke Health Care NHS Trust is now rated as ‘Requires Improvement’ for whether services are safe, effective, responsive and well-led and ‘Good’ for whether its services are caring.

Overall inspectors found the service was in a transition period following structural management changes. New systems and process were in place but these were yet to be embedded.

Staff were caring and compassionate towards patients but the emergency and medical services required improvement to ensure people were protected from avoidable harm. Services for patients at the end of their lives required improvement to ensure they received a safe, effective and responsive service that was well led.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Our return to Hinchingbrooke Health Care NHS Trust showed a number of improvements had been made but that further work was needed. This is reflected in the trust being rated as ‘Requires Improvement’ and I have made a recommendation to the Trust Development Authority (TDA) that the trust remains in special measures. We have informed the TDA of our findings for it to ensure these are appropriately addressed and that progress continues to be monitored through the special measures action plan.

“Our inspection at Hinchingbrooke Health Care NHS Trust highlighted a number of concerns regarding how the trust manages and monitors risk in a number of areas. There were also concerns regarding the A&E department including infection control practices. Urgent and emergency services are rated as ‘Inadequate’ overall.

“We also saw a number of areas of good and outstanding practice which included the chaplaincy service, which remains excellent and supportive to patients, their families and carers, and work on Apple Tree Ward to help patients with dementia.

“The trust was given feedback on all the areas where improvement is needed following the inspection and knows what it must do now to ensure positive changes are made.

“We will continue to monitor the trust and this will include further inspections.”

The inspection highlighted where the trust it must improve and this includes:

• Being able to provide assurance that all members of staff are aware of the procedure for and necessity to, report all clinical incidents and near misses in a timely and accurate manner, ensuring these are thoroughly investigated and reported externally where necessary.
• Ensuring all staff responsible for supporting the feeding of patients have adequate training in relation to the risks associated with various medical conditions.
• The end of life risk register must record all relevant risks involved in delivering end of life care to patients.
• Patient outcomes must be monitored and audited and the information used when reviewing the service.
• A robust incident and accident reporting system needs to be in place and lessons learned from investigations of reports shared with staff.
• Ensuring the service has effective governance and risk management systems to reflect current risk and that this is understood by all staff.
• Environmental risk assessments must be undertaken to ensure mental health patients are safe from ligatures and self-harm within the department.
• An effective process for monitoring ECGs and observations needs to be in place.
• An immediate review of the environment and provision of children’s services must take place.
• In the emergency department the time to treatment from a clinician must be reviewed and improved, infection control practices and processes for checking equipment also need to be improved.

Inspectors found examples of outstanding practice at the trust, including:

• A member of staff on Apple Tree ward had introduced ‘sensory bands’ for the ward’s dementia patients. These were knitted pockets, embellished with buttons and beads, for patients to wear or hold to give them an immediate focus to explore.
• There was a good infection prevention and control initiative which included different coloured aprons, for different ward bays, which acted as a reminder to staff to change or remove when staff moved out of areas.
• The chaplaincy service continued to provide an excellent service, supportive of patients, families, carers and staff.
• There was robust implementation of Duty of Candour.
• The inspection included and inspection on 20 and 21 October as well as unannounced inspections on 26 and 27 October and 5 November.

Full copies of the reports relating to the trust can be found on this website.

Ends

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