Chief Inspector of Hospitals recommends Kettering General Hospital NHS Foundation Trust should be placed into special measures

England's Chief Inspector of Hospitals has recommended Kettering General Hospital NHS Foundation Trust should be placed into special measures after a Care Quality Commission inspection rated the trust as Inadequate overall.

Following inspections carried out in October 2016, CQC found the trust, which provides a wide range of services to around 320,000 people across North Northamptonshire, South Leicestershire and into Rutland, needed to make urgent improvements in a number of areas to ensure it was consistently delivering care which was safe, effective, caring, and responsive to people’s needs in services that are well-led.

The trust was rated as Inadequate for being safe and well-led, Requires Improvement for being effective and responsive and Good for being caring.

Inspectors found several concerns in the emergency department which was rated Inadequate overall. There were insufficient staffing levels to meet the needs of patients and there were no effective processes in place to ensure patients who self-presented to the A&E were safe to wait up to two hours to see a clinician. The initial clinical assessment for patients who self-presented was not in line with national reporting guidelines.

Urgent improvements were also needed in services for children and young people. Significant risks identified on inspection had not been recognised, assessed or mitigated. Leaders did not always recognise the significance of risks throughout the service or weaknesses identified as part of audits or reviews. Some patients also experienced long delays waiting for treatment, specifically for urology, maxillofacial and ear, nose and throat.

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

“We found a number of serious problems when we inspected the services run by Kettering General Hospital NHS Foundation Trust and I have made a recommendation to NHS Improvement that the trust should be placed into special measures."

“We made NHS Improvement aware of our concerns following the inspection and it has begun to work with the trust to make sure these are appropriately addressed and that progress is monitored." 

“My inspection team found that the majority of staff were hard working, passionate and caring but had to struggle against the pressures they faced. We found that staff treated patients with dignity and respect which is why we rated the trust as Good for being caring. Good practice was noted across critical care and end of life care services in particular."

“One of the reasons we rated the trust as Inadequate for being well-led and safe was because risks to patients were not always identified and when they were identified, there was a lack of adequate management of these. In addition, there was a lack of learning from incidents to prevent patient harm. This was particularly the case in the emergency department, outpatients and services for children and young people."

“Patient flow and bed capacity to meet demand had been a significant pressure for the hospital for a number of months. Feedback from patients about staff was positive but it was clear staff were struggling with the demands of the service, particularly within A&E."

“While the trust had a vision and a set of values these were not well embedded or understood by staff across some services. There was a lack of capacity in the leadership team to learn from incidents and audits throughout the emergency department to drive improvements."

“The trust has been receiving support from an NHS Improvement and the trust managers have told us they have listened to our inspectors’ findings and have begun to take action where it is required. We have maintained contact with the trust since the inspection and will undertake further inspections, including unannounced visits to check that the necessary improvements have been made.”  

The inspection highlighted a number of concerns and areas where the trust must improve, including:

• The trust must ensure that there are sufficient numbers of nursing and medical staff in adults and children’s emergency department to meet the demands of the population and ensure safe care is delivered.
• There must be sufficient number of medical registrars and junior doctors to cover out of hours and weekend shifts at all times across medical care wards. Also, there must be the required level of consultant obstetrician presence on the delivery suite.
• Care and treatment must be provided in a safe way by following the British Cardiovascular Society guidance on nurse staffing numbers in the Coronary Care Unit.
• A qualified children’s nurse must work in the outpatient department in accordance with Royal College of Nursing guidance.
• Staff in medical care must follow the hospital’s medication policy in the safe prescribing, cancelling, handling, storage, recording and administration of medicines.
• Patient records must be completed with appropriate information to understand their care plans. All patients must have person-centred care plans that are well maintained and reflect changing needs and treatment.
• Staff must be supported to recognise and escalate potential risks to the safety and quality of care and treatment for all patients
• The trust must ensure effective systems are in place to assess, mitigate and monitor any risks. The hospital should ensure that the risk registers are accurate and reflective of any risks.

Despite the overall rating of Inadequate, inspectors identified a number of areas of Outstanding practice across the trust, including:

• The hospital has direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine.
• 60 volunteers support the chaplaincy service through a programme of daily and weekly visits to wards and clinical departments. Volunteers have attended a 10 week training programme, which included awareness sessions on end of life care, dementia, and hearing and visual impairment.
• The hospital had launched a “Joint School” education session for hip and knee replacement patients. The aim was to give patients a clear indication of what to expect from their operation and what was expected form them by the hospital.
• The hospital has launched a new laser operation to support patients who require treatment for benign enlargement of the prostate by using a light laser to reduce the size of the prostate. This process had reduced the surgical time and the length of stay was no more than one day.

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