Conditions lifted at Basildon following improvements but more action needed, says CQC

24 September 2010

The trust is now left with just one of the five conditions that CQC imposed on 1 April this year as part of its new registration system for NHS trusts. Two of the conditions were lifted following a review in May. The trust’s compliance with the remaining condition will soon be assessed by CQC.

CQC first raised concerns about the trust in 2009 after it found problems with infection control, the A&E environment and consistently high mortality rates.

CQC regional director Frances Carey said: ”There have been major problems at this trust in the past, so we intend to keep it under close scrutiny for some time to come.

“The trust has made progress against the conditions applied during registration. But we have recently identified that there is still more to be done on certain aspects of staff practices and training. The trust must address these concerns and we will be monitoring them to make sure they do.

“The trust must sustain its level of improvement and must constantly check that changes to process and policy are translating into better care for patients.

“We would like to thank the staff, patients and visitors who gave us frank and honest accounts of care at the hospital. We will continue to keep a very close eye on standards of care and won’t hesitate to take action if we see standards slipping back.”

CQC today published its latest review of standards at the trust, which was conducted in July.  It focused on two conditions – one concerning the supervision and appraisal of staff, and the other about training for clinical staff on identifying and managing patients whose health is deteriorating.

The regulator found that staff now receive appraisals of their performance, and staff who required training to identify and manage patients whose health is deteriorating have now received it. Consequently CQC is lifting the two conditions relating to these issues.

However, during the review CQC found that other improvements are needed. The trust must ensure staff properly explain to patients how they will be discharged from hospital and record it in their notes. Staff also need more training to deal with violent and abusive behaviour. CQC will monitor how the trust deals with these issues.

CQC will soon assess the trust’s compliance with the remaining condition on its licence, which is that it must demonstrate it has reduced the risk of patients contracting legionellas, in line with requirements from the Health and Safety Executive (HSE).

July review (published today)
CQC conducted an unannounced inspection on 22 July, which involved direct observations of care; interviews with patients and visitors; and interviews with staff and senior managers. CQC found significant improvements and will now lift the following two conditions:

• Appropriate systems must be in place by 30 June 2010 for the supervision and appraisal of staff.
• The trust must identify clinical staff that need training to identify and manage patients whose health is deteriorating. Training must be completed by 30 June.

However, concerns had been raised with CQC about how patients are discharged from hospitals, so inspectors were keen to check this during the review. CQC said some patients it spoke to did not understand how they would be discharged from hospital and their notes did not contain all the necessary information about discharge. It said these issues must be addressed.

CQC also checked on the trust’s progress in addressing other issues it had previously raised. It found the trust had:

• given A&E reception staff personal alarms to use if confronted with violent or aggressive behaviour;
• installed CCTV and mirrors so staff can better observe patients waiting in A&E. This is important to check on patient’s health as they wait for treatment and to deal with potential aggression or violence;
• the training programme for A&E reception staff in dealing with aggressive behaviour has not yet been implemented. 

May review
Following unannounced inspections in May, CQC found the trust had made necessary progress and lifted the following two conditions:

• Evidence must be available by 30 April to demonstrate that all inpatients are properly assessed, taking into consideration any personal needs or risks to safety.
• The trust must develop an action plan by 30 April, setting out how it will improve support for mothers in labour and address staff vacancies in the maternity unit. 

During this review, CQC called for improvements to how A&E reception staff are equipped to deal with violence and aggression, and to how patients were monitored in A&E.

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

Problems in the A&E department were among the concerns that prompted CQC and Monitor to intervene at the trust in November last year, demanding immediate action be taken to protect patients. As well as issues around A&E, there were breaches of the infection control standards, high mortality rates, and worries about the quality of care for people with learning disabilities.

Infection prevention and control
CQC carried out a follow-up inspection in December and found that the trust had taken action and was meeting the minimum hygiene standards. But in January there were two cases of infection from legionellas, and the HSE served a notice requiring the trust to reduce the risk of legionellas. CQC reinforced this by making it a condition of registration.

Mortality rates
High mortality rates were among the issues that triggered concerns about the trust last year. Mortality rates appear to have improved but that it is still too early to judge whether this decrease reflects a sustained improvement. CQC continues to monitor mortality rates at the trust.

People with learning disabilities
CQC has been working with the HSE to monitor the trust’s progress on its care of people with learning disabilities. Following a site visit in December, CQC wrote to the trust with a series of recommendations to improve care for people with learning disabilities and requested an action plan detailing how these would be implemented. The site visit carried out on 6 and 7 May as part of CQC’s review showed that progress is being made, and the Commission will continue to monitor this.