The Care Quality Commission (CQC) has welcomed improvements at University Hospitals of North Midlands NHS Trust but calls for further progress following an inspection of its surgical, medical and urgent and emergency services.
CQC carried out the inspections in August and October at County Hospital in Stafford and the Royal Stoke University Hospital, as part of continual checks on the safety and quality of healthcare services. An inspection of the well-led domain of the trust overall was also carried out.
As a result of the inspection, the overall trust rating remained requires improvement. Caring went up from good to outstanding and well-led went up from requires improvement to good. The trust ratings for being effective, responsive and safe remained as requires improvement.
The rating for medical care at Royal Stoke University Hospital went up from requires improvement to good. Urgent and emergency services remained requires improvement. The rating for surgery at The County Hospital remained as good and the rating for medical care remained as requires improvement.
Sarah Dunnett, CQC’s head of hospital inspection, said:
“Our inspection of University Hospitals of North Midlands NHS Trust found areas that had improved since we last inspected which is good news for people receiving care, but there were also areas where leaders need to make improvements.
“The trust must be commended for how compassionate and kind staff were across services despite the added workload caused by the pandemic, which is why we rated the trust outstanding for being caring.
“We were pleased to see that the trust was being led by effective managers and leaders which is why we rated well-led as good. The board understood the challenges that staff were facing and worked hard to support colleagues in a compassionate way.
“We saw a marked improvement across medical services at Royal Stoke University Hospital with a number of initiatives introduced to improve patient care. For example, falls had been identified as a top risk so low beds had been introduced and those at risk were placed together on wards which had significantly reduced the number of falls.
“I recognise the enormous pressure NHS services are under across the country and that usual expectations cannot always be maintained, especially in the urgent and emergency department, but it is important they do all they can to mitigate risks to patient safety while facing these pressures.
“Since our last inspection, improvements had been made regarding safety in A&E; patients were no longer cared for in corridors as this was identified as a significant risk. A new procedure had been implemented to keep patients safe in ambulances until a trolley was available. “A&E didn’t always have enough staff to keep patients safe. Medical staff told us they were concerned about the low number of doctors available on night shifts in such a busy department which could compromise patient care.
“We continue to monitor the trust closely and leaders know where improvements are needed and where to sustain areas where good patient care is already being delivered.”
At County Hospital, inspectors found:
- Infection risk was well-managed in surgery. Systems were used to identify and prevent surgical site infections
- Records were accessible, legible and stored securely in locked cabinets. This had improved since our last inspection
- Managers accurately calculated and reviewed the number and grade of staff needed for each shift in accordance with national guidance
- Staff understood how to protect patients from abuse and worked well with other agencies to do so
- There was a positive culture of reporting incidents and learning from them and all staff knew how and when to report issues.
At Royal Stoke University Hospital, inspectors found:
- Due to patients attending A&E who had tested positive for COVID-19, the trust built doors on cubicles to keep infection risk down
- Staff demonstrated detailed awareness of the principles of safeguarding and their responsibilities to protect patients from harm
- A&E staff often struggled to assess patients within the 15 minute target from arrival to first assessment. This included patients who self-presented as well as those who were brought by ambulance
- Staff identified and quickly acted upon patients at risk of deterioration
- Medical wards had successfully reduced patient falls due to the introduction of low beds and reviewing test results at an early stage.
Inspectors also found the following outstanding practice:
- Staff had been recruited to the emergency department who had oversight of the resuscitation equipment and supported the anaesthetist's and resuscitation teams. They were identified as a positive addition as their support ensured a swifter process for ensuring critically ill patients were seen quickly
- On ward 15 at County Hospital, training was available to staff on how to support patients who became agitated or distressed which reduced the reliance on security staff being called
- “Telescopic referrals” had been introduced which enabled around 1600 patients with cancer diagnosis to be identified and treated quickly. Specialist nurses conducted video examinations of the throat which freed up time for consultants to review higher risk referrals. All patients received an expert opinion within days of being referred by their GP.
Full details of the inspection are given in the report published on our website.
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