England’s Chief Inspector of Hospitals has told Northern Devon Healthcare NHS Trust that it must make significant improvements in the quality and safety of its services.
A team of inspectors from the Care Quality Commission visited North Devon District Hospital at Barnstaple unannounced in October to check the quality of four core services: urgent and emergency care, maternity, end of life care, and outpatients. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
As a result the trust’s overall rating remains Requires Improvement. Caring remains Good. Safety and responsiveness to people’s needs remains Requires Improvement, while effectiveness and leadership have been downgraded from Good to Requires Improvement. Full details of the ratings are available on our website.
CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been issued an indicative, or shadow, Use of Resources rating of Good because it demonstrated it has used its resources effectively. The trust is a recognised leader in its home first model of community care, and has also successfully reduced delayed transfers of care. The report is available on our website.
Following the inspection CQC has told the trust it must make improvements to prevent avoidable harm or risk of harm to people in maternity, outpatients and urgent and emergency care.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“It is disappointing to report that all four core services that we have inspected remain in need of improvement – and in some cases we have found the same concerns that we had raised during our inspections in 2014 and 2015."
“Although the staff working at North Devon District Hospital are invariably caring and conscientious, I have serious concerns about the quality of some services."
“In maternity we found that staff were not always following best practice, resulting in cases where a baby had come to harm. The relationship between the midwives and the consultants was poor, adding an unnecessary risk to the safety of their patients."
“In the outpatients department, people waiting for ophthalmology appointments were not always receiving the treatment they needed in time, with serious long term consequences for some of them."
“We have made it clear to the trust where it must take action to improve these services. Since the inspection the trust has been responding to these safety concerns and making changes to lessen the risks. We will continue to monitor the services involved, and we will take further action if that is required to protect the interests of patients. We will in any case return in the near future to check progress.”
At the time of the inspection CQC had been notified of four serious incidents within the maternity service over a five-month period where healthcare professionals did not assess and respond promptly to the risk involved. Inspectors found there was evidence that procedures had not been followed and that patients may have come to harm as a result.
In the past there had been a record of poor multidisciplinary working and collaboration between the consultant obstetricians and the midwifery team. Although the trust had made some progress there was still a rift between medical and midwifery staff, affecting safe care and treatment.
In outpatients there were a significant number of patients waiting for eye treatment who had gone past their dates for follow up appointments and had come to harm as a result. Patients on some follow-up lists were not being monitored to ensure they did not deteriorate while waiting for an appointment. Incidents were not always recorded and staff did not always receive feedback when raising incidents. Patients who had come to harm were not always informed as required by the Duty of Candour.
In urgent and emergency services, there was a positive culture where staff showed an enthusiasm to make improvements to support patient care and to learn from incidents. The trust was better than the England average for meeting the four-hour target to assess, admit, transfer or discharge patients.
But the cleanliness of the majors department was of concern, and there were low rates for mandatory training in non-clinical infection prevention and control. The management of patients with sepsis was poor; the department was only managing to administer antibiotics to 23% of patients within an hour of sepsis being identified.
Inspectors found that staff were polite and respectful to patients at all times. In urgent and emergency services patients felt their care was unaffected by the department being busy and said they were kept informed and were involved with their care. In maternity women were listened to and treated as partners in their care. In end of life care staff were compassionate and kind. In the outpatients department staff took the time to interact with patients and their relatives or carers, actively supporting patients’ emotional wellbeing.
Overall, CQC has identified 21 areas where the trust must improve. The trust has been told that it must send a report setting out action it will take to meet these requirements. CQC inspectors will return to check in due course.
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Although the staff working at North Devon District Hospital are invariably caring and conscientious, I have serious concerns about the quality of some services
The Chief Inspector of Hospitals, Professor Ted Baker