CQC rates Colchester Hospital University NHS Foundation Trust as Inadequate and recommends trust remains in special measures

England's Chief Inspector of Hospitals has recommended that Colchester Hospital University NHS Foundation Trust should remain in special measures after a Care Quality Commission (CQC) inspection resulted in it receiving an overall rating of Inadequate.

During the inspection in September and October 2015, CQC inspectors found the trust needed to make a number of urgent improvements to ensure it was consistently delivering care which was safe, effective, caring, and responsive to people’s needs.

At the time of the inspection the Chief Inspector of Hospitals, Professor Sir Mike Richards raised his immediate concerns about standards of patient safety with the trust, Monitor, NHS England and local commissioners. A letter was issued to the trust following the inspection that highlighted what urgent improvements were required. A new chief executive was appointed after the inspection to lead on the necessary improvements.

The trust was placed into special measures in November 2013 following concerns about patient care in cancer services.

CQC took urgent enforcement action with regard to the trust’s Urgent and Emergency Services and Medical Care departments following an inspection in November 2014. The action placed conditions on the trust’s registration to help it improve how patients were assessed, discharged and transferred. Urgent enforcement action was also undertaken in July 2015 because the trust failed to ensure that bank, agency and redeployed staff were suitably skilled and experienced. The trust was told to send CQC an action plan that set out how they planned to solve these issues.

Following the latest inspection, staffing continues to be a serious problem; there were not enough staff on inpatient wards to meet the needs of patients and agency staff brought in did not always have the required skills or receive effective inductions. The trust was told to address this as a matter of urgency.

Professor Sir Mike Richards, the Chief Inspector of Hospitals, said:

“Once again, we have found a number of serious problems when we inspected the services run by Colchester Hospital University NHS Foundation Trust. I am concerned that the trust has not taken sufficient action to address the requirements of our previous inspections and has shown only limited capacity to improve.

“While the staff have been working hard through many issues to drive improvements locally, their efforts have been affected by poor leadership and a high use of agency staff, some of whom are unsuitable in terms of their skills and knowledge.

“We found there was a disconnect between what was happening on the front line and the senior management team; for example the trust board seemed unaware of significant backlogs and patient safety concerns across outpatient services.

“The multiple changes in leadership have made many people lose confidence in the trust. It is clear that the trust cannot solve these important issues on its own, and will require continued support for the foreseeable future “

“The trust is now rated Inadequate for safety, effectiveness responsiveness and being well-led. This is extremely concerning, both in terms of the quality of care that people can expect from the trust, and for what it says about the trust’s ability to improve. This situation must not be allowed to continue and we are considering, along with partner agencies, the best option available in order to improve services rapidly for the local population.”

Sir Mike has written to the Secretary of State for Health recommending that the trust remain in special measures for a period of three months during which time they will submit a weekly improvement plan to CQC. If there is no improvement in that time, CQC will consider further steps.

Inspectors found longstanding concerns with the hospital’s capacity; staff had to reassess bed capacity at least three times a day and pressure on surgical services meant routine operations were frequently cancelled. Some cancer patients had waited 100 days for treatment.

There was a real lack of understanding and awareness of patient waiting lists in outpatient services which has placed patients at risk of harm. There were significant shortfalls of registered nursing staff in many areas which resulted in the high use of agency staff. There were also significant medical staffing shortfalls across many specialties from junior doctors to consultant grades. This was particularly evident at night and during weekends.

Improvements identified at previous inspections had not been undertaken. This included the service, maintenance and repair of equipment which was found to be poorly undertaken throughout the trust. End of life care provision had also deteriorated since with patients not receiving safe or effective care at the end of their life.

CQC has told the trust it must make improvements in a number of areas, including:

• Medical equipment must be serviced and maintained and calibrated so it is safe to use on patients.
• The culture within the organisation regarding poor staff morale, staff not being willing to raise concerns openly and concerns around bullying must be given sufficient priority by the board
• Improvements must be made to the classification of incidents to ensure that they are reported, escalated and graded appropriately.
• Conditions imposed by the CQC on the Emergency Assessment Unit must be effectively implemented.
• The trust must ensure that all staff in operational roles are educated in understanding the requirements and fundamentals of referral to treatment times.

Full reports including ratings of all core services have been published on this website.

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