CQC removed conditions at Sherwood Forest Hospitals NHS Foundation Trust, following improvements

21 September 2010

The Care Quality Commission (CQC) has lifted the two conditions imposed on the licence of Sherwood Forest Hospitals NHS Foundation Trust, after an inspection highlighted improvements in systems to monitor quality of care.

CQC imposed the conditions on 1 April this year when it introduced a new registration system for NHS trusts. CQC judged that the trust did not meet all essential standards of quality and safety and imposed two conditions on the trust’s registration.

At the time, CQC said the trust had not properly investigated concerns about the Integrated Critical Care Unit (ICCU) at King’s Mill Hospital when they were first raised by a whistleblower in 2008. It said the trust was slow to investigate the claims and internal review was not rigorous.

This indicated that the trust did not have effective clinical governance or adequate systems to assess and monitor care. Therefore, CQC required the trust to take action to ensure that:

• The Integrated Critical Care Unit (ICCU) has in place a system of clinical governance that supports continual improvement and clinical excellence by 31 May 2010.
• Effective systems to assess and monitor the quality and safety of service provision are in place across all services by 31 July 2010.

Andrea Gordon, CQC regional director, said: “These are vital systems that underpin any modern hospital. They allow clinicians, managers and the board to monitor care on the wards and address any problems that arise. This includes ensuring that risks are identified and managed and mistakes are reported and learnt from.

“We are pleased that the trust has made necessary improvements and we can now lift the conditions from its licence. This can only serve to improve the quality and safety of care patients receive.

“The trust must now sustain these improvements. We will continue to monitor the trust and if we find evidence that essential standards are not being met, we will not hesitate to take further action.”

CQC carried out an unannounced inspection at King’s Mill Hospital on 4 August 2010 to assess the trust’s progress. Inspectors observed patient care on wards and interviewed patients, their relatives and carers as well as staff. It also reviewed documented evidence.

CQC found that clinical governance systems in the ICCU had been strengthened and systems to regularly assess and monitor quality of services in the unit had been implemented. It found that:

• The trust holds weekly clinical governance meetings to assess clinical effectiveness and how risks will be managed.
• A monitoring tool has been developed to measure progress in improving quality of care. For example, the trust monitors the number of people who need to be readmitted to the unit 48 hours after discharge, as this can indicate that care was not sufficient the first time around.
• Patient safety incidents and near misses are discussed at a new communications board. Staff told CQC they knew how to report incidents and they now receive feedback on the action that is taken as a result of reporting an incident.
• Relatives of patients being treated in the ICCU were positive about the care delivered.
• All staff CQC spoke to recognised that there had been considerable effort and commitment to strengthening clinical governance arrangements.

CQC found that the trust has ensured effective systems to assess and monitor the quality and safety of care are in place across all the trust’s services. It found:

• All departments across the hospital have a lead clinician for clinical governance. Each directorate reports to the trust-wide clinical governance committee.
• At ward level, systems are in place to monitor the quality and safety of services and to ensure action is taken when risks are identified. For example, during the inspection, CQC saw nurses carrying out audits to ensure that any patient observations that are outside the normal parameters are followed up appropriately.
• When an incident occurs, the trust analyses how and why it happened. The information from this analysis is used across the trust and communicated to staff to help improve outcomes for patients. CQC also saw evidence of how changes to practice had been made as a result of learning from complaints.
• The trust routinely monitors mortality data, and uses this information to improve outcomes for patients.
• Staff told inspectors that they are given opportunities to make their views known to the trust through staff surveys, staff meetings and other ad hoc forums. They said the senior management team listened to them and they feel supported and confident to report any clinical incidents.

CQC will continue to monitor the trust’s performance through its ongoing monitoring processes, returning to the trust as necessary to check compliance with the essential standards.

Ends

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

Notes to editors