CQC tells Northern Devon Healthcare NHS Trust that it must improve urgent and emergency services

England's Chief Inspector of Hospitals has told Northern Devon Healthcare NHS Trust that it must continue to improve the quality of some of its services after its latest inspection by the Care Quality Commission.

Inspectors returned to North Devon District Hospital at Barnstaple on 5 August to check on improvements which had been called for following a comprehensive inspection in July 2014.

Following the latest inspection, CQC has rated emergency and urgent care, maternity and gynaecology and end of life care as requires improvement. A full report of the inspection is available.

Deputy Chief Inspector of Hospitals, Prof Edward Baker said:

“While there have been some improvements since our last inspection, The flow of patients from the emergency department into the hospital is still not being managed well. Although patients were being seen in a timely way within the department, some people were still having to wait too long to be admitted to a ward. This inevitably has an effect on patient care and I expect the trust to address this as a priority.

“The trust also needs to do more to address other matters that we found on our previous inspection. In particular, to provide effective and safe care for patients at the end of their life and to provide responsive and safe care for patients using urgent care services.

“However the trust has assured us that it is working steadily towards ensuring the improvements are taking place and I am satisfied that the trust leadership knows what is needed. We will continue to monitor its performance, and our inspectors will return at a later date to check on progress.”

Inspectors found that the relationships between the medical and midwifery teams had improved in the maternity and gynaecology services although more focused work was needed to ensure the teams worked better together.

Patients coming in to the emergency department were seen and treated in a timely way. But patient flow through the hospital, caused by lack of bed capacity and delays in discharging patients from wards continued to affect the department. A number of actions had been taken in the emergency department to improve infection prevention and control measures. These were supported by regular audits, which showed good compliance with trust policies

Delays to the discharge of patients nearing end of life sometimes meant that people were not being in their preferred place to die.

While this was not always in the control of the trust, the impact on people and their families was a matter of concern. Shortly after the inspection CQC asked the trust to provide a plan that set out how it will ensure it is providing an effective and well led service for people at the end of their life.

The report identifies a number of areas for improvement, including:

• The trust ensure there are enough staff in the emergency department.
• There must be a minimum of one registered children’s nurse on duty in the emergency department every shift.
• All staff must fully understand and comply with the duty of candour.
• Medicines and medical gases must be stored securely in the emergency department.
• The trust must train staff adequately to ensure the safety of children attending the emergency department.
• There must be a robust process for recording, reporting and monitoring mandatory training, including paediatric life support.

Inspectors also saw some areas of outstanding practice, including:

• Actions had been taken in the emergency department to improve infection prevention and control measures. These were supported by regular audits, which showed good compliance with trust policies.
• There had been a recent open day held by the maternity unit. This included stalls with information about smoking cessation, domestic violence, infant nutrition, perinatal mental health team, National Childbirth Trust, antenatal screening and the local Maternity Service Liaison Committee

Ends

For further information please contact CQC Regional Engagement Manager, John Scott on 07789 875809 or, for media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the duty press officer is unable to advise members of the public on health or social care matters). For general enquiries, please call 03000 61 61 61.