The Care Quality Commission (CQC) has told leaders at Sheffield Teaching Hospitals NHS Foundation Trust that they must make significant improvements following an inspection in October and November.
CQC carried out an unannounced inspection at the trust prompted by concerns received about the quality and safety of services.
In October, inspectors looked at:
- urgent and emergency care, medicine and surgery at the Northern General Hospital
- medicine and surgery at the Royal Hallamshire Hospital
- maternity services in the Jessop Wing Maternity Hospital.
A further follow up inspection of these services was also carried out in November.
An inspection of the community health services for adults at Beech Hill was also carried out in October, as well as an inspection of the well-led domain in November of the trust overall.
As a result of this inspection, the trust’s overall rating has dropped from good to requires improvement. The ratings for being caring and effective have also dropped from good to requires improvement. The safe key question has gone from good to inadequate, and the trust has dropped from outstanding to requires improvement for being responsive.
Maternity services at the Jessop Wing has not changed since our last inspection in March 2021 and remains rated as inadequate overall.
Due to the issues found during this inspection, the trust was issued with a letter of intent and a warning notice requiring them to take action to ensure significant improvements are made to improve the quality and safety of care provided.
Ann Ford, CQC’s deputy chief inspector for the north, said:
“This recent inspection of Sheffield Teaching Hospitals NHS Foundation Trust found deterioration in the quality of services provided by the trust, with some patients not receiving the standard of care expected.
“I recognise the enormous pressure NHS services are under across the country, especially in urgent and emergency care, however it’s vital that senior leaders are visible and have good oversight to manage and mitigate risks to ensure patients receive high quality and safe care. It was concerning that the leadership team didn’t always have oversight and weren’t always managing the risks effectively.
“It was most disappointing that several areas which we have identified in the last 12 months as needing urgent improvement, had still not been fully addressed. Some of the issues we identified around mental health and mental capacity assessments, falls, deteriorating patients and pressure ulcers were known to senior leaders and the board, however we were concerned about the lack of timely action taken and the monitoring of these actions to ensure they reduced the risks to patients.
“Our inspectors found deterioration, as well as safety concerns in maternity. Staffing issues and delays in induction of labour were putting women at risk of harm. There had been a lack of timeliness in addressing some of the concerns identified at our previous inspection.
“It was evident that some staff were being demoralised when raising concerns to improve patient care, and managerial action was not always taken. A number of staff told us they had stopped reporting incidents and when they did, the trust response was slow and untimely so reduced opportunities for timely intervention. Senior leaders must do more to support staff and create a no blame culture of reporting, learning and continuous improvement as well as a culture of openness and transparency. This must be addressed as a matter of urgency.
“Inspectors also escalated concerns about the care of some patients we observed during the inspection. The failure to provide safe and appropriate care to patients with mental health needs had resulted in incidents of avoidable harm. We found some patients in both medical and surgical services were not receiving care to meet their needs, so we asked staff to review immediately. We later discovered the reviews hadn’t been carried out as requested. These issues meant for some people they were not having their health needs met by staff in a caring and compassionate way or they didn’t receive safe care appropriate to their needs.
“We were however pleased to hear that most staff were proud to work for the trust and overall had a commitment to providing good care and positive experiences for patients, often under demanding and challenging circumstances.
“Following this inspection, we wrote to the trust requesting they take immediate action to improve the quality and safety of services, and the trust has provided an action plan to address our urgent concerns. However, the trust will need significant support to address these concerns to improve the quality and safety of services so I am pleased that NHS England and NHS Improvement will be providing appropriate support to the trust. We will continue to monitor the trust closely and will return to check on its progress.”
CQC inspection teams found:
- The trust did not always have enough staff, with the training in key skills to care for patients and keep them safe
- Staff did not always assess every risk to patients, and care records were not always up to date. Staff did not always manage medicines well
- The trust did not always respond to safety incidents in a timely way to reduce potential risk to patients
- During the inspection there were some instances when pain relief was not always given on time. Staff did not always support patients to make decisions about their care and access to information was not always easy
- In some instances, patient’s privacy and dignity was not protected. Staff did not always help patients to understand their conditions. Staff did not always provide emotional support to patients to minimise their distress
- The trust did not always plan care to meet the needs of local people, which, took account of patients’ individual needs, and made it easy for people to give feedback
- People could not always access services when they needed it and experienced long waits for treatment.
However:
- Staff understood how to protect patients from abuse
- The service-controlled infection risk well
- The trust had enough medical staff to care for patients and keep them safe. Staff worked well together for the benefit of patients and advised them on how to lead healthier lives
- Staff treated patients with compassion and kindness
- Local leaders ran services using information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff were committed to improving services.
Full details of the inspection are given in the report published on our website.
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