The Care Quality Commission (CQC) has published a report following a focused inspection of the medical care services at Weston General Hospital in Weston-super-Mare.
In April 2020, Weston Area Health NHS Trust and University Hospitals Bristol NHS Foundation Trust merged to form University Hospitals Bristol and Weston NHS Foundation Trust, and the management of Weston General Hospital came under new management as a result.
CQC would normally carry out a comprehensive inspection of a hospital when it changes management and the ratings for all services would be reviewed. During the COVID-19 pandemic inspection activity has been mainly restricted to focused inspections in response to concerns raised.
On 11 March, CQC inspected the medical care services department at Weston General Hospital to look at how safe and well-led it was, in response to concerns raised about nursing and medical staffing. As this was a focused inspection, no ratings were given.
Amanda Williams, CQC’s head of hospital inspections, said:
“When we inspected the medical care services department at Weston General Hospital, we were mindful that the two trusts merged at the start of the COVID-19 pandemic which has impacted on the plan for integration of the hospitals.
“We found that staff were caring and focused on the needs of patients, but it was clear that the leadership team needs to make a number of sustainable improvements in order to ensure that the service operates effectively. We have now told the trust that it must send us an action plan outlining what steps they are going to take to address our concerns and make improvements. We will continue to monitor the service to ensure that these are implemented and fully embedded.”
Inspectors found the following areas of concern:
- Although the leaders at Weston hospital understood the priorities and issues that the medical care services department faced, they did not always manage them or demonstrate that they had the capacity to run the service. There was a perception that the trust’s senior leadership team was not present enough on the wards to understand the issues that staff were facing
- Governance processes were not used effectively to monitor the quality of care and assess ongoing performance, learning and development of the service
- The service did not have enough permanent medical staff at all levels to meet the recommended guidance. The majority of medical staff at senior level were employed on a locum basis. There was also a shortage of permanent nursing or therapy staff with the right qualifications, skills, training and experience to keep people safe from harm and provide the right care and treatment
- Because of the COVID-19 pandemic, patients were grouped together on wards according to their COVID-19 status (positive, awaiting test results, or negative), in accordance with national infection control guidance. This meant that wards were no longer based on their speciality (for example, cardiology, stroke, or care of the elderly). This had resulted in some confusion amongst staff when determining who had senior responsibility for patients in the wards, making it difficult to escalate concerns about a patient’s treatment
- Although comprehensive risk assessments were mostly completed for patients who needed them, the staff shortages meant there was a risk that patients who were deteriorating were not always recognised in a timely way. In addition, patients did not always have their assessed needs, preferences and choices met by staff with the right skills and knowledge to do so
- The service did not always manage patient incidents well, or deal with issues early enough to prevent them from becoming problems. Staff recognised most incidents, but they did not always report them, and lessons were not always shared
- Not all staff were aware of what the trust’s vision, values or strategy were and their role in achieving them. They did not always feel respected, supported and valued and did not feel that they had protection to speak out safely
However, there were a number of positive findings:
- Staff understood how to protect patients from abuse and acted on any concerns
- Staff understood how to manage infection prevention and control and all areas were visibly clean. Staff wore appropriate personal protective equipment (PPE) to keep themselves and others safe from cross infection
- Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, and available to all staff providing care. Patient records were managed securely
- Staff anticipated people’s needs and responded compassionately when people needed help. They also recognised the importance of people’s privacy and dignity
Full details of the inspection are given in the report published on our website.
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