CQC warns Portsmouth Hospitals NHS Trust that it has failed to protect safety of patients

The Care Quality Commission has told Portsmouth Hospitals NHS Trust that it must make significant improvements to protect patients using medical care services at Queen Alexandra Hospital.

CQC has issued a Warning Notice requiring the trust to improve safety, patient consent, dignity and respect, safeguarding and overall leadership. At the same time CQC has placed six conditions on the trust's registration requiring specific action until the trust can demonstrate that patients are safe.

The enforcement action follows two separate inspections this year when inspectors identified a series of concerns about services for people requiring emergency medical care, particularly those affecting frail older people or patients living with dementia.

During the inspections in February and May, teams of inspectors visited the acute medical unit, 10 medical wards and five outlier and escalation areas including the discharge lounge, and day units for cardiac and renal patients.

The hospital's medical care has been rated as Inadequate; urgent and emergency care has been rated as requires improvement. Safety is rated Inadequate in both departments. A full report of the inspections is available on our website.

The Chief Inspector of Hospitals, Professor Ted Baker, said:

“At previous inspections we have found some very good services at this trust, but during our inspection in February 2017 - we found that the quality of care on the medical wards was poor - especially for the most vulnerable patients, whose needs were not being dealt with properly, and who were at risk of avoidable harm."

“Such was the level of our concern that we took enforcement action instructing the trust to implement improvements. We undertook a follow up inspection in May to look further into the wider culture, governance and leadership within the trust."

“It is a matter of concern that on this return inspection we found the trust had still not effectively got to grips with these issues. There was a distinct lack of management oversight. The board appeared to have no real understanding of what was happening on the wards: we concluded that the trust leaders were not giving sufficient attention to many of the concerns we identified or the concerns of their own staff."

“Portsmouth Hospitals has been under pressure for some time – too many beds are taken up by patients who are medically fit for discharge but unable to leave hospital until social care becomes available. This in turn creates further pressure on the wider healthcare system. All local system leaders must help resolve this issue."

“We have taken further action by placing specific conditions on the trust that demand clear progress over the coming months. The trust is required to send us weekly reports, and we have been working closely with NHS Improvement to ensure that the trust gets the support it obviously needs at the highest level."

“If the trust fails to meet these conditions, or if there is a continuing failure to provide services that are of sufficient quality, we will take further enforcement action to protect patients who depend on these services.”

Inspectors found that staff working in medical care services did not always recognise serious safeguarding concerns. Consent to care and treatment was not always obtained in line with the Mental Capacity Act (2005

Frail older patients and patients living with dementia did not have their needs appropriately assessed and risks for those patients were not properly dealt with.

Medicines management policies were not always followed, confidential information was not stored securely and staff did not always consistently follow infection control procedures.

Staff did not always respond to patients when they asked for assistance. On some occasions, the inspection team had to request that staff intervene to maintain patients’ safety. Patients who were deemed at risk of malnutrition were not assisted with their meals.

The trust did not always declare mixed sex breaches in line with current guidelines and patients were moved both during the day and night to help free up beds

Governance processes were not effective at identifying risks and improving the safety and quality of care and treatment. There was no clear or formal strategy to improve the urgent medical pathway, with no significant improvements since CQC's inspection in September 2016.

CQC has placed six conditions on the trust's registration:

• The trust must deploy enough suitably qualified and competent staff in the emergency decision unit in the emergency department to provide safe, good quality care to patients with mental health problems along with all other patients.
• The trust must ensure all patients presenting to the emergency department with mental health problems receive a full assessment of all risks assessment and corresponding risk management plan/care plan.
• The trust must identify, monitor and observe detained or high risk patients with mental health concerns or vulnerable safeguarding issues across the hospital and must have oversight of them at all times.
• The trust must ensure that there are clearly identified leads for mental health provision within the emergency department and acute medical unit at all management levels.
• The trust must ensure that Deprivation of Liberty Safeguards are applied as per the requirements of Mental Capacity Act, 2005, prior to depriving a person of their liberty.
• The trust must immediately take action to ensure patients are safe. As a minimum, deploying sufficient, suitably qualified and competent staff and completing robust risk assessments, plans and delivering the identified care and treatment for patients presenting with mental health issues.

The conditions will remain on the registered provider’s registration until it can demonstrate that the risk to patients has been removed and there is no longer any reasonable cause to believe that patients may be exposed to the risk of harm.

Ends

For further information please contact CQC Regional Engagement Officer Kerri James by email kerri.james@cqc.org.uk or by phone on 07464 92 9966. 

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