England’s Chief Inspector of Hospitals has welcomed improvements at Royal Cornwall Hospitals NHS Trust but says more work is needed following an inspection by the Care Quality Commission.
A team of inspectors from CQC visited Royal Cornwall Hospitals NHS Trust during September 2018 to check the quality of 10 core services: urgent and emergency care, maternity services, outpatient services, sexual health, medicine, surgery, critical care, diagnostic services, end of life and children and young people’s services. CQC also looked specifically at management and leadership to answer the key question: Is the trust well-led?
The trust is now rated as Requires Improvement overall for the quality of its services. The trust is rated Good for being caring, Requires Improvement for being safe, effective, and responsive to people’s needs and Inadequate for being well-led. The trust had previously been rated Inadequate following inspections in 2016 and 2017.
CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Requires Improvement for using its resources productively.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“The Royal Cornwall Hospitals has had a challenging recent history – so I am pleased to report that the trust is making progress in improving the quality of its services, albeit with further work to be done.
“At our earlier inspection in June 2018 we found real improvements in specific areas, and this wider inspection has now found further significant progress, including diagnostic imaging services which we rated Outstanding.
“However, many of the executive team are newly in place, and some of their changes will take time to take effect.
“We did find some remaining concerns during the inspection and while we are aware the trust is addressing these I am recommending the trust should remain in special measures for a further period. We will continue to monitor the service closely and return in the future to check on progress.”
Inspectors found the emergency department at the Royal Cornwall Hospital was frequently crowded and the layout did not always keep patients safe from harm. Patients were not always assessed within the 15 minutes target and processes to monitor patients were not always followed. The systems in place to assess and manage individual patient risk were not always being followed and records were not kept in a way which kept patients safe. However, learning was being identified when things went wrong and there were sufficient levels of nursing and medical staff to ensure patient safety and medicines were well managed.
At St Michael’s Hospital, Hayle, inspectors found within the medicines team, incidents were reported, investigated and lessons shared with the team and wider service. Medicines were managed, stored and administered safely. Patients were protected from abuse and avoidable harm. Infection control risks were managed but patient records were not always appropriately maintained.
In surgery, audits were used to review and monitor how effective care and treatment was and how they rated against the national benchmark. Teams were working together to ensure excellent treatment for patients. Inspectors found staff were providing treatment for patients that was caring and respectful.
The board was a relatively new formation with several interim positions and executive directors in their first posts. While the new board appeared to be working well together, inspectors found there was still a risk to the stability of the group with an interim Chief Executive and an acting Chair.
The leadership structures below the board needed strengthening. Local leadership teams varied across the trust with too many staff layers between the ward and board, although a new structure was being introduced at the time of the inspection.
Full reports and ratings for the core services are available at: www.cqc.org.uk/provider/REF
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