The Care Quality Commission (CQC) has rated the quality of services provided by Weston Area Health NHS Trust as Requires Improvement overall, following an inspection in February and March 2019.
While the overall quality rating for Weston Hospital remains unchanged, inspectors noted clear progress in some areas since its previous inspection. But the inspection also raised immediate concerns with the quality of some children’s mental health services.
Overall the trust is now rated as Good for being caring and effective, Requires Improvement for being safe, responsive and well-led.
Inspectors visited the trust to check the quality of four core services: urgent and emergency services, medical care, surgery, and child and adolescent mental health services. CQC also looked specifically at management and leadership to answer the key question: Is the trust well-led?
CQC has also published the trust’s Use of Resources (UoR) report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Inadequate for using its resources productively. The combined rating for the trust, taking into account CQC’s inspection for the quality of services and NHSI’s assessment of Use of Resources, is Requires Improvement.
You can read the latest reports in full here: www.cqc.org.uk/provider/RA3 , once the report has been published on the CQC website.
Dr Nigel Acheson, CQC’s Deputy Chief Inspector of Hospitals, said:
“It is well known that Weston Area Health has faced its challenges over recent years and I am aware that staff have worked hard to overcome these. The ongoing uncertainty over the trust’s direction continues to overshadow the day to day business of the hospital.
"While I am encouraged that the trust has made progress to address our concerns from our inspection in 2015 there is still a lot more to do. At the time of our inspection we made it clear that the risks created by the lack of staffing and the issues within the child and adolescent mental health services do need to be addressed quickly.
“The leadership team know what they needed to do to address the challenges that face them and there are a number of competing priorities for the team. This means that capacity to address all the challenges adequately is a concern but still these issues do need to be addressed.
“Despite the capacity issues on the leadership team, the trust has played a valuable and significant role in the Healthy Weston programme, which is a system review of health services in North Somerset
“We will continue to check the trust’s performance and will return to report on further improvements in due course.”
Inspectors found that In urgent and emergency care, patients could not always access care and treatment when they needed it and in the right setting. Staff did not always assess and respond to patient risk or monitor their safety. There was still a lack of staff with the right qualifications and experience to keep people safe. There was a lack of stable leadership team which in turn generated a culture where some staff did not feel supported. But, staff cared for patients with compassion and provided emotional support when they were distressed.
Within medical care, inspectors found that significant improvements had taken place since previous inspection. However, inspectors found that staff were not always following best practice when dealing with medicines. Patients were not always receiving the right medication at the right dose at the right time. There were not always enough staff to keep people safe from harm or to provide the right care and treatment. Patients who needed side rooms did not always receive the level of monitoring by nursing staff that was required or recommended. The service did take steps to control infection risks well most of the time. Staff kept equipment and the premises clean. Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. Staff collected safety information and shared it with staff, patients and visitors. Managers used this information to improve the service.
The child and adolescent mental health services dropped from Outstanding to Inadequate.
The staff had not assessed the ligature risks of the environment. There were no plans in place by staff of how to manage risks which were posed by the environment to young people who received care at the sites. Staff did not always feel able to protect young people from avoidable harm because there was not enough of them to meet the demand on the service. There was a high staff turnover rate and staff had felt the impact of this on their workload. The service had received an increase in referrals that was putting strain on its ability to see young people quickly.
Surgery services were rated Good and inspectors found the team-controlled infection risk well with systems in place to check and maintain standards of cleanliness and hygiene. The service was found to be managing patient safety incidents well. Junior doctors did tell inspectors that they did not always feel confident that the processes to support some patients overnight and at weekends was effective.
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