The Care Quality Commission has published a report on services provided by Gloucestershire Hospitals NHS Foundation Trust at Cheltenham and Gloucester Royal hospitals.
The report follows an inspection in January 2017 to follow up areas for improvement identified at the trust’s previous inspection in March 2015. As such, not all core services or all domains were inspected in all core services provided by the organisation. In view of that, CQC has not changed the overall rating of the trust following this focused inspection - which remains Requires Improvement.
At Gloucester Royal Hospital :
There were concerns about patient safety, particularly when the emergency department was crowded. Lack of patient flow within the hospital and in the wider community created a bottle neck in the emergency department, creating pressures in terms of space and staff capacity. This in turn increased the risk that patients may not be promptly assessed, diagnosed and treated.
Crowding was compounded by an acute shortage of staff and there were particular concerns raised by medical and nursing staff about medical cover at night. Consultants regularly worked longer hours to support their junior colleagues and there were questions asked whether this could be sustained. However, care was delivered in a coordinated and multidisciplinary way.
Medicines were not always managed correctly. Fridge temperatures were not always monitored or actions taken where these fell out of normal range.
Patients and their families were involved as partners in their care. They said they were kept well informed about their care and treatment. Inspectors heard doctors and nurses explaining care and treatment in a sensitive and unhurried manner.
Services within specialist palliative and end of life care had been continuously improved and sustainability supported since the last inspection
There was evidence that complaints were used to drive improvement.
At Cheltenham General Hospital:
There was an openness and transparency about incident reporting and incidents were viewed as a learning opportunity. Staff felt confident in raising concerns and reporting incidents.
Nursing and medical staff received regular teaching and clinical supervision within the emergency department. Staff were encouraged and supported to develop areas of interest in order to develop professionally and progress in their careers.
There was a new strong, cohesive and well informed leadership team within the urgent and emergency care service, who were highly visible and respected. This enhanced the cooperative and supportive relationships among staff. Inspectors observed exceptional teamwork, particularly when a department was under pressure. Staff felt respected, valued and supported. Morale was mostly positive, although to an extent, undermined by workload pressures. There was a detailed improvement plan in place with clear milestones and accountability for actions.
CQC did not visit the Stroud Maternity Hospital or Tewkesbury Hospital sites at this visit but reviewed information provided by the trust.
Since the last inspection, the trust had worked to address the majority of the concerns that had been raised. However, there were also areas of poor practice where the trust still needs to make improvements.
At Gloucester Royal Hospital- the trust must:
- Ensure the emergency department is consistently staffed to planned levels to deliver safe, effective and responsive care.
- Ensure patients arriving in the emergency department receive a prompt face-to-face assessment by a suitably qualified clinician.
- Ensure the safe management of medicines at all times, including storage, use and disposal and the checking and signed for controlled drugs.
At Cheltenham General Hospital - the trust must:
- Ensure that a suitable space is identified for the assessment and observation of patients presenting at the emergency department with mental health problems.
- Ensure that patients arriving in the emergency department receive a prompt face-to-face assessment by a suitably qualified clinician
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“It is clear that Gloucestershire Hospitals NHS Foundation Trust are trying to drive forward improvements. The new leadership has encouraged an open culture and we found the majority of staff feel engaged with this process."
“Staff that we met felt that the current financial deficit and difficulties with the newly implemented computer system are being addressed openly - as demonstrated to inspectors by the trust’s actions since the concerns with the system became apparent. "The trust has given assurances that the findings from the external report into the financial issues will be made public in the near future."
“However it is apparent that while many services are managed well across both sites, there remains a divide in culture between the hospitals. Staff seemed to identify with the culture of their particular hospital rather than the trust as a whole. However, staff worked consistently with the trust and divisional policies and procedures regardless of where they worked and there was no evidence of any impact on the quality and safety of care."
“We will continue to monitor the trust closely and return to check on their progress in due course. While there is still some concern regarding the trust’s urgent and emergency services and medicine, I hope that we will be able to report further improvement at our next inspection.”
Ends
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