Improvements made at Basildon and Thurrock NHS Trust but more needed, says CQC

29 June 2010

The Care Quality Commission (CQC) announced today (Tuesday) that it has removed two of the five conditions that it placed on the registration of Basildon and Thurrock University Hospitals NHS Foundation Trust in April.

In relation to two conditions, the trust has made the necessary improvements within the deadlines set. Standards of care at Basildon Hospital have improved in some of the areas where the regulator flagged up serious concerns, including the A&E department. But CQC says there is still some way to go before it will remove the remaining conditions on the trust’s registration, which have deadlines of July and August.

All trusts must now be registered with CQC against new essential standards of quality and safety. Once registered, trusts are continuously monitored against the standards.

CQC has been working with the HSE and the foundation trust regulator, Monitor, to drive improvements at the trust since CQC identified serious problems last year.

CQC today published a report on a review it has carried out of the progress made by the trust. The review included a site visit at Basildon Hospital on 6 and 7 May 2010 in conjunction with the Health and Safety Executive (HSE). This involved direct observation of care, and interviews with people using the service and staff in A&E, medical assessment unit, maternity unit and surgical wards.

Following its visit to the hospital, CQC lifted the condition requiring the trust to carry out an assessment of need, including a risk assessment, and produce a care plan for all inpatients at the hospital. CQC found that assessments and care plans were in place for all the people whose care it looked at during its visit.

It has also lifted the condition requiring the trust to complete an action plan in response to the recommendations made by the Nursing and Midwifery Council following its report on maternity services at the trust. The trust has completed an action plan and CQC will continue to monitor progress in this area.

Frances Carey, CQC regional director, said: “When the trust applied for registration under the new system that came into operation for NHS trusts from 1 April, it was clear that services at Basildon Hospital were not meeting some of the essential standards of quality and safety required by law for the welfare of patients.

“We placed a total of five conditions on the trust’s registration, setting out what areas needed to be improved and giving timescales for this to be achieved.

"The objective of our review last month was to establish whether the trust has taken the action needed to meet the two conditions that had a deadline of the end of April. We also wanted to see what progress the trust is making towards meeting the three other conditions, which have longer timescales.

"Our assessors and clinical experts visited Basildon Hospital and spent most of their time observing practice and talking to patients and staff in the A&E department, medical admissions unit, maternity unit and surgical wards.

"They found that the trust has made great strides towards turning around what were serious shortcomings, and it deserves credit for doing so.

“But there is still lots for the trust to do. Our review found that, although there have been improvements in the A&E department, further improvements need to be made in the waiting area. Our inspectors had concerns about poor practice in the observation of acutely ill patients in the waiting area in A&E, and staff raised concerns about poor provision of training to deal with work-related violence and aggression.

“We will continue to monitor the trust’s progress, to make more unannounced visits if necessary, and to take any further action that we deem necessary to make sure the trust gets it right."

The conditions of registration

When assessing its application for registration in April, CQC imposed five conditions on the trust, saying it must take action to ensure that:

• all in-patients have an assessment of their needs, and that a care plan and risk assessment are prepared (to be completed by 30 April 2010 – this has been met);
• an action plan is in place to address concerns arising from the Nursing and Midwifery Council’s review of pre-registration nursing (adult) education and maternity services at the trust, published in March 2010 (by 30 April – this has been met);
• clinical staff are assessed and trained to implement National Institute for Clinical Excellence (NICE) guidance on the care of acutely ill patients in hospital (by 1 July 2010). The trust has taken steps to identify the clinical staff that require training in the care of acutely ill patients, and training is in progress
• systems for supervision and appraisal of staff are in place (by 1 July). A number of staff said they had had an appraisal, and supervision arrangements were in place for them. The trust needs to ensure this is in place for all staff.
• premises are safe from legionella infection by taking action set out by the Health and Safety Executive (by 2 August 2010).
• CQC will carry out another review in the near future to monitor the trust’s progress on the three remaining conditions with deadlines of 1 July and 2 August.

Background to issues at the trust

Problems in the A&E department were among the concerns that prompted CQC and Monitor to intervene at the trust in November last year, demanding immediate action be taken to protect patients. As well as issues around A&E, there were breaches of the infection control standards, high mortality rates, and worries about the quality of care for people with learning disabilities.

Infection prevention and control

CQC carried out a follow-up inspection in December and found that the trust had taken action and was meeting the minimum hygiene standards. But in January there were two cases of infection from legionellas, and the HSE served a notice requiring the trust to reduce the risk of legionellas. CQC reinforced this by making it a condition of registration.

Mortality rates

High mortality rates were among the issues that triggered concerns about the trust last year. Although mortality rates for emergency admissions are still relatively high, they appear to have improved this year. CQC says this shows the rates are moving in the right direction, but that it is still too early to judge whether this decrease reflects a sustained improvement. CQC continues to monitor mortality rates at the trust.

People with learning disabilities

CQC has been working with the HSE to monitor the trust’s progress on its care of people with learning disabilities. Following a site visit in December, CQC wrote to the trust with a series of recommendations to improve care for people with learning disabilities and requested an action plan detailing how these would be implemented. The site visit carried out on 6 and 7 May as part of CQC’s review showed that progress is being made, and the Commission will continue to monitor this.

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to Editors

In November 2009, as well as CQC’s own concerns about the quality of care at the trust, Monitor found the trust to be in significant breach of its terms of authorisation and intervened under Section 52 of the National Health Service Act 2006. The concerns raised by Monitor were around the governance arrangements within the trust to assess and monitor the quality of service provision. For more details see the Monitor website.

The Nursing and Midwifery Council (NMC) made 22 recommendations after carrying out a review of pre-registration nursing (adult) education and maternity services at the trust, published in March this year. As a result the trust submitted an action plan as evidence of its compliance with the relevant condition placed on its registration by CQC. The timeframe for completion is December 2010. More details can be found on the NMC website.

On 8 June this year the trust was fined £50,000 after a prosecution by the HSE over the death in 2006 of Kyle Flack, a severely disabled young man whose head became trapped in bedrails. More details can be found on the HSE website.