The Care Quality Commission (CQC) has rated the services provided by South Tees Hospitals NHS Foundation Trust as Requires Improvement overall following inspections in January and February 2019. Previously it was rated Good.
The trust was rated as Requires Improvement for being safe, effective and well-led, and Good for being caring and responsive.
A team of CQC inspectors visited the trust on 15 to 17 January and 5 to 7 February 2019 to assess four core services across James Cook University Hospital and Friarage Hospital: urgent and emergency, medical care, surgery and diagnostic imaging - which was inspected for the first time as a separate service.
They also looked specifically at management and leadership to answer the key question: Is the trust well-led? During this part of the inspection concerns about critical care services were identified prompting an unannounced inspection of the service on 21 to 23 February 2019. Critical care in both hospitals was rated Inadequate for are services safe? and Requires Improvement overall.
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 Requires Improvement 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.
Full details of the ratings, including ratings for each individual service are given in the report published online at: www.cqc.org.uk/provider/RTR
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“We saw a lot of good practice across the services we visited. Patients felt involved in their care and staff were kind and compassionate.
“However, it was clear that since the last inspection the trust has not sustained all of the improvements they made previously. During our visit we identified the need for further inspection and found additional concerns in the critical care services and leadership.
“These improvements need to be revisited and action taken quickly, we will be monitoring the trust’s performance and return to inspect again in due course.”
Whilst leaders were aware of some of the risks, issues and challenges they were not always acted upon in an effective or timely manner. Some staff voiced concerns that the leadership created a top down and directive culture, staff morale throughout the services was mixed and staff engagement was poor.
The well-led review prompted an inspection of the critical care services. Inspectors found a lack of assurance that nurse staffing levels were appropriate to safely care for patients. Inspectors identified several concerns with infection control, pressure care management and capacity challenges – harm had occurred to patients from three serious incidents because critical care beds were not available. Staff were not reporting staffing shortages and their impact, and infection control breaches were due to the service not being able to isolate patients with an infection. Following the inspection CQC wrote formally to the trust to ensure it took immediate action to protect patients. The trust continues to send weekly information to CQC to provide assurance that staffing levels are safe.
However, inspectors did see staff in the critical care service treating people with kindness and compassion. Feedback from patients inspectors could talk with about their care was consistently positive.
Whilst some concerns were identified in urgent and emergency services and medical care, the care being provided in these services and surgery was good. The trust was frequently meeting or exceeding national performance standards in urgent and emergency care. Patient flow through the urgent and emergency care service was effective and the leadership was stable, staff felt well supported. Previous concerns in medical care had been addressed, refurbishment was continuing and issues with emergency call systems were resolved.
The overall ratings for James Cook University Hospital and Friarage Hospital went down to Requires Improvement.
Ends
For media enquiries, contact David Fryer, Regional Engagement Manager on 07754 438750 or david.fryer@cqc.org.uk or Regional Engagement Officer Mark Humphreys mark.humphreys@cqc.org.uk 01912011675
Please note: the press office is unable to advise members of the public on health or social care matters.
For general enquiries, please call 03000 61 61 61.