The Chief Inspector of Hospitals has recommended that Norfolk and Norwich University Hospital NHS Foundation Trust should remain in special measures so it can continue to receive the support it needs to make further improvements.
Between 22 January and 27 February 2019, a team of CQC inspectors visited the trust and looked at seven core services, Cromer Hospital and carried out an inspection of whether the trust is well-led.
The inspection found evidence of improvements at the trust and, where the trust was previously rated as Inadequate overall, it is now rated Requires Improvement overall.
All CQC’s comprehensive inspections of NHS trusts now include inspection of the well-led key question, as there is a strong link between the quality of overall management of a trust and the quality of its services. The trust is now rated as Requires Improvement for whether its services are well-led; previously it was rated as Inadequate.
The trust’s rating for whether the trust is safe has improved from Inadequate to Requires Improvement. Its overall rating for whether services effective and responsive remain the same, Requires Improvement, and its rating for whether services are caring is also unchanged at Good.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“On our return to Norfolk and Norwich University NHS Foundation Trust we found improvements at the trust, but it was clear there was still work to be done to ensure people can consistently receive the care they should be able to expect.
“While we found improvements in medical care, surgery and critical care, targets for mandatory training in medical care were not being met and governance process were not embedded. This meant there were inconsistences in how risks were reviewed. In urgent and emergency care there were issues regarding culture, leadership and the management of patient flow through the emergency department and staff recognising and responding to patient risks.
“We served a warning to the trust under section 29A of The Health and Social Care Act 2008 as a result of the ongoing concerns in urgent and emergency care.
“I am recommending the trust remains in special measures, so that it can continue to receive the support it needs to make further improvements and ensure any changes can be maintained and sustained.
“We will continue to monitor the trust and check on its progress. This will include further inspections.”
There are a number of areas where the trust must make improvements, including:
- The trust must ensure the process for governance and oversight of risk, and quality improvement, continue to be embedded and become consistent across the organisation.
- Local audit findings must be used to identify actions for improvement and be monitored, and reviewed.
- The trust must continue to take definitive steps to improve the culture, openness and transparency throughout the organisation and reduce inconsistencies in culture and leadership.
- The assessment and quality of care delivered to patients with mental health concerns must continue to improve.
- All staff must complete mandatory training and the appropriate level of safeguarding adults and children training.
- An adequate number of staff must be available on each shift to safely care for patients.
- In urgent and emergency services the trust must ensure staff respond appropriately to changing risks to patients who use the services.
- The trust must ensure patients in urgent and emergency care access services to receive the right care at the right time and, that during times of high demand, access to care is managed by staff to consider patients with urgent needs.
- Medication must be stored in line with trust policy and staff must record medication refrigeration temperatures to ensure its safe storage.
- Emergency equipment checks must be performed consistently.
- The trust must ensure that children and young people having their surgeries cancelled are rebooked in a timely manner.
- The trust must improve its governance and assurance processes so that recurring safety issues are not left unresolved.
Inspectors found a number of areas of outstanding practice at the trust, including:
- The surgical division had maximised the use of the urology robot for major urological cancer resection, and have demonstrated improvements in outcomes and in reductions in length of stay.
- The trust was the first in East Anglia to carry out robotic colorectal cancer surgery. A consultant surgeon was the first surgeon in Norfolk to be certified by the European Academy of Robotic Colorectal Surgery (EARCS).
- Within critical care a new one hour target had been introduced in aim of admitting patients in one hour from consultant intensivist authorisation opposed to the national four hour target. An audit was being carried to determine compliance with this target.
- Within critical care there was strong emphasis on the safety and well-being of staff. Staff told us that there were staff running groups and regular activities arranged for the team.
- A team of senior medical staff called the “fatigue team” supported doctors in reducing fatigue levels due to work. Doctors told us that they were encouraged to take their break by consultants and had to report when this did not happen.
Full details of the ratings, including a ratings grid, are given in the report published online at: www.cqc.org.uk/location/RM102
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