Inspectors note progress as Bradford Teaching Hospitals NHS Foundation Trust is rated Requires Improvement

England's Chief Inspector of Hospitals has told Bradford Teaching Hospitals NHS Foundation Trust that it must continue to make improvements to services following an inspection by the Care Quality Commission.

Overall Bradford Teaching Hospitals NHS Foundation Trust has again been rated as Requires Improvement. The trust was rated as Requires Improvement for safety, responsiveness and well led and rated as Good for effectiveness and caring.

Full reports including ratings for all the trust’s core services are available at: www.cqc.org.uk/provider/RAE

Bradford Royal Infirmary and St Luke’s Hospital, Bradford were individually rated as Requires Improvement, with the in-patient community services rated as Good. A team of inspectors including specialist advisors visited the trust from January 11 to 13 and a subsequent unannounced visit took place on 26 January 2016.

The main findings included:

• There had been improvements since the last comprehensive inspection in October 2014, when the trust had also been rated Requires Improvement overall. Particular improvements included work which had taken place to address issues within the outpatients’ services, which was starting to have a positive effect. Overall ratings for urgent and emergency services, medicine and surgery were un-changed .
• Inspectors noted that changes had taken place in leadership across all levels, including the executive team and throughout various management posts.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Since our last inspection in 2014, we have found some real improvements in some of the core services - notably in critical care services and outpatients and diagnostic and imaging. Changes across outpatient services included a strengthening of governance arrangements and the introduction of improved training and development, which has been having a positive impact.

“At the previous inspection, concerns were raised about the out of hours medical cover at St Luke’s Hospital and the management of the deteriorating patient. At this inspection CQC found that all staff had a good understanding of the arrangements for medical cover out of hours. The trust had also commissioned an external review of medical staffing at St Luke’s and had concluded the medical cover was adequate for the service.

“Inspectors noted that the out of hour’s medical cover at St Luke’s had improved. During the 2014 inspection, CQC had raised this as a concern. At this inspection CQC found that was much better organised. An external review had found that adequate cover was now in place at all times.

“Generally, we found staff were now aware of incident reporting and their responsibilities under the Duty of Candour and the Mental Capacity Act.

“However there remain areas where further work is needed. A lot of patients are waiting too long for treatment after their initial referral. While there have been some changes in staffing levels, there are some areas where staffing was overstretched.

“This report shows that the trust is heading in the right direction. There is a lot to look forward, to – the introduction of new models of care, the further integration of services and the opening of the new hospital wing in November, all of which I hope will bring real benefits to patients in the near future.”

Inspectors found a number of areas for improvement, including:

• The trust must ensure that infection prevention and control procedures are followed in relation to hand hygiene, the use of personal protective equipment and the cleaning of equipment.
• The trust must review and risk assess the environment on some wards and put in place actions to mitigate the risk of the spread of infection.
• Referral to treatment waiting times must be reduced.
• There must be enough skilled, qualified and experience staff at all times, taking into account patients’ dependency levels.

There were a number of areas where inspectors identified outstanding practice including:

• The trust was collaborating with another local trust to work towards recruiting and retaining a workforce that reflected the 35% black, Asian and minority ethnic (BAME) population in the Bradford area. Between June 2014 and September 2015, the trust had improved the BAME representation on the trust board of directors to 29%.
• The trust was involved in the ‘Well North’ programme, which was a collaborative programme aimed at improving the health of some of the poorest communities in the most deprived areas in the north of England.

The Care Quality Commission will present its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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