England’s Chief Inspector of Hospitals has rated the services provided by Royal United Hospitals Bath NHS Foundation Trust as Requires Improvement following a comprehensive inspection by the Care Quality Commission.
A team of inspectors, which included a variety of specialists and experts by experience, inspected services provided by Royal United Hospitals Bath and Royal National Hospital for Rheumatic Diseases between 15 and 18 March 2016. The trust serves a population of around 500,000 across Bath, North East Somerset and Wiltshire.
CQC has rated the trust as Requires Improvement overall. It was rated as Good for being effective and well-led, Requires Improvement for being safe and responsive to people’s needs and rated Outstanding for being caring.
The full reports on the trust and on each hospital are available on this website.
Prof Edward Baker, Deputy Chief Inspector of Hospitals, said:
“Overall we have found the standard of caring to be Outstanding with patients being treated with kindness and compassion throughout the trust - but especially in services for children and young people and in end-of-life care where patients and their families were universally positive about the way they were treated by staff.
“There is a strong safety culture at the trust with a leadership at all levels which encourages openness and transparency about safety and promotes the delivery of high-quality person-centred care.
“However, there were periods where staffing and skill mix at the Royal United Hospital were not as planned by the trust, especially in the busiest times in the emergency department and on some medical wards. The flow of patients throughout the trust from admission to discharge was not efficient and there were long waiting times, delays and cancellations of routine operations within the trust. Patients sometimes stayed in hospital longer because ward teams were not able to arrange transfer to community hospitals or to easily accessible packages of social care in the community.
“The trust must continue to work in collaboration with partners and stakeholders in its catchment area to improve patient flow within the whole system, thereby taking pressure off the emergency department, reducing overcrowding and the length of time that patients spend in the department.”
CQC has identified a number of areas where the trust must make improvements, including:
- The trust must take steps to ensure that the emergency department is consistently staffed to planned levels to deliver safe, effective and responsive care.
- The trust must take steps to ensure that patients in the emergency department receive prompt and regular observations and that early warning scores are calculated, recorded and acted upon.
- The trust must ensure staff in the emergency department adhere to safe systems to ensure resuscitation equipment and medicines are safely stored.
- The trust must ensure there are specialist bereavement staff and there is an appropriate environment to effectively provide care and support for bereaved gynaecology and maternity patients and their families.
- The trust must ensure the access and flow of patients in the rest of the hospital reduces delays from critical care for patients admitted to wards. Reduce the number of patient discharges at night.
CQC also identified a number of areas of outstanding practice including:
- The emergency department had developed guidelines on the management of patients during periods of high demand and when flow out of the department is limited. The guidelines aimed to reduce patient safety risks associated with overcrowding by minimising the number of ambulance-borne patients with undifferentiated diagnosis waiting in the corridor for assessment. The document also describes measures to maintain patient comfort and dignity of patients queuing in the corridor.
- Inspectors observed and heard from patients and relatives numerous examples of outstanding, compassionate care provided by nursing, medical and cleaning staff for patients at the end of their lives.
- The orthopaedic and fracture clinic had a sensory box that could be used for patients with dementia, a learning disability and children. The box had a range of sensory objects as well as appropriate picture books. Staff told us they use the box regularly as part of distraction therapy.
- The Royal National Hospital for Rheumatic Disease was a centre of excellence for lupus care and treatment.
- Staff worked well as a multi-disciplinary team throughout the hospital. Inspectors saw outstanding team working during a multi-disciplinary team meeting we attended. The patient was at the centre of the meeting, with all professionals striving to promote the health and wellbeing of the patient.
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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