England’s Chief Inspector of Hospitals has recommended that the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust should remain in special measures following an inspection by the Care Quality Commission.
The trust, which was placed into special measures last year, is rated as Inadequate overall.
Between 5 March and 24 April 2019, a team of CQC inspectors visited the trust and found that insufficient improvements had been made and a number of concerns remained.
It is rated as Inadequate for whether the trust’s services are safe, effective and well-led and it is rated as Requires Improvement for whether its services are caring and responsive. As a result of the inspection, CQC also took enforcement action placing urgent conditions on the trust’s registration.
The trust, which is in Norfolk, was initially rated as Inadequate and placed in to special measures following an inspection in April 2018.
CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said
“It was extremely concerning to find little evidence of improvement on our return to the Queen Elizabeth King’s Lynn Hospital NHS Foundation Trust. Improvements that needed to be made had not been made and the service fell short of what people should be able to expect.
“During our inspection we found a lack of processes and systems to ensure the effective oversight and governance of services. We found significant concerns and risks to patients within the urgent and emergency service, medicine, end of life care and gynaecology which were raised with the trust immediately. Many of these concerns had previously been identified at our inspection in 2018, yet necessary improvements had not been made.
“Our findings are such that I have recommended that the trust remains in special measures, and continues to receive the support from this, to ensure it improves its services and delivers safe care and treatment.
“It is vital that the trust board concentrates on what we have told them and does all it can to ensure swift and sustainable improvements are made. We will continue to liaise with NHS Improvement with regard to the trust and our inspectors will return in due course to carry out further inspections.”
The trust must make improvements in a number of areas, including:
- The trust must improve how the board functions and ensure there are formalised processes to develop and support current and new executive directors and non-executive directors.
- Processes must be in place for leaders, at all levels, to ensure a programme of clinical leadership and management training and development are in place to drive improvement.
- Divisional leadership must ensure it has the capacity to support significant improvements in the safety and quality of care and that inconsistencies across divisions are reduced.
- The trust must review, define and implement a corporate strategy aligned to clear strategic priorities.
- Requirements, recommendations and learning from regulators, external reviews and local audits must be used to identify action for improvement and be monitored and reviewed effectively.
- The trust must improve the culture, ownership and accountability of clinicians, at all levels across the organisation, to empower and effect change.
- An effective and consistent process for governance, quality improvement and risk management must be in place.
- Processes for incident reporting, investigation, action and learning must improve and become embedded across all services.
- Patients must be treated individually, with dignity and respect and be kept informed of and involved with plans for their care.
- The trust must ensure that risk assessments are undertaken for all patients presenting in the emergency department, including children, with mental health concerns and/or at risk of deliberate self-harm or suicide, and ensure that action is taken to mitigate the identified level of risk.
- The trust must ensure an effective system is in place for regular oversight of the waiting area for walk-in patients to ensure that patient needs are being met and patients at risk of deterioration are identified and escalated appropriately.
- An effective system must be implemented to ensure that there are sufficient numbers of suitably qualified, skilled and experienced clinical staff throughout the emergency department to support the care and treatment of patients.
- The trust must ensure that an effective system are in place within diagnostic imaging for the regular oversight and appropriate escalation of significant findings, including diagnostic imaging undertaken out of hours, to ensure any patients at risk are escalated appropriately.
Full details of the ratings, including a ratings grid, are given in the report published online at: www.cqc.org.uk/location/RCX70
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