Series of breaches at Scarborough and North East Yorkshire Healthcare NHS Trust a “serious concern”, says CQC

7 October 2010

The Care Quality Commission (CQC) today said it had identified a series of breaches of safety and quality standards at Scarborough and North East Yorkshire Healthcare NHS Trust. It ordered the trust to take immediate action, warning that it could face enforcement action if swift improvements are not made.

CQC said there was no evidence of harm to patients as a result of the breaches. However, the high number of breaches presented a serious concern and the risks to patients are higher than in other trusts that comply with the standards.

CQC today published two reports, which detail a range of concerns at the trust. These include concerns about staffing levels, buildings and maintenance, patient records, safeguarding arrangements and systems for assessing and monitoring service quality.

At Scarborough Hospital CQC inspectors found the trust was fully compliant with only one of the 16 essential standards of quality and safety. Of the 16 standards we had a major concern in respect of 5.
At Bridlington Hospital inspectors found the trust was fully compliant with six of the 16 standards. We had a major concern in respect of one of the standards.
Today’s reports follow four days of inspections in July this year. Inspectors visited both hospitals, speaking to patients, carers and staff, and looking in detail at the care experienced by a number of people. CQC presented its immediate concerns to the trust after the inspections.

The regulator has now given the trust 14 days to produce its plans to show how it intends to achieve compliance. Inspectors will return to the trust unannounced to check whether the necessary improvements have been made and to decide whether it needs to initiate formal enforcement action.

Jo Dent, Regional Director of CQC for Yorkshire and Humber, met with the Scarborough and North East Yorkshire Healthcare NHS Trust last week to discuss the regulator’s concerns.

Ms Dent said: “No hospital will ever be risk-free, but risks can be minimised by meeting these essential standards. We have no evidence of people being harmed as a result of the breaches at either Scarborough or Bridlington hospitals. But we want people to be aware that the risk of receiving poor care is greater in these hospitals because standards are not being met.

“When nurses don’t keep proper records on patients or when staff aren’t trained to protect vulnerable people from abuse the consequences can be serious. If staffing falls below safe levels, or if staff are stretched too thinly, then people cut corners and mistakes can be made.”

She added: “It is the responsibility of the trust to make sure improvements are made, that standards are met and that patients receive the safest possible care. In the meantime we will be monitoring the trust closely and will not hesitate to take action if standards don’t improve.”

At Scarborough Hospital, the most significant concerns included:

• Care and welfare of people who use services: Records which should have been kept by nurses to assess, plan and deliver care were incomplete in places, particularly on the medical wards.
• Safeguarding people from abuse: Most staff had not been trained in adult safeguarding. Inspectors found that the use of restraint, including bedrails, was not adequately assessed or documented. Guidance for staff was not finalised. Non-clinical risks to children using play areas did not appear to have been assessed.
• Safety and suitability of premises:Inspectors noted a backlog of maintenance work, and numerous general safety issues Including disabled access, trip hazards and poor signage. There was no process to report findings of any environmental risk assessments to the facilities directorate.
• Staffing: A shortage of junior doctors was due to be addressed during the summer. Inspectors noted that numbers of medical staff on duty did not match numbers required by staff rotas in some areas, such as the accident and emergency department. After 1am, only junior doctors were routinely available in the A and E department, although senior doctors were on call. On a number of occasions, numbers of nursing staff were lower than the levels deemed by the trust itself to be safe.
• Assessing and monitoring the quality of service provision: Records containing risk assessments and clinical audit findings were mostly poor. Inspectors found significant concerns about the effectiveness of monitoring arrangements and the trust’s ability to regularly assess and monitor the quality of services.

At Bridlington Hospital, the most significant concern related to:

• Safeguarding people who use services from abuse: Training in safeguarding vulnerable people is in place but most staff had not yet been trained. Inspectors found that the use of restraint, including bedrails, was not adequately assessed or documented. Guidance for staff was not finalised.

CQC said that, alongside the breaches, it did identify two areas of improvement. In April, when it introduced a new registration system, CQC registered the trust on two conditions, requiring it to:

• conduct a full risk assessment of its premises and put plans in place to make improvements to the environment.
• employ more medical records staff

CQC said the trust had addressed these two issues and it would lift the conditions. However, it warned that the trust faced tougher enforcement action if it did not address the series of concerns raised in today’s reports.

Ends

For further information contact David Fryer Regional Communications Manager on 07901 514220.

You can also contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.