University Hospital of South Manchester NHS Foundation Trust is rated Requires Improvement by CQC

England's Chief Inspector of Hospitals has told University Hospital of South Manchester (UHSM) NHS Foundation Trust that it must make improvements to services following an inspection by the Care Quality Commission.

Overall UHSM 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/RM2

Wythenshawe hospital was individually rated as Requires Improvement, and Withington hospital as Good. Community services within the trust were rated overall as Requires Improvement.

A team of inspectors including specialist advisors visited the trust from 26 to 29 January 2016.

The main findings included:

• Some community nursing staff had been redeployed following changes within community services. However, CQC were not assured that the redeployed staff had the right competencies to fulfil their new role.
• There was a new executive team in place, led by an interim chief executive. It was clear the team was in a transitional phase however inspectors did find they were positive about the services they provided and were found to be caring and compassionate.
• Cleanliness and infection control were good. Staff demonstrated good infection control and inspectors could see locations were clean. The rate of cases of Clostridium Difficile was within the expected range.

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

“The University Hospital of South Manchester (UHSM) NHS Foundation Trust faces a number of challenges. In recent months there have been a number of significant senior executive changes which had affected the long term strategy and staff morale.

“The trust acknowledged that it had lost clarity regarding its strategic direction. Actions were being taken to refocus the strategic approach against the reconfiguration of health and social care services in Manchester.

“We found that nurse vacancies were high and we were concerned at the recent increase in sickness levels amongst the nursing staff. More positively, among the doctors, the skill mix showed the proportion of consultants and junior grades was higher than the England average. There was a positive culture amongst all grades of medical staff who felt supported by managers and their seniors.

“Although we found some improvements in urgent care services, such as in the treatment of patients with sepsis, we were less assured about the work done to follow up audits of services in other areas such as care for children suffering fits, or mental healthcare. Action plans did not always acknowledge requirements to improve or include deadlines for implementing changes and senior medical staff were not always aware of areas requiring improvement.

“The University Hospital of South Manchester NHS Foundation Trust know the areas where they need to focus on. The inspection did find some excellent practice and I congratulate them. I am hopeful that the new executive board will translate their vision and strategy into real improvement by the time of our next inspection.”

Inspectors found a number of areas for improvement, including:

• The trust must ensure that equipment checks in resuscitation areas at Wythenshawe Hospital Urgent and Emergency Care are completed daily and followed up when needed
• In medicine, the trust must ensure that staffing levels are appropriate to meet the needs of patients across the medical services and ensure there is an appropriate skill mix on each shift
• The trust must remove the risk of ligature from ceiling vents in the mental health room, in line with guidance from the Royal College of Emergency Medicine

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

• The bereavement midwife at Wythenshawe Hospital had been nominated for the national Butterfly awards for her work providing bereavement support
• A rapid access clinic had been introduced for menstrual disorders and post-menopausal bleeding to meet demand and allow for the development of innovative out-patient treatments
• In Children's services, the cystic fibrosis team won the first National Cystic Fibrosis Registry Quality Improvement Award in recognition for their innovative use of a database which provides focussed and early intervention to prevent further deterioration in a patient’s condition

The Care Quality Commission has presented 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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