Chief Inspector of Hospitals publishes his findings on Musgrove Park Hospital, Taunton

21 November 2013

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by Taunton and Somerset NHS Foundation Trust at Musgrove Park Hospital.

The trust was one of the first to be inspected under radical changes which have been introduced by the Care Quality Commission providing a much more detailed picture of care in hospitals than ever before.

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts spent two days at Musgrove Park Hospital during September. They examined the care provided in accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients. Inspectors also visited the hospital unannounced on three occasions.

The report which CQC publishes today is based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

Overall the report concludes that Musgrove Park Hospital is providing patients with safe and effective care. But the hospital is dealing with a high number of patients and the quality of care and the effectiveness of treatment was affected at busy times. Some patients were experiencing long waits for surgery and outpatient appointments.

The majority of patients said that the staff were caring and kind. Some people identified areas where treatment, the attitude of some staff and communication needed to improve.

The trust had areas of outstanding practice, including its staff and the support they received, the speed of treatment given to heart patients, and the care given to patients with cancer and children with life-limiting illnesses.

The inspection team found areas of good practice which included:

• Patients said that staff were caring, helpful and compassionate and that they were treated with dignity and respect.
• There was good multi-disciplinary coordinated care in children’s day surgery and neonatal care and for stroke patients.
• Sedgemoor Ward which has been specially designed to enhance the hospital experience for older people, and especially for people who have dementia.
• The Beacon Centre for cancer care which has won a number of awards for providing high quality patient-centred care.
• COMPASS, a specialist multi-disciplinary team that supports families as they cope with the emotional and physical effects of living with a child with a serious, life-limiting illness.
• The monthly one-hour sessions for all trust staff (called Schwarz rounds) to look at emotional and social dilemmas that arise when caring for patients.
• The trust's call to treatment times for emergency intervention following a heart attack, which are among the best in the country.
• A national survey by the Intensive Care National Audit &Research Centre highlighted the work carried out by the intensive care unit, with figures demonstrating that fewer people died in ITU compared to other hospitals.

CQC has told the trust it must take action to improve in the following areas:

• Ensuring that there are sufficient senior doctors present at night and at the weekend.
• Reducing the number of patients transferred to the wrong specialist ward and improving patient discharge to alleviate service pressures.
• Ensuring that staff have appropriate training to deliver care and treatment safely and to an appropriate standard.
• Ensuring that patient records are appropriately maintained and available, including Do Not Attempt Resuscitation forms.
• Ensuring that equipment is appropriately maintained and is available for use.
• Improving leadership of the maternity unit.

The Chief Inspector, Professor Sir Mike Richards said: "Whenever we inspect we will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?

"At Musgrove Park Hospital, we found that most patients received safe and effective care. They appreciated the caring, helpful and compassionate attitude of staff. However, there were a number of areas for improvement in all of the services we inspected: the theatre and wards in the older part of the hospital needed to be better maintained. We found that the hospital was under pressure, particularly at weekends. At busy times, patients had to wait longer for specialist treatment and older people may not receive the care and emotional support they need. Some patients were waiting a long time for planned operations and outpatient appointments."

Is it safe?

"We found that patients received safe care and were protected from risks. Infection rates were low and the hospital was clean. Risks to people’s safety increased during busy times. Some equipment needed to be better maintained and some areas were in need of refurbishment.

Is it effective?

"We found that care and treatment was effective. Best practice guidelines were used, but they were not followed consistently. There were not enough senior doctors at night and weekends in the A&E, medical care and surgical departments. This was affecting the quality of medical decisions and handovers in those areas.

Are services caring?

"Overwhelmingly all the patients we talked to told us that staff were caring and compassionate, and that they were treated with dignity and respect. Patients told us their care needs were being met although some staff told us that when they were busy, it was difficult to always meet patients’ emotional and care needs.

Are services responsive to people’s needs?

"Patients told us that the hospital responded to their needs and the trust was working to improve its care for vulnerable patients. However, we had concerns about discharge arrangements and waiting times for some operations and outpatient appointments. Information for the public was available in English but not in a format that all patients could understand.

Are services well-led?

"The trust has a clear clinical strategy and governance arrangements. It is focused on making sure it provides good quality, safe services and clinical staff were involved in making improvements to services. Staff told us they were proud to work in the trust. They had a sense of collective responsibility to deliver quality care and a duty of candour was developing to ensure staff were open about performance issues. However, leadership in some services needs to improve, especially in maternity."

The Care Quality Commission has already 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.

CQC inspectors will return to Musgrove Park in due course to follow up the findings of this inspection and to report on the trust’s progress in making required improvements.

Ends

Notes to editors

The Chief Inspector, Professor Sir Mike Richards, announced in July that he will lead significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike identified 18 NHS trusts representing the variation of care in hospitals in England. These will be the first hospitals to test the new inspection regime.

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