The Care Quality Commission (CQC) has again rated Norfolk and Norwich University Hospitals NHS Foundation Trust as requires improvement following an inspection of their leadership and three services that finished in November last year.
The unannounced inspection of three services at the Norfolk and Norwich University Hospital was prompted due to concerns CQC had received from staff and people using services about the safety and quality of the surgery, outpatients and diagnostic imaging services. The inspection also looked at how well-led the trust was overall.
Due to a large-scale transformation programme and staff sickness at CQC, this report hasn’t been published as contemporaneously as it should have been. These issues increased the time needed to review evidence and allowed the trust time (as part of the normal process) to review the factual accuracy of the draft report. CQC have apologised to the trust for the amount of time this has taken.
Following the inspection the trust’s leadership rating remains requires improvement, how effective the trust’s services are also remains as good. The trust has again been rated as requires improvement overall.
At Norfolk and Norwich University Hospital the overall rating for outpatients has dropped from good to requires improvement and surgery and diagnostic imaging services at the hospital have again been rated as requires improvement. These ratings see the hospital rated as requires improvement overall again.
Rob Assall, CQC’s director of operations in the East of England, said:
“During this inspection, we identified areas for improvement in leadership at the trust overall and also at Norfolk and Norwich University Hospital. Our experience tells us that when a trust isn’t well-led, this has a knock-on effect to the level of care being given, which is what we found when we inspected the trust.
“Across all of the services we looked at, we found people couldn't always access services when they needed them, and often faced long waits for treatment or had their appointments cancelled. The trust also wasn’t meeting national standards around waiting times from referral to treatment or in how they were admitting, treating, or discharging people from their care, which could put people using their services at risk.
“However, people told us staff treated them with compassion and kindness and respected their privacy and dignity. Staff also took account of their individual needs and helped people to understand their conditions.
“Some staff told us they didn't always feel respected, supported and valued which was reflected in their staff survey results. Despite the trust’s effort to promote equality and diversity in daily work and provide opportunities for career development staff shared ongoing concerns about bullying and harassment, particularly among ethnic minority and disabled staff. Senior leaders recognised that the staff survey and workforce data reflected the lived experience of staff, and knew they had more to do before they could say the workplace was inclusive.
“Since the inspection last year, the trust has employed a new substantive chief executive and we’ve seen signs of significant improvements, which includes ambulance handover times and the length of time people are spending waiting in the Emergency Department. We’ve been working very closely with the trust in the months since the inspection and will return to check on the quality of services following these improvements. Until we return, we’ll continue to monitor the trust closely to ensure people are safe.”
Inspectors found:
- The trust didn’t have good systems for purchasing, renewing, and replacing equipment, resulting in people’s treatment being affected by equipment failures
- Not all staff had knowledge of how to access and locate ligature cutters if they required them
- Senior leaders weren’t doing enough to address issues raised by staff feedback
- According to the Workforce Race Equality Standards reports, both ethnic minority staff and staff with a disability experienced harassment, bullying or abuse from other staff and discrimination from their managers. The trust had an action plan to tackle this, but the action plan didn't have a named accountable person for the outcome.
However:
- The trust worked to promote an open culture where people using the service and their families could raise concerns and complaints without fear
- Staff were committed to learning and service improvement. They were developing a good understanding of quality improvement methods and the skills to use them
- The trust had a staff council to provide a forum where staff could engage and contribute to staff survey actions and priorities.