The Care Quality Commission (CQC) has found improvement is needed in some services run by Royal Devon University Healthcare NHS Foundation Trust, following inspections undertaken in November and December last year.
Inspectors carried out focused inspections of medical care and surgical services at North Devon District Hospital and the Royal Devon & Exeter Hospital sites. This was in response to the trust reporting 16 never events between March 2021 and November 2022. Also, CQC received information of concern regarding medical care at the trust.
Inspectors also undertook a full inspection of diagnostic services at both sites.
The Royal Devon and Exeter Hospital moved from good to requires improvement overall for medical care. It was rated as requires improvement for being safe and well-led. Effective, caring and responsive were inspected but not rated.
Surgery at both locations, dropped from good to requires improvement overall as did the ratings for safe and well-led. How responsive, caring and effective the service is was inspected but not rated.
Medical care at North Devon District Hospital remains requires improvement overall. It was rated as requires improvement in safe and well-led. Effective, caring and responsive were inspected but not rated.
Diagnostic imaging at both locations was rated as good overall. It was also rated as good for being caring, responsive and well led, and requires improvement for safe. As per all of our inspections, diagnostic services are inspected but not given a rating for how effective they are as it is not usually used for treatment.
This is the first inspection of the trust since the Royal Devon and Exeter NHS Foundation Trust and Northern Devon Healthcare NHS Trust merged to form the Royal Devon University Healthcare NHS Foundation Trust in April 2022.
Cath Campbell, CQC deputy director of operations in the south, said:
“Our inspection of Royal Devon University Healthcare NHS Foundation Trust was prompted by concerns about the number of never events that had taken place.
“Although we understand the pressures that healthcare providers have faced, and continue to face, never events are precisely that - they should never occur. If they do, it’s important they are thoroughly investigated to ensure they don’t happen again. Once an investigation has taken place learning should be shared with all staff and that wasn’t always happening.
“The trust had mitigated risks by putting in place a never event investigation report. Whilst individual investigations into each never event had taken place, the trust also recognised the need to join up the learning and communicate this between all trust locations as it wasn’t currently happening.
“Inspectors found staff knew how to safeguard people. They also treated people with kindness and compassion, considering their individual needs and preferences.
“Following the inspections, we reported our findings to the trust. Its leaders know what they need to do to improve services, and where there’s good practice on which they can build on.
Inspectors found:
- The service had a high number of vacancy rates at all levels. There was a high reliance on a locum workforce. Due to the shortages on most shifts, some people had to wait longer to receive help with food and personal care
- In medical care, people’s documentation and risk assessments were not always completed. This meant staff did not always identify or act quickly enough for patients at risk of deterioration
- In medical care staff did not always know if people had enough food and drink to meet their needs and improve their health as it was not recorded
- In surgery, outcomes for people did not always meet expectations based on national standards. The surgical division was under pressure with long waiting lists which were increasing
- In surgery and medical care, there were challenges with the new integrated electronic patient record system as a complete oversight of the service provided was difficult. Some audits that were required had been postponed during the pandemic and the results were currently unavailable due to the introduction of a new integrated electronic patient record system. This did not give sufficient oversight of performance and how to improve
- Staff were not always competent in using the new integrated electronic patient record system.
- At the safety and risk meeting in October 2022, the trust acknowledged they were not completely assured that all the steps identified to minimise the amount of never events, were being taken. While individual investigations were completed, the trust did recognise the need to join up the learning and communicate this between all trust locations.
However:
- People didn’t stay in hospital longer than they needed to. Managers and staff started planning each person’s discharge as early as possible
- Staff were open and honest and understood the duty of candour. They gave patients and families a full explanation if and when things went wrong. This was well documented in investigation reports
- If staff were concerned about people’s mental health, the service had 24-hour access to mental health liaison and specialist mental health support. This was provided onsite by the local mental health trust
- In diagnostic imaging services, staff were discreet and responsive when caring for people. They took the time to interact with people and those close to them in a professional, respectful, and considerate way – to ensure people understood every issue.