The Care Quality Commission (CQC), has found improvements are still needed in leadership and across four services at East and North Hertfordshire NHS Trust, following inspections in June and August.
CQC inspected how well-led the trust was overall, as well as surgery, to follow up on improvements they were told to make at the previous inspection of these areas in 2019. CQC also inspected urgent and emergency care services and medical care because there were concerns about the quality of these services. Maternity services were re-inspected to follow up on the progress of improvements they were told to make when they were last inspected in October 2022 as part of CQC’s national maternity programme.
In surgery, how safe the service is has improved from inadequate to requires improvement. It has again been rated as good for being effective and caring, and requires improvement how responsive and well-led it is, and requires improvement overall.
Medical care has again been rated as requires improvement for how well-led and safe it is, but how effective it is has dropped from good to requires improvement. Caring has again been rated as good overall. Medical care overall has again been rated as requires improvement.
Maternity has improved overall going from inadequate to requires improvement. How well-led maternity services are, and how safe they are, has also improved from inadequate to requires improvement.
Some of these service rating changes have changed the overall hospital level ratings for Lister Hospital. How safe the hospital is moves up from inadequate to requires improvement, however how effective the hospital is, has moved down from good to requires improvement. Caring has again been rated as good, and how responsive and well-led the hospital is has again been rated as requires improvement. This means that Lister Hospital has again been rated as requires improvement overall.
The trust level ratings have not changed as a result of this inspection. Overall they are rated requires improvement, as well as for how safe, responsive and well-led they are. The trust remains rated as good overall for how effective and caring it is.
Catriona Eglinton, CQC deputy director of operations, said:
“Whilst we saw caring staff across all of the services we looked at, it’s disappointing that we found a mixed picture with some small improvements, but also some deterioration.
“Leaders at the trust haven’t been able to demonstrate they’ve taken all the learnings from previous inspections, and used them build on good work, to continuously improve services for the people in East and North Hertfordshire.
“Leaders must find a way to sustain the improvements that they make, and we’ve identified some of the areas that would help them do this, especially around learning and taking action from it. We saw services didn’t manage safety incidents well, and didn’t always ensure lessons were learnt from them. We also saw a similar pattern with risk management. Whilst leaders were good at identifying it, they didn’t always take actions to reduce the risk.
“It was concerning that we found a decline in the quality of care being provided in urgent and emergency services. The trust must work across all of its departments right from outpatients, to surgery, as well as wider in the local system to address the challenges it faces.
“We saw people couldn’t always access the care and treatment they needed in a timely manner, and the waiting times from referral to treatment and discharge weren’t in line with national guidelines.
“However, we saw the foundations of a much safer and more well-led service in maternity, which is why we’ve improved their overall rating from inadequate to requires improvement, but there is still work for them to do.
“We now expect the trust to take what we’ve told them and use it to make and sustain improvements, and build on some of the good work they’ve done to make them more widespread. We’ll continue to monitor services during this time to make sure people are safe.”
Inspectors found:
- Staff didn’t always complete mandatory training and it wasn’t being monitored to meet the trust’s completion target
- There weren’t always enough staff to meet people’s needs
- In urgent and emergency care people were sometimes being treated in crowded and unsuitable areas of the emergency department
- The trust must ensure that investigations into incidents are completed in a timely manner to allow actions and learning to be shared with the relevant staff to prevent possible future occurrence.
However:
- Staff treated people with compassion and kindness, and respected their privacy and dignity. They also provided emotional support to people using services, their families, and carers
- Staff worked well together for the benefit of people using services, advised them on how to lead healthier lives, and supported them to make decisions about their care, giving them access to good information
- Managers monitored the effectiveness services and made sure staff were competent.