The Care Quality Commission (CQC) has published a report on the adult critical care unit at Oxford’s John Radcliffe Hospital, which is run by Oxford University Hospitals NHS Foundation Trust, following an inspection undertaken last year.
The unit – which had 22 open beds at the time of inspection, including for people being treated for organ failure – was inspected because CQC received concerns from some of the service’s staff.
As the inspection only assessed specific areas of concern in this critical care service, it was not extensive enough to issue new ratings – so the service remains rated good.
This also means there were no ratings changes for the hospital or trust, so both continue to be rated requires improvement.
Karen Hill, CQC interim deputy operations director, said:
“While many aspects of the care provided to people on John Radcliffe Hospital’s adult critical care unit were safe and effective, there were several areas Oxford University Hospitals NHS Foundation Trust needs to address.
“The service’s staff didn’t always have the right training and mix of skills to meet the needs of people receiving its care. This increased the risk people faced, and it contributed to staff being tired and experiencing low morale.
“Insufficient oversight from senior leaders was a factor behind this. Leaders were unaware of some of the issues and risks the service faced, so they hadn’t developed adequate solutions to help it improve.
“However, staff felt respected and supported by local leaders, and they were focused on the needs of people receiving care.
“Infection risk and medicines were managed well, which supported safe care.
“We also found records were comprehensive, and safety incidents were reviewed to help make improvements.
“We’ve reported our findings to the trust so its leaders know where there’s good practice on which they can build, and where there’s issues they need to address.
“We continue to monitor the service to support it to provide safe and effective care and treatment to people.”
Inspectors found:
- The service met national standards. It was clean, and infection risk was controlled. Provision to support increased infection control measures, if needed, were in place
- Medicines were well managed
- Staff assessed risks to people and kept good care records
- Safety incidents were managed well and used to drive improvement
- There was a flexible approach to managing staffing to ensure there was enough staff to care for people
- Staff received annual appraisals, and nursing staff were up to date with their mandatory training
- There was a vision and plans for the service’s development
- Staff felt respected, supported and valued by leaders.
However:
- The service did not always have the right staff skill mix, and it was unable to meet the recommended national guidelines on nursing skill mix in intensive care units
- Staff fatigue was high, and morale was low. Strained relationships, staff turnover and the fast pace of change at the unit all impacted its working environment
- Medical staff had not completed mandatory training to a level required by the trust
- The processes for identifying and escalating risk appeared to be inconsistently used, which created a disconnect between the unit and senior leaders. Leaders of various seniority were unaware of local risks, or interpreted risk differently to those on the frontline
- Audits were not always completed. This meant some information was not being used to measure the quality and safety of the unit, or help it meet challenges.