The Care Quality Commission (CQC) has rated Royal Devon University Healthcare NHS Foundation Trust as requires improvement, following inspections undertaken in November 2022 and May 2023.
Inspectors carried out focused inspections of medical care, surgical services and diagnostic services at North Devon District Hospital and the Royal Devon & Exeter Hospital sites in November. The findings from this inspection published in a report on CQC’s website in May.
Inspectors also looked at the management and leadership of the trust to answer the key question: is the trust well-led? This was carried out in May as it was postponed from January due to pressures in the NHS.
This was the first inspection looking at how well-led the trust is, 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.
Following this latest inspection, the trust is rated as requires improvement overall and for being well-led and safe, Effective and responsive remain rated as good. Caring remains rated as outstanding.
Cath Campbell, CQC deputy director of operations in the south, said:
“When we carried out this inspection, we found that leaders had the skills, experience, and capacity to manage the trust. They were all aware of the challenges the trust faced as well as the whole local healthcare system.
“Before our inspection, a trust wide electronic patient record system had been implemented. However, this had an impact on the quality of data while the electronic reporting system was embedding.
“We had previously highlighted the number of never events which had taken place at the trust and how they were going to be addressed. These are serious incidents which are wholly preventable. It was concerning, leaders lacked pace in addressing these issues which must be actioned as a priority to keep people safe.
“The trust is in the national oversight framework segment 4 due to its financial performance and delivery against performance targets and is receiving support from NHS England. However, we are aware the leadership team had put plans in place to tackle both their finances and their performance targets.
“The trust also needed to continue to address culture and work on equality, diversity, and inclusion. As a newly integrated trust, culture and inclusivity was a key focus to support the organisations to merge successfully. The trust recognised there was work to be done to bring teams together and build a culture that is inclusive. Staff satisfaction was mixed, but the board had ensured a plan of improving the culture and staff satisfaction was seen as a priority.
“Following the inspections, we reported our findings to the trust. Its leaders know what they must do to improve services, and where there’s good practice on which they can build on.
Inspectors also found:
- The trust must consider how it can improve the pace in responding to issues when they arise, for example the high number of never events and the data issues which have arisen from the implementation of the electronic patient record system
- The board should continue to address delays with serious incident investigations to ensure learning is identified and action taken in a timely manner
- Leaders should consider how executives can link with the executives at the mental health trust to help find solutions facing mental health provision in the area
- Leaders should continue to address culture and work on equality, within the organisation and consider how they respond to discrimination and bullying
- The board should review the support provided for neurodiverse staff and how staff can have protected time for roles such as inclusion champions and setting up and supporting staff networks.
However:
- Most staff felt respected, supported, and valued and felt proud to work in the organisation
- There were clear processes for speaking up within the trust and concerns were investigated sensitively and confidentially with lessons shared and acted on
- There was a clear vision and strategy. The strategy was aligned to local plans in the wider health and social care economy and services were planned to meet the needs of the local population.