The Care Quality Commission (CQC) has published a report following an inspection of the emergency department, medical and surgery services at Hull University Teaching Hospitals NHS Trust in November and December.
The inspection was carried out as part of CQC’s continual checks on the safety and quality of healthcare services.
Following the inspection, the trust’s overall rating for safety has moved down from requires improvement to inadequate, responsive and well-led have moved down from good to requires improvement, caring remains good and responsive remains requires improvement.
The overall rating for urgent and emergency care has moved down from requires improvement to inadequate and the overall ratings for medical and surgery services has also moved down, from good to requires improvement.
The overall rating for Hull University Teaching Hospitals NHS Trust remains requires improvement.
Sarah Dronsfield, CQC deputy director of operations in the North, said:
“When we inspected Hull University Teaching Hospitals NHS Trust, we saw that leaders understood the issues the service faced. However, they didn’t always manage services with timely and decisive action which has caused a deterioration in the quality of care.
“In the emergency department, patients weren’t always checked regularly to see if they had enough to eat and drink, including those with specialist nutrition and hydration needs. We reviewed one diabetic patient who waited 16 hours before receiving a drink or food.
“We reviewed another patient who reported high levels of pain but hadn’t received adequate pain relief in a timely manner.
“Managers needed to do more to mitigate the impact of staff shortages on people’s care in medical and surgery services, with both areas reporting issues. Managers confirmed they’d successfully recruited several new nurses, so we hope this soon starts to make a difference to ensure patients are safe.
“In medical services, staff were frequently moved between wards to cover staff shortages which prevented a continuity of care to people, and nursing levels were consistently below the safe and recommended levels on surgery wards. Again, managers needed to do more to mitigate these risks.
“However, it was good to see positive interactions between staff and people across the service with staff going the extra mile to ensure people were comfortable and their needs were met.
“It was also pleasing to note that specialist support staff such as dietitians and speech and language therapists were available for people who needed additional support.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can continue to receive a good standard of care.”
Inspectors found the following during this inspection:
In the emergency department:
- Staff knew how to make a safeguarding referral and who to inform if they had concerns. We saw completed examples of safeguarding referrals during inspection and saw no errors or omissions
- The service had enough nursing and support staff to keep patients safe
- Staff did not follow infection control principles including the use of personal protective equipment (PPE) or the principles of bare below elbow (BBE).
In medical services:
- The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection
- Staff completed risk assessments for each patient on admission or arrival, using a recognised tool and reviewed this regularly, including after any incident
- Managers supported nursing staff to develop through regular, constructive clinical supervision of their work.
In surgery:
- Managers didn’t always investigate incidents thoroughly and were slow in sharing the learning, resulting in potential harm to patients
- Staff didn’t dispose of clinical waste safely and sluice room doors were unlocked in some areas
- Junior doctors at Hull Royal Infirmary said they felt the workload was unmanageable at times and expressed concerns as to how ‘stretched’ they felt.