The Care Quality Commission (CQC) has told Gloucestershire Hospitals NHS Foundation Trust that it must make improvements following a recent inspection of its surgical services.
In April and June, CQC carried out an unannounced inspection of the trust’s surgical services at Cheltenham General Hospital and Gloucestershire Royal Hospital and an announced well led inspection of the trust. The inspection was undertaken in response to concerns received about the safety and quality of the services. These concerns included staff whistleblowing, and the sizeable number of never events reported over the previous year.
Following the inspection, CQC issued the trust with a warning notice to make sure significant improvements in areas of safety, leadership, managing risk and governance for surgical services were carried out to improve patient care.
Surgery at both Cheltenham General Hospital and Gloucestershire Royal Hospital is now rated inadequate overall. Previously surgery had been rated as good. Safe and well-led are also rated as inadequate. Effective and responsive are now rated as requires improvement and caring as good.
The overall rating of the trust has now dropped from good to requires improvement. Safe and well-led have also dropped from good to requires improvement. The rating for responsive remains requires improvement and caring remains good.
Catherine Campbell, CQC head of inspection, said:
“We are very aware of the pressure that the NHS is under and how hard staff are working to provide good care for patients.
“During our well led inspection we found there was a lack of trust in senior leaders and a fear of speaking up. Inspectors were told when staff did raise concerns they were not always supported or treated with respect. Some staff said they had tried repeatedly to raise concerns and due to either a lack of response or a negative response, eventually they had become disengaged and focused instead on day-to-day service provision.
“There was also a disconnect in the governance of the trust, so senior leaders were not sighted and hence had not taken action to rectify issues and matters arising in wards and departments.
“There were some cultural challenges within the trust and leaders did not always promote equality and diversity in day-to-day work.
“During our inspection of surgery services at Cheltenham General Hospital and Gloucestershire Royal Hospital, both hospitals we visited were incredibly busy and we saw the impact that staff shortages were having on the service.
“The trust had reported a total of eleven never events across the organisation including seven never events in the surgery division from March 2021 to February 2022. A never event is a serious patient safety incident that should not happen if healthcare providers follow national guidance on how to prevent them. There was limited evidence of learning from never events being shared with staff across the trust. The trust had started to take action using their quality improvement approach. However, we saw limited improvements and therefore were not clear how effective actions had been and were concerned over the pace of the work.
“Staff had raised concerns regarding staffing and low morale but didn’t feel they were listened to.
“The trust have shared their improvement plan with us. We will continue to monitor the trust to ensure it is putting the improvements that are needed in place.”
Throughout both surgery departments, inspectors found the following:
There were no effective systems to identify when to open and close theatre recovery area for patients requiring ward-based care, in times of escalation. CQC reviewed the patient flow and escalation policy, but this did not include the use of theatre recovery as a designated escalation area. Some patients were kept in recovery areas within the hospital for extended periods of time mainly due to a lack of beds within the rest of the hospital.
The majority of managers had the skills and abilities to run the service and understood the issues the service faced. However, they were not always able to manage risk effectively.