The Care Quality Commission (CQC) has told Gloucestershire Hospitals NHS Foundation Trust to make improvements to its maternity department, however improvements were found in its surgical services.
CQC carried out a focused inspection in April to follow up on two warning notices which were issued to the trust last April 2022 for surgical services and maternity.
Following this recent inspection, the trust’s surgery department has met the requirements of the warning notice. However, due to further issues found, CQC issued the trust with a further warning notice to the maternity department to make sure safeguarding training level 3 was provided for all staff and incidents were investigated in a timely way so learning can be shared quickly to reduce the risk of them happening again. This is a repeat of part of the warning notice issued following the inspection last April.
Due to the nature of this focused inspection surgery was not re-rated and remains rated as requires improvement. Maternity also was not re-rated and remains rated as inadequate.
The overall rating of the trust remains requires improvement.
Cath Campbell, CQC deputy director of operations in the south, said:
“During our inspection of Gloucestershire Hospitals NHS Foundation Trust, we found a number of positive changes since our last inspection, and we were pleased to find the culture had improved and it was more open and transparent.
“These positive changes had impacted on the quality of care. Also, staff were receiving the support they needed to manage their wellbeing.
“However, we did find areas where improvements still need to be made. For example, at the inspection last April, we issued a warning notice due to poor compliance with safeguarding training level 3 in maternity. Following this latest inspection, we found that this hadn’t been addressed fully and have re-issued the warning notice.
“We also found that incidents were still not being investigated in a timely way. At the end of March there were still 215 incidents due to be investigated. While this was an improvement from the last inspection, further improvements were required to make sure that any poor practice was identified, improvements were made, and staff learnt from these in a timely way to help prevent them from happening again.
“We also found in surgery that not all of the department was clean due to ongoing building work. Ceilings in the non-clinical areas were dirty with a significant amount of dust. However, staff did tell us that the infection prevention and control team had assessed these areas and only non-clinical areas were affected.
“We'll continue to monitor these services, including through further inspections, to ensure people are receiving safe care and support the trust to continue building on the improvements made so far.”
In surgery inspectors found the following:
- Staff felt there had been an improvement in staffing since last inspection and vacancies across the directorate had been reduced.
- There had been an improvement since the previous inspection in the number of people nursed in areas that were outside of their intended purpose.
- The surgical assessment unit had now been extended and the number of people who required ward-based care being nursed in recovery had been reduced.
- There had been a reduction of never events across both sites with no reported never events since December 2021.
However, inspectors also found:
- There were instances of children undergoing non-specialist emergency surgery at Cheltenham General Hospital, which was not in line with national guidance.
In maternity inspectors found the following:
- Incidents were not always investigated in a timely way which delayed the outcome and learning being shared
- Not all medicines practices were safe and potentially they placed women and people using the service at risk of harm.
However, inspectors also found:
- Waiting time for women in triage to meet the 15 minute standard had improved to reduce any delays in care and treatment
- Safety checks on emergency equipment was completed daily to make sure it was ready to use.