The Care Quality Commission (CQC) has found improvements need to be made in services run by Torbay and South Devon NHS Foundation Trust, following inspections in May, June, and July.
CQC carried out inspections of urgent and emergency care, outpatients, medical care, and diagnostic and imaging services. Inspectors also looked at the management and leadership of the trust to answer the key question: is the trust well-led?
The inspections took place due to concerns raised about staffing, referral to treatment times, ongoing delays in ambulance handovers and waiting times.
As a result of this inspection the rating for Torbay and South Devon NHS Foundation Trust is rated as requires improvement.
Cath Campbell, CQC deputy director of operations in the south, said:
“During our inspection of Torbay and South Devon NHS Foundation Trust we found that leaders had the skills, experience, and capacity to manage the trust. They were aware of the challenges the trust faced as well as the whole local healthcare system and were working to tackle these.
“The trust is currently in the national oversight framework segment 4 due to its financial performance issues and delivery against performance targets, and is receiving support from NHS England. The trust leadership team have plans in place to tackle both their finances and their performance targets.
“We saw several issues with the environment at the urgent and emergency and outpatients departments at Torbay Hospitals which could be a potential risk to people’s safety. The emergency department was too small for its growing needs, and some areas were overcrowded with equipment and people too close together.
“The outpatient department was almost 100 years old and like the emergency department, the size and needs of the population it serves had grown and the hospital had not grown along with it, so it was no longer fit for purpose.
“The trust also needed to continue to address culture and work on equality, diversity, and inclusion. 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.
“We’ve reported our findings to the provider, and they know what they must address and the areas in which they’ve improved. We’re working closely with the trust to ensure people are receiving safe care and we will return to inspect the trust to make sure more improvements have been made.”
At trust wide level inspectors found:
- Staff views and concerns were encouraged, but they were not always heard and acted on, staff were not consistently told about action taken to improve processes
- Some staff felt issues were not fully understood by leaders or action wasn’t taken in a timely manner to resolve issues
- Staff felt some of the board were not fully aware of some of the key safety issues for clinical services at risk
However, inspectors also found:
- Leaders had the experiences, capacity, capability, and integrity to ensure the trust strategy could be delivered and risks to performance addressed
- The board had a realistic strategy which was aligned to local plans in the wider health and social care economy
- The trust engaged with relevant partners to build a shared understanding of challenges to the system. The board understood the needs of the population and engaged with people to gather feedback.
In urgent and emergency care inspectors found:
- The emergency department did not meet national recommendations for emergency departments, including waiting and treatment areas for children and families in a crisis
- Some of the computer screens were left open and unsupervised with people’s records visible. Inspectors saw people’s names and were able to enter and access the detailed records.
However, inspectors also found:
- Staff treated people with compassion and kindness, respected their privacy and dignity, and took account of their individual needs
- Staff felt respected, supported and valued. They were focused on the needs of people receiving care.
In diagnostic and screening services inspectors found:
- Checks to make sure the right person received the correct scan were not always effective
- Areas were not always designed to meet people’s needs. There were no dedicated waiting areas for children and some areas did not have dedicated changing rooms.
Inspectors also found:
- The service had developed training materials and posters to promote and clarify the use of inclusive language throughout the department and across all modalities which was being considered by a professional body for roll out nationally
- The department had developed an inclusive pregnancy check form in line with guidance and has taken this one step further by consulting the trust LGBTQIA+ community for feedback.
In medical care inspectors found:
- The outcomes for people were not always positive and consistent and did not always meet national standards. People were not always admitted to a stroke unit within four hours and did not always spend 90% of their time on a stroke ward in line with national guidance
- Following an audit for people who had problems swallowing it was found staff did not always provide people with food and drinks in accordance with their care plan.
Inspectors also found:
- Staff understood how to protect people from abuse, and managed safety well
- Staff kept good care records and managed safety incidents well and learned lessons from them.
In outpatients inspectors found:
- Staff said they sometimes needed to work extra hours to ensure there was enough staff to keep people safe
- Harm had come to people waiting to be seen in ophthalmology because risks to people on waiting lists were not always identified
- People could not always access the service when they needed it and had long waits for treatment.
However, inspectors also found:
- Managers monitored the effectiveness of the service and made sure staff were competent
- Staff worked well together for the benefit of people.