The Care Quality Commission (CQC) has raised the rating for urgent and emergency services at Milton Keynes University Hospital from requires improvement to good following an inspection in April. The rating for safe for the Milton Keynes University Hospital NHS Foundation Trust has also been raised from requires improvement to good.
This inspection was prompted in part by a notification from Milton Keynes University Hospital to CQC regarding an incident following which a person using the service died. The information shared with CQC about the incident indicated potential concerns about the systemic safety and quality of people’s care, which were examined on this inspection. Inspectors found the safety and quality of people’s care was good. The hospital was proactively implementing learning following the incident to better protect people in similar circumstances.
As well as CQC raising the urgent and emergency services’ overall rating, CQC have also raised the services’ ratings for being safe and well-led from requires improvement to good. CQC have again rated the service as good for being effective, caring, and responsive.
As a result, the Milton Keynes University Hospital NHS Foundation Trust will remain rated good overall, and for effective, caring, responsive, and well-led. It will be raised from requires improvement to good for being safe.
Stuart Dunn, CQC deputy director of operations in the east of England, said:
“When we inspected the urgent and emergency services at Milton Keynes University Hospital, we were pleased to see leaders supported a strong learning and safety culture. This had led to clear improvements to the quality of people’s care and a reduction in the length of people’s stays in the emergency department.
“Staff treated people with empathy and compassion and respected people’s dignity and consent. For example, they used privacy screens when transferring people from an ambulance stretcher to a hospital bed. Staff discussed people’s psychological and emotional needs during handovers.
“Staff worked well with colleagues from separate mental health providers to ensure a seamless integration of people’s physical and mental healthcare services. For example, staff arranged a private entrance for a person attending the emergency department from a local secure mental health unit to maintain their dignity, and this person was warmly welcomed and assigned a senior nurse to provide consistent care throughout their journey in the department.
“Leaders thoroughly investigated incidents when things had gone wrong, involving the people affected, and we saw changes had been made to improve people’s care in future. Leaders encouraged collective problem-solving, inviting staff and partner organisations to raise concerns and contribute to improvement work.
“People told us staff were busy, especially during peak times, but that they felt safe and were seen quickly by nursing staff when they arrived. Staff gave people clear and real time information to manage expectations on wait times and since our last inspection the trust had added new same-day emergency care services, which allowed some people to receive care quickly without staying overnight in the hospital.
“Staff also worked well with teams from separate mental health providers to quickly triage people with mental health concerns. However, staff told us children could experience long waits for mental health specialists and beds provided by other providers, which is an issue we have seen nationally. This puts pressure on the emergency department, which had limited dedicated, private spaces for people to wait in in the meantime.
“Inspectors also found there were some areas still in need of improvements. Leaders hadn’t identified a shortage of medical staff as a potential risk to people’s safety, some emergency equipment wasn’t checked daily to ensure it was ready for use, and some time-crucial medications weren’t always being prescribed in a timely way. Leaders showed action they were taking to reduce these risks following our inspection, including a robust recruitment plan.
“We’ve shared our findings with the trust so they can continue to build on the good practice we saw, and we will continue to monitor the service to ensure these changes are sustained long term.”
Inspectors also found:
- Staff met people’s individual needs in safe and supportive ways, and responded when people had immediate needs.
- Staff used translation services effectively when caring for people who didn’t speak English as a first language.
- Staff knew how to protect people from abuse. Inspectors saw two people for whom safeguarding concerns had been identified and action taken.
- Other organisations gave positive feedback about working with the emergency department. For example, ambulance crews said wait times were low and staff managed people’s care well.
- Security staff confidently used de-escalation techniques and listening and communication skills to engage with people struggling with mental health issues and other challenging behaviour.
However:
- The service didn’t have an approved policy on how to respond when the emergency department was reaching its capacity. Inspectors were provided with a draft of a new policy before this inspection finished.
The report will be published on CQC’s website in the coming days.