The Care Quality Commission (CQC) has told University Hospitals of North Midlands NHS Trust to make improvements at County Hospital and Royal Stoke University Hospital following an inspection in October.
Inspectors carried out an unannounced focused inspection of the medicine core service at County Hospital, CQC also looked at the medicine core service and the urgent and emergency care service at Royal Stoke University Hospital, this was in response to a warning notice issued in 2021. At that inspection, CQC found that staffing in urgent and emergency care at the Royal Stoke University Hospital and the risk management of patients with mental health needs at County Hospital required significant improvement.
Following this latest inspection, the overall rating for the medicine core service at County Hospital, as well as for being safe and effective in this service has moved down from requires improvement to inadequate. Responsive and well-led have remained rated requires improvement, and caring remains rated as good.
The overall rating for County Hospital remains rated as requires improvement.
As it was a focused inspection at the Royal Stoke University Hospital, the services inspected were not rated, therefore the rating as requires improvement overall remains for the hospital. Safe, responsive and well-led also remain requires improvement. Effective remains good and caring remains outstanding.
Craig Howarth, CQC head of hospital inspection, said:
“Following our inspection of University Hospitals of North Midlands NHS Trust, we found that the Royal Stoke University Hospital had made enough improvements around staffing in urgent and emergency care, therefore the warning notice had been met.
“However, this wasn’t the case at County Hospital. There was evidence that changes had not been made as quickly as we would like, and staffing was still an issue. Also, the trust didn’t seem to have a complete overview of the issues in medical services around supporting patients with acute mental health needs.
“The service must also ensure that learning from serious case reviews, audits and incidents are shared and embedded across the trust.
“After the inspection we fed back our findings and concerns to the leadership team. The team have been working hard to put immediate and significant improvements in place and we will return to check on their progress and ensure that these are fully embedded.”
At the County Hospital inspectors found:
- The service did not have enough staff to adequately support patients who required enhanced supervision to protect themselves or others
- Not all staff had access to good information when working with patients with mental health conditions or symptoms
- Staff did not receive structured support following incidents of violence or aggression. Oversight of some aspects of managing patients with mental health conditions or symptoms was not in place
However, inspectors also found:
- Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them.
At the Royal Stoke University Hospital inspectors found:
- Staff did not always raise concerns, report incidents or near misses in line with trust policy. Managers did not always identify training needs their staff had or gave them the time and opportunity to develop their skills and knowledge. All staff we spoke with said they would welcome some additional mental health training
- The service faced significant challenges on delivering care to meet the needs of local people. People could attend the service when they needed it but faced significant waits for care and treatment
- The trust had amended their electronic medical records system to include a mental health risk assessment which was to be completed when the patient was reviewed by a member of medical staff.