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Monday, 22 December 2014

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Chief inspector finds that Cumbria hospital trust requires improvement

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has recommended that North Cumbria University Hospitals NHS Trust remains in special measures after publishing his first report on the quality of care provided by the trust.

The trust was placed into special measures by Sir Bruce Keogh in July last year after concerns were raised about mortality rates and standards of care. While CQC found that some improvements had been made at the trust since then, there has not yet been enough progress to recommend that the trust leave special measures at this time.

Under the new inspection model, CQC has given individual ratings to each of the core services at the hospitals, including Accident and emergency (A&E), Medical care (including older people’s care), Surgery, Critical care, Maternity and family planning, Services for children and young people, End of life care, and Outpatients.

West Cumberland Hospital, Whitehaven, and Cumberland Infirmary, Carlisle, were rated Requires Improvement overall by CQC, while maternity services at Penrith Community Hospital were rated Good. At both West Cumberland Hospital and Cumberland Infirmary, critical care and end of life care were rated Good, while all other services were rated Requires Improvement.

CQC rated the trust Requires Improvement overall, after being rated as such for safety, effectiveness, responsiveness and leadership. The trust was rated Good for caring. The full reports for each hospital and the wider trust can be found on the CQC website: http://www.cqc.org.uk/provider/RNL.

Inspectors found that there was a shortage of both doctors and nurses at West Cumberland Hospital and Cumberland Infirmary, and a heavy reliance on temporary staff. The shortage of doctors was a particular problem in the medical wards at West Cumberland Hospital.

Patient flow was poorly managed within the trust, and this led to patients being placed in wards which did not meet their needs. Outpatient clinics ran late due to problems with the availability of patient records. In some cases, patients were subjected to long waits, and in a few cases, patients were not seen at all.

While staff were positive about leadership at ward level, feedback about the leadership at higher levels of management was mixed. Some staff said that they were reluctant to raise concerns because they were afraid of reprisals. The culture within the trust did not encourage staff to raise concerns.

The trust has been told that it must make improvements in a number of areas, including:

  • Staffing levels must be addressed as a matter of urgency.
  • Waiting times in and patient flow from A&E must be improved, to ensure that patient transfers are not delayed, patients are not moved at inappropriate times, and patients do not unnecessarily spend the night in A&E.
  • Work must be done through engagement with staff to address the culture within the trust, so that the trust supports openness, transparency, and learning.
  • Policies and procedures designed to support patient safety must be robust, and must include a major incident plan for surgery.
  • National guidelines must be followed regarding anaesthetist cover at all times for obstetrics at West Cumberland Hospital, with a second operating theatre made available for obstetrics and gynaecology use.
  • The trust must support outpatients to provide a better service to patients and meet national targets, ensuring that patient records are available to support patient consultations.

Inspectors found that services across the trust were caring, and rated these as Good. Throughout the inspection, staff were seen to treat patients with compassion, dignity and respect. Patients and relatives said they felt involved in their care and that they received good emotional support from staff. It was clear that staff were very committed and caring and did their best to achieve the best outcomes for patients.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “I recognise that North Cumbria University Hospitals NHS Trust has been working hard over the last year to make improvements. While we did see some signs of this improvement when we inspected, the trust still has a long way to go before it reaches the required standard.

“It should be noted that staff were seen to be compassionate and supportive, and that patients and relatives praised the staff for the commitment they showed to their work.

“I have recommended to the Trust Development Authority that the trust remains in special measures for now. I am hopeful that, in the next few months, the trust will be able to demonstrate enough improvement for me to review this again.

“Services should be safe, caring, effective, well led and responsive to people’s needs. We will continue to monitor the trust closely and will inspect again in due course.”

Inspectors also visited the sites unannounced as part of the inspection, held focus groups with staff, and held a public listening event. The report which CQC publishes today is based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

CQC inspectors will return to the hospital in due course to check that the required improvements have been made.

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