A probe of trusts with high death rates found inadequate staffing and sustained failures to ensure adequate maintenance of estates and medical equipment at North Cumbria University Hospitals Trust.
NHS England medical director Sir Bruce Keogh’s review of 14 English trusts, published this afternoon, also highlights “significant weaknesses” in infection control at North Cumbria, and failures to learn from both serious incidents and “never events”.
It states that the trust’s governance processes had “failed to identify significant shortcomings in the assessment and maintenance of the estate and equipment”. The panel investigating North Cumbria saw medical equipment labelled as past its servicing date at the trust’s Cumberland Infirmary, and highlighted “concerns that over 1,000 maintenance requests were outstanding”.
It reports that North Cumbria had “failed to respond to a report that its ultra-clean ventilation (UCV) theatres at the Whitehaven site were not meeting relevant standards, and could not provide evidence that other operating theatres had been adequately tested.”
This resulted in the closure of two operating theatres at the Whitehaven site pending validation by North Cumbria that their ventilation was up to standard.
The review report adds: “Staff at both Cumberland Infirmary and West Cumberland Hospital spoke about poor nurse and medical staffing, especially out of hours. This was evidenced through a review of ward staff rotas and staffing audit charts whilst on-site, and by information provided which indicated low medical cover of some areas, for example, general and acute medicine at West Cumberland Hospital, and an over-reliance on locum appointments.”
Employees told the panel that they had not had time to complete mandatory training. The report states: “This means that staffing shortfalls may be having a compounding effect on risks to patient safety and experience.”
On the trust management’s relationship with staff, it noted: “Senior and middle management need to drive openness and support. Whilst there is evidence that this is being introduced by the new [chief executive], discussions with staff and patient stories suggest that they do not feel supported, and in many cases provided evidence of feeling intimidated and bullied; nor do they seem to be receiving effective communication.
“Evidence suggests that staff who were favoured are treated as elite, whilst on the other hand there were three allegations of potential racism.”
The panel also found documentary evidence demonstrating a “slow response to serious incidents”. Staff told the panel that learning was “still not adequately shared” with “deep set cultural issues, such as apportionment of blame” impeding learning. The report adds that the recurrence of certain categories of incidents and “never events” also suggested that “the organisation is slow to learn from serious incidents”.
But it states: “This is something that the new [chief executive] is aware of and has been prioritising as evidenced within the ‘face to face’ meetings she is now having with.”
North Cumbria is in the process of being acquired by neighbouring Northumbria Healthcare Foundation Trust, which recently installed interim chief executive Ann Farrar at the trust.
The review states that this leadership changeover has brought “positive changes”, but adds “the extent and pace of change has been insufficient to rectify all weaknesses in governance”.
Ms Farrar said in a statement: ““Many of the areas highlighted are problems that we are acutely aware of and are actively working very hard to address. Equally, however, there are areas of considerable concern where much better processes and procedures should have been in place to protect our patients. Together with our various health partners we are now taking very urgent action to address these issues in the very best interests of patient safety.”
She added: “I want our teams to operate in an environment which is free from blame, where colleagues support each other to continuously strive to do to the absolute very best we can for patients every single day. To do this requires a significant culture change and one which will not happen overnight.
“We have made some great inroads in the past ten months with a really positive increase in the number of serious incidents that are now being openly reported so that we can learn from these and continue to improve quality. This is a crucial first step.”