Basildon and Thurrock University Hospitals NHS Foundation Trust has failed to address safety and quality concerns raised 10 months ago, according to a Care Quality Commission report.
In a high profile case, foundation trust regulator Monitor intervened at the trust in November 2009 over quality concerns. It was subsequently registered with conditions in four areas by the CQC in April 2010.
In December the final CQC registration condition was removed and last month’s trust board meeting was informed of the “completion of the action plans developed to ensure compliance” with CQC conditions.
South West Essex primary care trust’s November board minutes noted “negative comments” about Basildon and Thurrock in a patient experience, quality and safety report. But the PCTs deputy chief executive and chief nurse Barbara Stuttle said that new director of nursing Diane Sarkar “is bringing about a cultural shift”.
However CQC inspectors visiting in the December looked at 16 essential standards and found four in need of action and six where improvements were suggested.
The CQC report found “evidence of a lack of consistent, timely nursing care planning and assessment practice”.
It noted that risk assessments for patients were not always in place and discharge documentation was lacking in some cases. The report said this was a “significant concern” because the issues had been raised and an improvement plan put in place in April 2010.
It also found a lack of knowledge around dementia awareness and challenging behaviour and problems addressing patients’ dietary needs.
The report said: “Two care records observed showed patients with significant weight loss, which was unexplained, and a further patient record showed poor nutritional intake with no actions stated to address this.”
CQC regional director Frances Carey said: “Despite having all of its registration conditions lifted, the trust has not yet achieved full compliance across standards. We have made repeated visits to the trust and each time we have had to impose at least one new compliance action.
“The trust needs to ensure that it sustains improvement across the board. By law, providers of health care services have a legal responsibility to make sure they are meeting the essential standards of quality and safety.”
The CQC has told the trust where it needs to improve and has given it 14 days set out plans.
Director of nursing Diane Sarkar said: “It’s much more positive than previous reports. The inspectors found that patient feedback was overwhelmingly positive.”
She said the main issues that have been raised were with nursing documentation. “Clearly we need to bring this up to a very good standard. But this is not a unique problem, it’s a national problem.”
She said concerns about dealing with dementia were being dealt with and problems around dietary needs were also down to documentation. She said patients had not been fed because “One was asleep and one was drowsy”, and poor documentation meant that missed meals were not recorded.
Basildon and Thurrock chief executive Alan Whittle also pointed to positive comments made by patients and staff in the latest CQC report.
He said: “We have already provided the CQC with a plan of action to address the four areas where they have moderate concerns. Two of these are around the standard of nursing documentation and dementia care.
“These areas are recognised across the NHS as needing greater focus and improvement. We are far from unique in finding it difficult to consistently achieve exemplary standards in documentation, which presents a challenge for the service as a whole.
“We are putting in place a nursing documentation programme which the CQC accepts is a major project that will take some 12-18 months to complete, starting with nurse training.”
The trust was also fined £50,000 plus £40,000 in costs in June last year for not providing appropriate care leading to the death of disabled child. Kyle Flack died in 2006 after his head got trapped in some bars that on his bed, leading to concerns into safety at the hospital.
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