The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust has been returned to “special measures” after its latest inspection by regulators, who identified safety concerns.
Particular problems were highlighted by the Care Quality Commission in urgent and accident and emergency care, maternity care and medical care – with issues often linked to staffing levels.
“Our inspection found concerns in urgent and emergency care, maternity and medical care”
Inspectors found the A&E department did not always have systems in place to ensure staff were able to “identify and respond appropriately to changing risks” to their patients, said the CQC’s report, which was published this week.
In addition, the numbers and skill mix of nursing and medical staff were “not always suitable” for the needs of the emergency department. Learning from serious incidents was “not always robust”.
In maternity, there were safety concerns linked to risk assessment procedures, care planning for high-risk women, equipment and drugs monitoring, and mandatory and safeguarding training.
“We found that leadership within the service had broken down and that the service’s leaders did not have oversight of risk or quality improvement within the service,” warned inspectors in their report.
“We found that leadership within the service had broken down and that the service’s leaders did not have oversight of risk”
Meanwhile, in medical care, the CQC inspectors observed high staff turnover, sickness and vacancy rates.
“There was evidence that low nurse staffing levels were impacting on patient safety because staff did not have capacity to assess patient risk and meet basic food, drink and toileting needs promptly,” said the report.
After its latest visit, the CQC rated the trust’s services as “inadequate” overall and recommended that it should be placed in special measures, a move subsequently confirmed by NHS Improvement.
The Norfolk trust was inspected between 4 April and 21 June 2018, with inspectors highlighting a wide range of concerns and areas for improvement.
Specifically, it was rated as “inadequate” for being safe and well-led, as “requires improvement” for whether its services were effective and responsive, but “good” for whether its services were caring.
The trust was previously rated as “requires improvement” following its inspection in June 2015.
- King’s Lynn removed from special measures but with Monitor warning
- King’s Lynn trust set to leave special measures regime
- Queen Elizabeth Hospital pledges action on staffing
The trust has now been told that it must make improvements in a number of areas, including that mental capacity assessments must be consistently and competently carried out where required.
The CQC also stipulated that patient care records must be accurate, complete and up-to-date, including those relating to weight and nutritional assessments and fluid balance charts.
In addition, the trust has been told it must ensure that there is an effective process for governance, quality improvement and risk management in all its departments.
Meanwhile, processes for incident reporting, investigation, actions and learning must be embedded across all services, with serious incidents identified, reported and investigated in a “timely manner”.
However, the CQC found outstanding practice in the multi-disciplinary rapid assessment team, which worked in the emergency department.
Regulator to review care for newborns following baby’s death
CQC chief inspector of hospitals, Professor Ted Baker, said: “There had been a deterioration in the service provided since our last visit and a number of improvements were needed.
“Our inspection found concerns in urgent and emergency care, maternity and medical care,” he said. “All three departments are now rated as ‘inadequate’ overall following our inspection and surgery, which was previously rated as ‘good’, is now rated as ‘requires improvement’.
“Our concerns in relation to the maternity service were such that we raised these with the executive directors while on site, issued a warning notice to the trust, identifying areas where it must improve,” said Professor Baker.
“We know the trust initiated an immediate action improvement plan for maternity services and we will return to check on improvements in the service,” he added.
In response, the trust said a “raft of improvements” were now under way following the CQC’s latest inspection report.
The aim of the changes is to quickly improve levels of care and service following its rating of “inadequate”, said the trust in a statement.
“I would like to apologise to those patients who we have let down and to our dedicated staff who work so hard”
Chief executive Jon Green said the trust’s focus was solely on bringing about the necessary improvements as soon as possible.
He said: “Reading the report leaves me saddened. I would like to apologise to those patients who we have let down and to our dedicated staff who work so hard under sometimes extreme pressures.
“We have already started to address the issues highlighted in the report and have comprehensive plans in place to ensure we turn this situation around,” said Mr Green.
“When we welcome the CQC back into our organisation next year I feel confident we will be able to demonstrate significant improvements to them, many of which are already under way,” he said.
He added: “We and our dedicated staff our working hard to meet our patients’ expectations. We are listening to them and the wider community.”
CQC inspectors are due to return next year to check on the progress of improvements.