A Midlands trust where patients died in the corridors last winter has been rated “inadequate” again, with the Care Quality Commission suggesting outside support will be required “for the foreseeable future”.
The CQC’s inspection report, published today, revealed a long list of failings at Worcestershire Acute Hospitals NHS Trust, where performance, particularly in emergency care, has continued to worsen since it was first placed in the special measures regime in December 2015.
A preliminary CQC report had identified widespread problems at the trust including a “culture” of patients being kept in corridors, medication errors and poor infection control, as reported earlier this month by Health Service Journal.
In its latest report, the CQC recommended the trust remain in special measures for at least another three to six months to allow its new management team to push through “urgent improvements”.
The CQC report was based on five inspections in November and December 2016. As a result, the CQC issued a formal warning notice requiring urgent improvements by 10 March with a further two follow-up inspection conducted in April. They showed that the trust continued to struggle to improve.
Today’s report rated the trust as being “inadequate” for safety, responsiveness and being well led. The trust was rated “requires improvement” for effectiveness and “good” for being caring.
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said it was clear the trust “will require continued support for the foreseeable future”.
He added: “This is extremely concerning, both in terms of the quality of care that people can expect from the trust, and for what it says about the trust’s ability to improve.
“This situation must not be allowed to continue and we are considering, along with partner agencies, the best option available to improve services rapidly for the local population,” said Sir Mike, who is stepping down at the end of July.
On the trust’s workforce, he added: “Generally, staff were hard-working, passionate and caring and because of the quality of staff interactions with patients, we rated the trust as good for caring.
“Many staff, however, were clearly frustrated that they were not able to effect change due to poor communication between ward, divisional and executive levels,” he said.
Trust chief executive Michelle McKay said she was disappointed with the rating but that she accepted the CQC’s report.
Ms McKay, who joined the trust in March as one of four new senior appointments at the trust since September, said more stable leadership should help drive improvements.
“We want all our patients to get the best care possible and regret that this isn’t currently always happening, but we’re determined to put things right,” she said.
However, Ms McKay said there had been improvements in some services, such as maternity and children’s, since the last inspection. In February, it was reported that both maternity and children services at Alexandra Hospital had been “temporarily” transferred to Worcestershire Royal Hospital.
She added: “I am pleased that the reports acknowledge that we are a caring organisation, rating care across our hospitals as ‘good’, and our end of life care as ‘good’. Our staff continue to deliver compassionate care to the thousands of patients who use our services every day.”
Last winter was particularly difficult for Worcestershire Acute’s A&E services, which reported three patient trolley deaths. The trust was singled out by health secretary Jeremy Hunt in January as the trust the Department of Health was “most worried about”.
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The trust has longstanding sustainability challenges, particularly at Alexandra Hospital, and a report on the proposed reconfiguration of its services is expected next month.
However, Sir Mike suggested that other NHS organisations in the area – which include University Birmingham Hospitals NHS Foundation Trust, South Warwickshire NHS Foundation Trust and Wye Valley NHS Trust – should be more involved in helping Worcestershire Acute “address the problems the trust cannot deal with on its own”.
The CQC’s outstanding areas of concern included:
- Patient documentation, including risk assessments, must always completed accurately and routinely to assess the health and safety of patients
- The trust must improve performance against the 18 week referral to treatment time, with the aim of meeting the trust target
- Flow in the hospital must be maintained to prevent patients being treated in the emergency department corridors for extended periods of time
- Patient privacy, dignity and confidentiality must be maintained at all times. For example, patients staying overnight in the gynaecology assessment unit
- The trust must improve performance against the national standard for cancer waiting times. This includes patients with suspected cancer being seen within two weeks and a two week wait for symptomatic breast patients
- There must be access to 24-hour interventional radiology services
- Patients under child and adolescent mental health services must receive care from appropriately trained staff at all times
- There must be an appropriate mental health room in the emergency department to care for patients presenting with mental health conditions that complies with national guidance
- There must be a robust system in place to ensure that all electrical equipment has safety checks as recommended by the manufacturer
- The trust must ensure that there is clear oversight of the deterioration of patients and that this is documented appropriately
CQC report and trust statement