Colchester Hospital University NHS Foundation Trust should remain in special measures, with staffing a key problem for the Essex provider, according to latest inspection reports from the Care Quality Commission.
After its most recent inspection in September and October 2015, the trust received an overall rating of “inadequate” from the regulator.
“We found there was a disconnect between what was happening on the frontline and the senior management team”
According to the reports on the visit, published yesterday, CQC inspectors found the trust needed to make a number of urgent improvements to ensure it was consistently delivering care that was safe, effective, caring, and responsive to patient needs.
At the time of the inspection, the CQC raised immediate concerns about standards of patient safety with the trust itself, fellow regulator Monitor, NHS England and local commissioners.
The trust was originally placed in the special measures failure regime in November 2013, following high profile concerns about patient care in cancer services.
The CQC took urgent enforcement action over urgent and emergency services and medical care departments following a visit in November 2014 and again in July 2015 because the trust failed to ensure temporary staff were suitably skilled and experienced.
Following the latest inspection, the CQC found staffing continued to be a “serious problem”.
There were not enough staff on inpatient wards to meet the needs of patients and agency staff brought in did not always have the required skills or receive effective inductions. The trust was told to address this as a matter of urgency.
Inspectors also found longstanding concerns with the hospital’s capacity. Staff had to reassess bed capacity at least three times a day and pressure on surgical services meant routine operations were frequently cancelled.
In addition, end of life care provision was judged to have deteriorated since previous inspections, with patients not receiving safe or effective care at the end of their life.
“We took immediate action to make real improvements – hiring more doctors and nurses”
Meanwhile, the CQC told the trust it must make improvements to its culture so staff felt willing to raise concerns openly, and concerns around bullying must be given sufficient priority by the board.
The trust was also told it must ensure that all staff in operational roles were educated in understanding the requirements and fundamentals of referral to treatment times, and mandatory and statutory staff training rates throughout the trust must be increased.
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “Once again, we have found a number of serious problems.
“While the staff have been working hard through many issues to drive improvements locally, their efforts have been affected by poor leadership and a high use of agency staff, some of whom are unsuitable in terms of their skills and knowledge,” he said.
“We found there was a disconnect between what was happening on the frontline and the senior management team. For example, the trust board seemed unaware of significant backlogs and patient safety concerns across outpatient services,” said Sir Mike.
He added: “The trust is now rated inadequate for safety, effectiveness responsiveness and being well-led. 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.”
Sir Mike Richards
As a result, Sir Mike said he had written to the health secretary recommending the trust remain in special measures for a period of three months during which time it will submit a weekly improvement plan to CQC.
In a response statement, trust chief executive Frank Sims, who joined the organisation on 19 October last year, pledged to use the findings of the latest visit as a “blueprint for improvement”.
“After the CQC inspection, we took immediate action to make real improvements – hiring more doctors and nurses, reducing the number of people waiting for procedures in areas such as dermatology, and introducing new levels of maintenance for equipment,” he said.
He added: “There is clearly much more to do, but I hope that patients who are using our services are already starting to see improvement.”
He highlighted that on 31 December, the trust had more registered nurses in post – 1,024 whole-time equivalents – than at any point in 2015, and 75 more than last January, a rise of 7.9%.
Mr Sims said the CQC reports would be used by the trust to update its quality improvement plan, which he is leading personally, with support from medical director Dr Angela Tillett and director of nursing Barbara Stuttle.