The Royal Cornwall Hospitals NHS Trust has been placed in special measures after the Care Quality Commission identified serious failings - likely to have led to patient deaths - and unsafe staffing levels at some of the services run by the organisation.
Inspectors, who visited the organisation in July to see if improvement has been made since 2016, found that the Royal Cornwall Hospital in particular was providing an “inadequate” service overall.
“Despite their best efforts Royal Cornwall Hospitals has a history of poor performance, with a failure to make improvements over a number of years”
Its surgery, maternity and gynaecology, end of life and outpatient services were all given the lowest rating.
Ophthalmology and cardiology patients at the hospital suffered harm because of longs waits for treatment, according to the CQC.
In cardiology, from December 2016 to June 2017, 554 patients had been delayed past their agreed date for follow-up appointments.
Two patients died of cardiac-related causes while delayed on the waiting list, said the CQC.
“While it is not possible to say the deaths were directly linked to the delay, the trust reported it was highly likely,” it added.
During the first six months of 2017, four ophthalmology patients lost whole or partial sight due to long waits for follow-up appointments, said the CQC.
Meanwhile, in surgery, across four areas nurse vacancies ranged from 11% to 23%.
“We could not be assured that community midwives had the necessary equipment to manage obstetric or neonatal emergencies”
CQC report on Royal Cornwall Hospital
“We saw during April to June 2017, the surgical wards were consistently under plan for nurses on shift during the day, with the exception of Wheal Coates,” said the CQC in its report on the hospital.
There were also insufficient numbers of suitably qualified nursing staff in the paediatric emergency department to provide safe care at all times, said inspectors.
Other problems included there being no clear nursing observation area on the high dependency unit of the children’s ward. Inspectors said this represented a risk to children, who were not visible to nursing staff at all times.
Maternity, outpatients, end-of-life and diagnostic imaging departments were also compromised by staff shortages.
Maternity was a particular concern with not enough midwives and no process to ensure that that there was always a nurse or midwife on duty with the skills to manage high dependency women, the CQC report said.
In addition, community midwives did not have training to cannulate women, and not all were up to date with neonatal life support training.
“Throughout our inspections, we have invariably found the staff to be caring and compassionate”
“We could not be assured that community midwives had the necessary equipment to manage obstetric or neonatal emergencies in the community in the event that the ambulance was delayed,” said the report.
However, the latest inspection of the trust found services provided at its St Michaels Hospital in Hayle and at West Cornwall Hospital in Penzance were “good” overall. The trust’s Penrice Birthing Centre at St Austell has been assessed as “requires improvement”.
CQC chief inspector of hospitals, Professor Ted Baker, criticised ineffective management systems and a lack of oversight by the trust’s board for consistently failing to improve standards – but praised staff for their caring attitude.
“Throughout our inspections, we have invariably found the staff to be caring and compassionate,” he said.
“Despite their best efforts Royal Cornwall Hospitals has a history of poor performance, with a failure to make improvements over a number of years. The time has now come to bring in external support - which is why I am recommending that the trust goes into special measures,” he added.
“We take the CQC report very seriously and I want to apologise to any patient who has not received the very best care”
“I am determined that we will continue to monitor the trust’s progress, in partnership with [regulator] NHS Improvement and NHS England and in due course we will return to check that the improvements have been made,” he said.
Royal College of Nursing regional officer Steve Pulsford said nursing staff were doing a good job in very difficult circumstances.
Staff should feel proud that their care has been rated a ‘good’ while the trust is clearly struggling,” he said.
Royal Cornwall Hospitals NHS Trust chief executive Kathy Byrne said it was responding “swiftly and effectively” to the CQC recommendations.
“We take the CQC report very seriously and I want to apologise to any patient who has waited too long for treatment or not received the very best care,” she said.
“We have now established a stable senior leadership team and we want good clinical leadership to be at the heart of our quality improvement programme.
“We thank patients for their continued support for our caring and dedicated staff, which has been rightly recognised by the CQC,” she added.