Integrated provider the Isle of Wight NHS Trust and acute provider Kettering General Hospital NHS Foundation Trust in the Midlands have been placed in “special measures” by regulators.
Both trusts were rated “inadequate” overall by the Care Quality Commission, before being formally placed in the in the support scheme for struggling providers by NHS Improvement.
They join United Lincolnshire Hospitals NHS Trust and Northern Lincolnshire and Goole NHS Foundation Trust, which have both also been placed in special measures in recent days.
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The CQC carried out inspections over five days in November and January at the Isle of Wight trust, which provides acute, ambulance, community and mental health services to around 140,000 people.
Its acute services, provided at St Mary’s Hospital, and community services were rated as “requires improvement”, while its ambulance and mental health services were rated as “inadequate”.
Inspectors identified concerns about the quality and safety of services, low staff morale and an “out of touch” leadership team preventing staff from providing good services. The CQC’s new report, which was published today, also found serious concerns about the safety of mental health services.
“My inspectors found people were exposed to unacceptable risk of harm”
Immediately after the inspection, the CQC placed conditions on the registration of the trust to minimise the risk of patients being exposed to harm.
It told the trust that it must operate an effective system to prioritise patients who urgently needed access to community mental health services.
The trust was also required to carry out an urgent assessment of the physical environment on the mental health wards at St Mary’s Hospital, with a comprehensive assessment of ligature points.
The regulator was particularly scathing of the trust’s leadership, which was rated as “inadequate” and described as not always having the “necessary experience, or capability to lead effectively”.
Karen Baker, a former nurse and midwife, stood down from her role as chief executive of the trust on 31 March, ahead of the expected criticism from regulators.
In addition, inspectors described a culture of “subtle bullying” throughout the trust, with staff “working in old fashioned ways and holding up barriers to change”. Staff said morale was low, with people leaving and sickness rates going up, warned the CQC.
Inspectors also reported that the trust’s mental health and community services were facing serious challenges and were unable to safely meet the needs of patients.
Meanwhile, not all staff had the skills and knowledge required to undertake their role, with some nursing staff in acute medicine services lacking key competencies to care for patients.
However, the CQC noted there were many areas where staff were dedicated and committed to patient care, and staff did their “upmost to provide care that was compassionate”, involving patients in decision-making and providing good emotional support to patients.
Sir Mike Richards
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, noted that the Isle of Wight NHS Trust was “unique in England” in terms of the range of integrated services that it provided.
“Since our last inspection in June 2014 we have found a number of significant concerns,” he said. “My inspectors found people were exposed to unacceptable risk of harm.
“On the mental health wards, staff did not always report safeguarding incidents to their local teams and wards were not holding local records of ongoing safeguarding concern,” he said. “There was poor communication of safeguarding concerns when patients were transferred between services.”
He added: “Since this latest inspection we have been assured by the trust that there have been changes to their safeguarding procedures to ensure that incidents are properly reported and investigated.”
“It was clear staff were struggling with the demands of the service, particularly within A&E”
Meanwhile, Kettering General was told by the CQC that it needed to “make urgent improvements in a number of areas”, including accident and emergency, and children’s services.
It was rated as “inadequate” overall, and also for being safe and well-led. The trust was given a “requires improvement” rating for being effective and responsive, but “good” for being caring.
Inspections were carried out in October 2016 at the trust, which provides a wide range of services to around 320,000 people across North Northamptonshire, South Leicestershire and into Rutland.
Inspectors found several concerns in A&E, with insufficient staffing levels and no effective processes in place to ensure patients who self-presented were safe to wait up to two hours to see a clinician.
The trust must ensure that there are sufficient numbers of nursing and medical staff in adults and children’s emergency department to ensure safe care is delivered, said the CQC in its new report on the trust, which was published today.
Urgent improvements were also needed in services for children and young people, with significant risks having neither been “recognised, assessed or mitigated”.
Two more trusts placed in ‘special measures’ regime
Source: John Winterbottom
The regulator noted that a qualified children’s nurse must work in the outpatient department in accordance with Royal College of Nursing guidance.
In addition, care and treatment must be provided in a “safe way” by following the British Cardiovascular Society guidance on nurse staffing numbers in the coronary care unit.
Meanwhile, staff in medical care must follow the hospital’s policy in the safe prescribing, cancelling, handling, storage, recording and administration of medicines, and patient records must be completed with appropriate information to understand their care plans.
Inspectors did, however, identify a number of areas of “outstanding practice”, including the trust having direct access to electronic data held by community services, meaning hospital staff could access up-to-date information about patients.
The hospital had also launched a “joint school” education session for hip and knee replacement patients.
Sir Mike said: “My inspection team found that the majority of staff were hard working, passionate and caring but had to struggle against the pressures they faced.
“Feedback from patients about staff was positive but it was clear staff were struggling with the demands of the service, particularly within A&E,” he added.