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Kettering exits special measures but has room to improve on nursing

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Kettering General Hospital NHS Foundation Trust has been told it still needs to improve some aspects of basic nursing care, having just been removed from “special measures”.

Hospital inspectors found the East Midlands trust, which was first rated “inadequate” and placed into the special measures scheme in April 2017 after an inspection back in October 2016, had made steady improvements in care.

“We observed both nursing and medical staff not adhering to appropriate hand hygiene practice”

CQC report

After visits in January, February and March this year, the Care Quality Commission upgraded the trust’s overall rating to “requires improvement” and recommended it exit special measures status.

As a result, its removal from the support scheme for struggling service providers has now been confirmed by NHS Improvement and NHS England.

CQC inspectors said they found the trust now had a “clear vision and strategy” developed with frontline workers and a “positive culture that supported and valued staff”.

They also found staff “cared for patients with compassion” and worked well together in a range of services they visited.

“Doctors, nurses and other healthcare professionals supported each other to provide good care,” said the CQC’s report.

However, inspectors went on identify a range of areas where further improvements were needed, including when it came to ensuring nursing risk assessments and safety checks were carried out.

They found patients arriving in urgent care under their own steam “did not always receive initial assessment and observations in a timely way”.

“While staff kept records of patients’ care and treatment, some of them did not contain all the information required. The completion of nursing risk assessments, care planning or fluid balance charts were not consistently carried out,” added the report.

While staffing levels were generally okay, inspectors found the medical division “did not have enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment”.

Nurse vacancy rates were “significantly higher than the trust’s average” and inspectors noted “a high proportion of staff were bank or agency staff”.

Meanwhile, inspectors also raised concerns about some aspects of infection control in medical care.

“We observed both nursing and medical staff not adhering to appropriate hand hygiene practice,” said the report.

Other issues raised included gaps in mandatory training. For example, inspectors found not all nursing staff in emergency and nursing care had completed training in medicines management and sepsis.

The areas inspected also included maternity, outpatients and diagnostic imaging, while the trust’s leadership and use of resources were also examined.

Examples of outstanding practice highlighted in the report included maternity care, which was praised for achieving the top level of the UNICEF baby friendly initiative.

“Women who used the maternity service were supported to live healthier lives and manage their own health, care and wellbeing,” said the report.

Outpatient services were commended for excellent practice in the way chemotherapy was delivered and for improvements in how clinics were organised spearheaded by the outpatient matron.

This included a review of the way rooms were being used and nursing rotas, as well as a new system of regular meetings, with speciality matrons in advance of appointments.

“Managers told us this had given them assurance that that they were making the best use of their two most valued commodities; staff and clinic space, to enable them to provide more clinics to more patients,” said the report.

Evidence seen by inspectors showed an extra 4,787 extra patients had been seen from July to September 2018 as a result of identifying spare capacity in clinics.

“We will be working down that list and addressing all of the matters raised”

Leanne Hackshall

Overall, the trust was rated “good” for being caring and well-led and “requires improvement” for safety, effectiveness and being responsive.

The hospital trust’s director of nursing and quality, Leanne Hackshall, said staff were working to address issues raised in the report.

She said: “The report does list areas where we can improve our care and our processes and we will be working down that list and addressing all of the matters raised.

“Themes have included the need to continue to focus on staff training; being thorough in delivering the basics of care, such as patient assessments, documentation and privacy and dignity, and also improving our facilities,” she said.

“We will be working to address all of these issues and I think both our digital transformation and forthcoming estates strategy will help with this – along with the usual actions we would take to address specific matters,” she added.

Trust chief executive Simon Weldon said he was pleased the CQC, NHS England and NHS Improvement had recognised the progress made by the organisation and praised staff for their hard work and dedication.

“I would like to thank all staff for their commitment over the past year – this achievement really belongs to them. Their dedication and strong desire to provide good care for our patients shines through in this report,” he said.

“I also acknowledge the further challenges ahead,” he said. “I know there is more hard work that we need to do to continue our journey and the CQC has clearly set out the issues that we need to address.”

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