England’s Chief Inspector of Hospitals has recommended that North Cumbria University Hospitals NHS Trust should remain in special measures following its latest inspection by the Care Quality Commission.
Inspectors found that while the trust had made significant improvements in surgery, outpatients, and services to children and young people, concerns remained in other areas, particularly in medical care.
Overall both West Cumberland Hospital, Whitehaven, and Cumberland Infirmary, Carlisle, have been rated Requires Improvement. Medical care at West Cumberland Hospital has been rated Inadequate.
The trust had been placed into special measures two years ago by Sir Bruce Keogh because of concerns about mortality rates and standards of care.
Professor Sir Mike Richards, the Chief Inspector of Hospitals, said:
“In the past two years there have been significant changes to the senior management team at North Cumbria University Hospitals NHS Trust. The team has worked well together, with external support, to address the issues identified in both the Keogh Review and in our inspection last year.
“While the trust continues to make progress, I remain particularly concerned by its difficulties in the recruitment and retention of doctors and nursing staff, and the impact this is having on the quality and timeliness of services for patients.
“Importantly, mortality rates are now within expected limits and generally, patient outcomes compare well with the national averages. However, the trust is still struggling to meet national waiting targets and there are too many patients waiting for a bed on the right ward at the right time..
“I recognise that North Cumbria’s geography creates its own challenges. Nevertheless it is clear that the trust cannot solve these important issues on its own, and will require continued support for the foreseeable future. Others with a responsibility for health services in the area need to help address the problems the trust cannot deal with on its own. In these circumstances, it would not be appropriate to recommend that the trust leave special measures.”
North Cumbria University Hospitals NHS Trust was placed into special measures by Sir Bruce Keogh in July 2013. After a further inspection last year rated the trust as Requires Improvement, Sir Mike recommended that the trust should remain in special measures.
Following the latest inspection, in March and April, the trust has now been rated as Requires Improvement overall. The trust has been rated Good for being Caring. The full reports and ratings are available at http://www.cqc.org.uk/provider/RNL
The inspectors found that the trust remained under pressure from the number of admissions through the accident and emergency departments, with both hospitals struggling to meet Department of Health targets to admit, transfer or discharge patients within four hours of arrival.
Patients were often placed in wards and areas that were not best suited to their needs, or moved from ward to ward. Some operations were cancelled because beds were not available, and patients were waiting too long from referral to treatment.
Despite efforts by the trust to recruit consultants, there were too many vacancies, which were affecting waiting times, and meant that junior doctors were not fully supported in some core services. The numbers of nurses had improved, but there were times when wards and departments were not adequately staffed, presenting a risk to patient safety. It was clear to the inspectors that staff at all levels in the trust felt passionately about improving care and were very proud of their achievements.
There had been three Never Events since March 2014. Although serious incidents were properly investigated, the figures suggested that that not all incidents were being reported.
Both hospitals were visibly clean, infection rates were within acceptable limits, and patients’ outcomes for a range of surgery were similar to or better than the national average.
CQC has told the trust it must make improvements in a number of areas:
- The trust must ensure that medical staffing is sufficient to provide appropriate and timely treatment and review of patients at all times including out of hours.
• Medical staffing must be appropriate at all times including medical trainees, long-term locums, middle-grade doctors and consultants.
• Nursing staffing levels and skill mix must be appropriate particularly in medical care services
• The trust must take action to improve the levels of mandatory training the completion of staff appraisals.
• Patient flow throughout both hospitals must improve to ensure patients are cared for on the appropriate ward for their needs and reduce the number of patient bed moves, particularly in the medical division.
• The trust must improve the rate of incident reporting
The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
David Blacklock, Chief Executive Officer for Healthwatch, said:
“We are pleased that the hard work of the staff at both hospital sites has been recognised and that some improvements have been achieved. However, as we are out and about in communities listening to experiences all the time, we know that all people are still not receiving the care and treatment that they deserve.
Clearly the fact that the Trust has remained in special measures and the announcement that national support is now being focused on north and west Cumbria through the Success Regime will mean that opportunities for further improvements to address continued concerns will be accelerated. We are making sure that people are central to these discussions going forward”.