Hospital called ‘inadequate’

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England’s Chief Inspector of Hospitals has recommended that East Sussex Healthcare NHS Trust should be placed into special measures after publishing a second report on the quality of care provided by the trust.

The Care Quality Commission (CQC) had previously inspected the trust in September 2014, when Conquest Hospital at Hastings and Eastbourne District General Hospital were both rated “inadequate”.

A team of CQC inspectors followed this up with a further unannounced inspection in March 2015, to check on the progress which had been made to address the main areas of concern – focussing on maternity services, outpatient and diagnostic imaging services, surgery and accident and emergency care.

In a report just published, the trust has again been rated as “inadequate” overall. Although all services were rated “good” for caring, the trust has also been rated “inadequate” in safety and leadership. The full reports for each hospital and the wider trust can be found on the CQC website.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “It is clear from our most recent inspection that East Sussex Healthcare NHS Trust has been struggling to deal with deep-rooted problems which have been having an impact on its core services. I am disappointed that the trust has made too little progress in dealing with the significant issues in the underlying culture which have been all too apparent for some time.

“While I recognise that the trust has been working over the last few months to make further improvements I am chiefly concerned at the rate of progress since our inspection last year. The continuing disconnect between the trust board and staff is worrying, and I am sure lies behind the continuing poor performance.

“I know there has been some improvement; I am aware of the renewed determination by the new senior managers to take more robust and focussed action. Despite these assurances, I do not feel the improvements we have seen are nearly enough to put to rest the concerns of the people who use the services or local stakeholders. Therefore I am recommending to the NHS Trust Development Authority that this trust should be placed into special measures, which will enable it to get the support it needs.

“We will continue to monitor the trust’s performance closely. I am hopeful that when we return in the future to check again – we will find evidence of significant changes for the benefit of all who those depend on its services.”

During the inspection in March, CQC found that there was a widespread disconnect between the trust board and staff. Although the board recognised that staff engagement was an area of concern, there was no effective strategy to improve. Inspectors found that staff remained afraid to speak up or share concerns in case of repercussions.

Low staffing levels were affecting the trust’s ability to deliver efficient care. Patients were not always being seen for follow up appointments within the timescales requested by their clinician and at times clinics were cancelled at short notice. Patients were not always being informed until they arrived for their appointment.

The trust frequently breached requirements on the provision of single sex accommodation, but was not identifying or reporting this. Women and men were both accommodated overnight in the clinical decisions unit and had to walk past people of the opposite sex to use toilets and washing facilities. There was little consideration for people’s privacy in the outpatient department and radiology, where changing and waiting facilities were unsuitable, and where weighing and other procedures were carried out in corridors.

Staff remained unconvinced of the benefits of incident reporting, and were not reporting incidents or near misses in a way that would lead to the trust improving services from that learning. While there had been some improvements in maternity and surgery, learning was still limited, and lessons learned were not embedded.

In previous inspections, CQC had expressed concerns regarding the management of medicines. Checks on controlled drugs were inconsistent in the Accident and Emergency Department despite an incident of drugs going missing in one area.

The trust has been told that it must make improvements in 12 main areas, including:

  • The board must ensure it gives serious consideration to how it is going to rebuild effective relationships with its staff, the public and other key stakeholders, as required in the inspection in September 2014.
  • The board must create an organisational culture which is grounded in openness, where people feel able to speak out without fear of reprisal.
  • The trust must undertake a root and branch review across the organisation to address the perceptions of a bullying culture, as required in our previous inspection report.
  • There must be sustained compliance with the NHS National Schedule for Cleanliness.
  • The trust must ensure that health records are available and that patient data is confidentially managed.
  • Staff levels in maternity services must be reviewed to ensure that there are enough staff so that the trust meets the recommendations made by the Royal Colleges.
  • The trust must review the reconfiguration of outpatients’ services to ensure that it meets the needs of patients. The waiting times for outpatients’ appointments must be reviewed so that they meet the government’s standard waiting times.
  • The trust must reduce the proportion of outpatient clinics that are cancelled at short notice and develop systems to ensure that, where this is unavoidable, patients are informed in a timely manner.

Inspectors found that services across the trust were caring, and rated these as “good”. Throughout the inspection, staff were seen to treat patients with compassion, dignity and respect. Patients and relatives said they felt involved in their care and that they received good emotional support from staff. It was clear that staff were very committed and caring and did their best to achieve positive outcomes for patients.

The Care Quality Commission presented its findings to a local quality summit last Friday, September 18, which included 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.

(Source: Chief Inspector of Hospitals)

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