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Archived: Hinchingbrooke Health Care NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings
Important: Services have been transferred from this provider to another provider

All Inspections

Announced inspection: 10- 11th May 2016. Unannounced inspection 20th May 2016.

During an inspection looking at part of the service

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 15 and 18 September 2014 at which the trust was rated as inadequate and placed into special measures. The CQC undertook a review of the areas rated as inadequate in January 2015 to ensure the safety of patients. At this inspection we rated most elements as requiring improvement although the urgent and emergency services were rated as inadequate. We undertook a focused inspection to review all areas identified as requiring improvement or inadequate in October 2015 to monitor the trusts progress. We returned on 10 May 2016 to monitor whether the improvements seen at the previous inspection were sustained.

Since 1 April 2015 the trust has a traditional management structure of an NHS trust. The trust has a trust board and with non-executive directors. The chief executive has now been in post for nearly 10 months. The changes that had been put in place were beginning to embed and staff were aware of the process for escalating issues to the senior team. The trust were aware of challenges and had plans in place to address these. We were aware of ongoing talks with a neighbouring trusts about efficient use of resources across the county.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall the trust has a rating of ‘Good’.

Our key findings were as follows:

  • Most new systems and process were in place and these were embedded. Senior managers could articulate risks both internal and external to the organisation.
  • Some new systems in processes in the emergency department such as triaging patients arriving by ambulance were yet to be embedded.
  • There was an increased emphasis on incident reporting and disseminating learning to all areas of the trust though there were some delays in reporting incidents in surgery.
  • Medicines were well managed across the trust with consistent processes to investigate concerns.
  • Staff were caring and compassionate in their care of patients.
  • Organisational development work had significantly impacted on the trusts development into a learning organisation.
  • The emergency department continued to be under pressure through increasing volumes of attending patients and small numbers of emergency care consultants.
  • The care of patients with a mental health condition was improved in the emergency department.
  • There was an increased programme of audit including stroke audit though performance against some audits in the emergency department was below the England average.
  • Referral to treatment times (RTT) were met for medical and surgical patients.
  • There were clear visions for the services and visible leadership within the divisions.
  • The trust and individual divisions were working with other providers and stakeholders on sustainability and transformation plans. Staff and managers had plans for improving care pathways though there was some anxiety amongst staff about collaborative working with other providers.
  • There was a detailed end of life strategy in place which had received additional resourcing to meet the needs of patient and their relatives.

We saw several areas of outstanding practice including:

  • The trust employed an Admiral Nurse to support people living with dementia, their relatives and carers as well as staff. This was one of only five Admiral Nurses in acute trusts in England.
  • Staff worked with a local prison where consultants review patients that are at the end of their lives and work with prison and hospital staff to ensure that patients were safely admitted to the hospital or referred to the local hospice.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure that there are sufficient numbers of suitably qualified, skilled and experienced medical staff on duty in the emergency department. Also ensuring that there are robust contingency plans and which forecast shortages and ensure that sufficient cover is provided.
  • Ensure that the time to treatment from a clinician in the emergency department is reviewed and times to treatment are improved.
  • Ensure that the triage process for ambulance arrivals is received to ensure that the pathway for patients is safely and times of assessment accurately recorded.
  • Ensure that infection control practices within the emergency department are improved.
  • Ensure that the processes for the checking of equipment, particularly blood glucose and anaphylaxis boxes, in the emergency department is improved and safe for patients.

In addition, the trust should:

  • Review the observation and seating arrangements for the children’s area to ensure parents and children only sit in this areas.
  • Should ensure that fridge temperatures are routinely checked.
  • Should allow staff to attend and receive updated mandatory training.
  • Review the need to monitor the culture of staff within the emergency department.
  • Review the environment and provision of children’s services and where children are treated.
  • Ensure that records are used in a consistent way across wards, that they are contemporaneous; reflect patient needs and appropriate actions taken following risk assessment.
  • Review the relative risk of readmission for surgery patients as data shows this to be significantly above the England average.
  • Review the complaints process and the time taken to provide people who complain with a full response.
  • Should ensure that audits are undertaken locally within the emergency department to improve quality measurement and assurance.
  • Should ensure a consistent monitoring of preferred place of death for patients receiving end of life care.
  • Should ensure that there is a clear target for fast track discharge of patients requiring end of life care and ensure consistent monitoring of the timeliness of these discharges.

Based on the findings of this inspection I would recommend the trust be removed from special measures. However I would recommend that ongoing support continue during this period of transition.

Professor Sir Mike RichardsChief Inspector of Hospitals

20 -21 October 2015 Unannounced inspections on 26 & 27 October and 5 November 2015

During an inspection looking at part of the service

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 15 and 18 September 2014 at which the trust was rated as inadequate and placed into special measures. The CQC undertook a review of the areas rated as inadequate in January 2015 to ensure the safety of patients. At this inspection we rated most elements as requiring improvement although the urgent and emergency services were rated as inadequate. We undertook a focused inspection to review all areas identified as requiring improvement in October 2015 to monitor the trusts progress.

At our previous inspection the trust the trust had been privately managed by an independent company. This company withdrew its management of the trust at the end of March 2015. Since 1 April 2015 the trust has reverted to the traditional management structure of an NHS trust. A new board and new non-executive directors have been appointed. There is a new interim chief executive who replaces the previous chief executive. This has meant a number of changes have occurred at the trust since this time and we found a service in transition on inspection.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall, the trust has a rating of 'Requires Improvement' this despite an inadequate rating in safe.

Our key findings were as follows:

  • Due to the structural management changes that had occurred over the past six months we found a service in transition. New systems and process were in place but these had yet to be embedded.
  • Staff were caring and compassionate in their care of patients.
  • The emergency and medical services required significant improvement to ensure patients were protected from avoidable harm.
  • Services for patients at the end of their lives required improvement to ensure that patients received a safe, effective and responsive service that was well led.

We saw several areas of outstanding practice including:

  • A member of staff on Apple Tree ward had introduced ‘sensory bands’ for the ward’s dementia patients. These were knitted pockets which would be embellished with buttons and beads etc. There was an example band on display with an explanation within the ward. The intention of these sensory bands was that patients could wear or hold them to give them an immediate focus to explore.
  • Good infection prevention and control initiative including different coloured aprons for different ward bays highlighting if staff move out of these areas without removing or changing their apron.
  • The chaplaincy service continued to provide an excellent service, supportive of patients, families, carers and staff.
  • There was robust implementation of Duty of Candour.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Be able to provide assurance that all members of staff are aware of the procedure for and necessity to, report all clinical incidents and near misses in a timely and accurate manner, ensuring these are thoroughly investigated and reported externally where necessary.
  • Ensure that all staff responsible for supporting the feeding of patients have had adequate training in relation to the risks associated with various medical conditions.
  • Ensure the end of life risk register records all the relevant risks involved in delivering end of life care to patients in the hospital setting.
  • Ensure patient outcomes are monitored and audited and the information is used when reviewing the service.
  • Ensure that there is a robust incident and accident reporting system in place and that lessons learnt from investigations of reports are shared with staff to improve patient safety and experience.
  • Ensure the service has an effective governance and risk management systems that reflect current risk and is understood by all staff.
  • Ensure that environmental risk assessments are undertaken to ensure that mental health patients are safe from ligatures and self-harm within the department.
  • Ensure that there is an effective process for monitoring ECGs and observations to ensure the safety of patients.
  • Ensure that there is an immediate review of the environment and provision of children’s services.
  • Ensure that the time to treatment from a clinician in the emergency department is reviewed and times to treatment are improved.
  • Ensure that the triage process for ambulance arrivals is received to ensure that the pathway for patients is safely and times of assessment accurately recorded.
  • Ensure that infection control practices within the emergency department are improved.
  • Ensure that the processes for the checking of equipment in the emergency department is improved and safe for patients.
  • Ensure that allergies are recorded on medicines charts.

On the basis of this inspection I have recommended that Hinchingbrooke Health Care NHS Trust remains in special measures.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 - 18 September 2014 and an Unannounced Focused Inspection 2 January 2015

During an inspection looking at part of the service

The Care Quality Commission (CQC) carried out a comprehensive inspection which included an announced inspection visit between the 16 and 18 September 2014 and subsequent unannounced inspection visits on 21 and 28 September. We carried out this comprehensive inspection of the acute core services provided by the trust as part of Care Quality Commission’s (CQC) new approach to hospital inspection. We returned unannounced on 2 January 2015 to ensure that the care provided on Apple Tree and Juniper wards and in the Emergency department had improved. We did not re-inspect the whole hospital nor did we look at every aspect of care at this inspection. We reviewed many aspects of the domains of safe and well led in the Emergency services, safe caring and well led in Medicine and caring in Surgery as these were all previously rated as inadequate. We did not reassess the well led domain at our focused inspection in January 2015 , as we know that the trust is undergoing a major change in management and that a governance review is being undertaken. We will return to the trust to undertake a further inspection of this domain.Where we inspected we have amended the report in line with our most recent findings.

Hinchingbrooke Hospital is an established 304 bed general hospital, which provides healthcare services to North Cambridge and Peterborough. The trust provides a comprehensive range of acute and obstetrics services, but does not provide inpatient paediatric care, as this is provided within the location by a different trust. The trust is the only privately-managed NHS trust in the country, being managed by Circle since 2012.The Trust's governance is derived from the Franchise Agreement and Intervention Order approved by the Secretary of State for Health. This approach empowers all members of staff to take accountability and responsibility for the planning and implementing of a high quality service.

Prior to undertaking the inspection in September 2014 we spoke with stakeholders and reviewed the information we held about the trust. Hinchingbrooke Health Care NHS Trust had been identified as low risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was in band 6, which is the lowest band.

The hospital was first built in the 1980s. It was the first trust in the country to be managed by an independent healthcare company, Circle, which occurred in February 2012. It is led by a multidisciplinary team of clinical and non-clinical executives partnered with a non-executive Trust Board. However we found that the trust was predominantly medically led but a new director of nursing had been appointed four months prior to our visit and was beginning to address the input of nursing within the hospital.

We found significant areas of concern during our inspection visit In September 2014 which we raised with the chief executive, director of nursing, head of midwifery and the chief operating officer of the trust and the next day with the NHS Trust Development Authority. We were concerned about patients safety and referred a number of patients to the Local Authority safeguarding team. Since the inspection the Trust Development Authority have given the trust significant support to address the issues raised in this report. CQC served a letter which informed the trust of the nature of our concerns in order that action could be taken in a timely manner. CQC also requested further information from the trust as we considered taking urgent action to reduce the number of beds available on Apple Tree Ward. However the trust took the decision to reduce the number of beds as part of their action plan and so this regulatory action was therefore not necessary. The matter has been kept under review and the CQC has undertaken two unannounced inspections, attended the Annual Public Meeting [i.e. the Annual General Meeting] on 25 September 2014 and held two follow up meetings with the trust to ensure that action have been taken.

We returned unannounced on 2 January 2015 to review progress made in Apple Tree and Juniper wards and in the A&E department in respect of the inadequate ratings. We found that improvements had been made in respect of the inadequate ratings for medicine and surgery but that there was little or no improvement within the emergency department. We have rated the domains of safe, caring and well led in medicine and caring in surgery as requiring improvement but the emergency department remains inadequate for well led but has moved to requires improvement in safe. Overall the location is now rated as requires improvement however we did not inspect the provider in terms of the well led domain as we were aware that they were undertaking a governance review and significant changes were planned to occur.

Our key findings were as follows:

  • We found many instances of staff wishing to care for patients in the best way, but unable to raise concerns or prevent service demands from severely impinging on the quality and kindness of care for patients. In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • In September 2014 we found that the provision of care on Apple Tree Ward, a medical ward, was inadequate and there were risks to patient safety. This required urgent action to address the concerns of the inspection team. We re inspected this area in September 2014 and in January2015 and found that the hospital had taken action. We found that risks to patient safety were reduced on this visit.
  • In September 2014 we found that there was a lack of paediatric cover within the A&E department and theatres that meant that the care of children in these departments was, at times, increasing potential risks to patient safety. However the trust took immediate action and employed temporary paediatric staff. The trust has since appointed permanent paediatric start who should be in place by the end of February 2015. Therefore mitigating the risks in this area, however we have yet to be assured that the risks are sufficiently mitigated.
  • The senior management team of the trust are well known within the hospital; however, the values and beliefs of the trust were not embedded, nor were staff engaged or empowered to raise concerns by taking responsibility to 'Stop the Line'. Stop the line is a process which empowers all members of staff to raise immediate concerns when they believe that patient safety is being compromised. Initiating a "Stop the Line" facilitates management support to the area identified and action to address the issue. We did not review this issue in January 2015 as we were aware that the trust was reviewing their governance systems.
  • In September 2014 we found that there was a lack of knowledge around Adult Safeguarding procedures, Mental Capacity Act and Deprivation of Liberty processes. The trust has taken action to improve the knowledge of staff in these areas however we did not inspect all areas of the trust in January 2015.
  • In September 2014 we found that response to call bells in a number of areas, in Juniper Ward, Apple Tree ward and the Reablement Unit for example, was so poor that two patients of the 53 we spoke to in the medical and surgical areas stated that they had been told to soil themselves. A further one patient advised that they had soiled themselves whilst awaiting assistance. We brought this to the attention of the trust and they investigated. However neither CQC nor the trust could corroborate these claims. Since September we have had information of concern that supports that this was still occurring in November 2014. At our January 2015 inspection we found that responses to call bells had improved on the two wards we inspected.
  • In September 2014 we found that risk assessments were not always reflective of the needs of patients in surgery and medical wards. This was evidenced by review of 46 sets of notes of which 19 were found to have incomplete information or review. At our inspection in January 2015 we reviewed eight sets of notes and found that risk assessments continued to be poorly documented and personalised to individual patients.
  • In September 2014 we found that infection control practices were not always complied with in A&E Apple Tree ward, Cherry Tree ward, Walnut ward and in the Treatment Centre. When we inspected Apple Tree ward in January 2015 we noted significant improvements in infection control practices.
  • In September 2014 we found that medicines, including controlled drugs, were not always stored or administered appropriately in A&E, Juniper ward, Apple Tree ward or Cherry Tree ward. When we inspected in January 2015 we found that medicines in A&E, Apple Tree and Juniper wards had improved but required action to be taken to ensure the safety and efficacy of medication.

In September 2014 we saw several areas of good practice, which we did not reinspect in January 2015, including:

  • In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • The paediatric specialist nurse in the emergency department was dynamic and motivated in supporting children and parents. This was seen through the engagement of children in the local community, in a project to develop an understanding of the hospital from a child’s perspective, through the '999 club'.
  • The support that the chaplaincy staff gave to patients and hospital staff was outstanding. The chaplain had a good relationship with the staff, and was considered one of the team. The number of initiatives set up by the chaplain to support patients was outstanding.

However, there were also areas of poor practice, where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure all patients health and safety is safeguarded, including patient’s nutrition and hydration needs are adequately monitored and responded to.
  • Ensure that staffing levels and skill mix on wards is reviewed and the high usage of agency and bank staff to ensure that numbers and competencies are appropriate to deliver the level of care Hinchingbrooke Hospital requires.
  • Ensure records, including risk assessments, are completed, updated and reflective of the needs of patients.
  • Ensure that there are sufficient appropriately skilled nursing staff on medical and surgical wards to meet patients’ needs in a timely manner.
  • Ensure medicines are stored securely and administered correctly in the Emergency department and that liquid preparations are marked with opening dates in the medical and surgical wards.
  • Ensure that all staff are trained in, and have knowledge of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).
  • Ensure that patients are treated with dignity and respect in the Emergency department.
  • Ensure that all staff are adequately supported through appraisal, supervision and training to deliver care to patients.
  • Ensure pressure ulcer care is consistently provided in accordance with National Institute for Health and Care Excellence (NICE) guideline CG:179.
  • Ensure that catheter and intravenous (IV) care is undertaken in accordance with best practice guidelines.
  • Ensure patients are treated in accordance with the Mental Capacity Act 2005.
  • Ensure that the staff to patient ratio is adjusted to reflect changing patient dependency.
  • Review the ‘Stop the Line’ procedures and whistle blowing procedures, to improve and drive an open culture within the trust.
  • Standardise and improve the dissemination of lessons learnt from incidents to support the improvement of the provision of high quality care for all patients.
  • Ensure that all appropriate patients receive timely referral to the palliative care service.
  • Ensure action is taken to improve the communication with patients, to ensure that they are involved in decision-making in relation to, their care treatment, and that these discussions are reflected in care plans.
  • Review mechanisms for using feedback from patients, so that the quality of service improves.
  • Ensure that the checking of resuscitation equipment in the A&E department, and across the trust, to ensure that it occurs as per policy.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16-18 Sept; Unannounced inspections: 21 and 28 Sept 2014

During a routine inspection

The Care Quality Commission (CQC) carried out a comprehensive inspection which included an announced inspection visit between the 16 and 18 September 2014 and subsequent unannounced inspection visits on 21 and 28 September. We carried out this comprehensive inspection of the acute core services provided by the trust as part of Care Quality Commission’s (CQC) new approach to hospital inspection.

Hinchingbrooke Hospital is an established 304 bed general hospital, which provides healthcare services to North Cambridge and Peterborough. The trust provides a comprehensive range of acute and obstetrics services, but does not provide inpatient paediatric care, as this is provided within the location by a different trust. The trust is the only privately-managed NHS trust in the country, being managed by Circle since 2012.The Trust's governance is derived from the Franchise Agreement and Intervention Order approved by the Secretary of State for Health. This approach empowers all members of staff to take accountability and responsibility for the planning and implementing of a high quality service.

Prior to undertaking this inspection we spoke with stakeholders and reviewed the information we held about the trust. Hinchingbrooke Health Care NHS Trust had been identified as low risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was in band 6, which is the lowest band.

The hospital was first built in the 1980s. It was the first trust in the country to be managed by an independent healthcare company, Circle, which occurred in February 2012. It is led by a multidisciplinary team of clinical and non-clinical executives partnered with a non-executive Trust Board.However we found that the trust was predominantly medically led but a new director of nursing had been appointed four months prior to our visit and was beginning to address the input of nursing within the hospital.

We found significant areas of concern during our inspection visit which we raised with the chief executive, director of nursing, head of midwifery and the chief operating officer of the trust and the next day with the NHS Trust Development Authority. We were concerned about patients safety and referred a number of patients to the Local Authority safeguarding team. Since the inspection the Trust Development Authority have given the trust significant support to address the issues raised in this report. CQC served a letter which informed the trust of the nature of our concerns in order that action could be taken in a timely manner. CQC also requested further information from the trust as we considered taking urgent action to reduce the number of beds available on Apple Tree Ward. However the trust took the decision to reduce the number of beds as part of their action plan and so this regulatory action was therefore not necessary. The matter has been kept under review and the CQC has undertaken two unannounced inspections, attended the Annual Public Meeting [i.e. the Annual General Meeting] on 25 September 2014 and held two follow up meetings with the trust to ensure that action have been taken.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each core service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall; the trust has a rating of 'inadequate'.

Our key findings were as follows:

  • We found many instances of staff wishing to care for patients in the best way, but unable to raise concerns or prevent service demands from severely impinging on the quality and kindness of care for patients. In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • The provision of care on Apple Tree Ward, a medical ward, was inadequate and there were risks to patient safety. This required urgent action to address the concerns of the inspection team.
  • There was a lack of paediatric cover within the A&E department and theatres that meant that the care of children in these departments was, at times,increasing potential risks to patient safety.
  • The senior management team of the trust are well known within the hospital; however, the values and beliefs of the trust were not embedded, nor were staff engaged or empowered to raise concerns by taking responsibility to 'Stop the Line'. Stop the line is a process which empowers all members of staff to raise immediate concerns when they believe that patient safety is being compromised. Initiating a "Stop the Line" facilitates management support to the area identified and action to address the issue.
  • There was a lack of knowledge around Adult Safeguarding procedures, Mental Capacity Act and Deprivation of Liberty processes.
  • A response to call bells in a number of areas, in Juniper Ward, Apple Tree ward and the Reablement Unit for example, was so poor that two patients of the 53 we spoke to in the medical and surgical areas stated that they had been told to soil themselves. A further one patient advised that they had soiled themselves whilst awaiting assistance. We brought this to the attention of the trust and they investigated. However neither CQC nor the trust could corroborate these claims.
  • Risk assessments were not always reflective of the needs of patients in surgery and medical wards. This was evidenced by review of 46 sets of notes of which 19 were found to have incomplete information or review.
  • Infection control practices were not always complied with in A&E Apple Tree ward, Cherry Tree ward, Walnut ward and in the Treatment Centre.
  • Medicines, including controlled drugs, were not always stored or administered appropriately in A&E, Juniper ward, Apple Tree ward or Cherry Tree ward.

We saw several areas of good practice including:

  • In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.
  • The paediatric specialist nurse in the emergency department was dynamic and motivated in supporting children and parents. This was seen through the engagement of children in the local community, in a project to develop an understanding of the hospital from a child’s perspective, through the '999 club'.
  • The support that the chaplaincy staff gave to patients and hospital staff was outstanding. The chaplain had a good relationship with the staff, and was considered one of the team. The number of initiatives set up by the chaplain to support patients was outstanding.

However, there were also areas of poor practice, where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure all patients health and safety is safeguarded, including ensuring that call bells are answered in order to meet patients’ needs in respect of dignity, and patient’s nutrition and hydration needs are adequately monitored and responded to.
  • Ensure that staffing levels and skill mix on wards is reviewed and the high usage of agency and bank staff to ensure that numbers and competencies are appropriate to deliver the level of care Hinchingbrooke Hospital requires.
  • Ensure that the arrangements for the provision of services to children in A&E, operating theatres and outpatients areas provided by the trust, is reviewed to ensure that it meets their needs, and that staff have the appropriate support to raise issues on the service provision.
  • Ensure records, including risk assessments, are completed, updated and reflective of the needs of patients.
  • Ensure the care pathways, including peadiatric pathways, in place are consistently followed by staff.
  • Ensure an adequate skill mix in the emergency department and theatres to ensure that paediatric patients receive a service that meets their needs in a timely manner.
  • Ensure that there are sufficient appropriately skilled nursing staff on medical and surgical wards to meet patients’ needs in a timely manner.
  • Ensure medicines are stored securely and administered correctly.
  • Improve infection control measures in the Emergency department and medical wards to protect patients from infection through cross contamination.
  • Ensure staff are trained in, and have knowledge of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).
  • Ensure that patients are treated with dignity and respect.
  • Ensure that all staff are adequately supported through appraisal, supervision and training to deliver care to patients.
  • Ensure pressure ulcer care is consistently provided in accordance with National Institute for Health and Care Excellence (NICE) guideline CG:179.
  • Ensure that catheter and intravenous (IV) care is undertaken in accordance with best practice guidelines.
  • Ensure patients are treated in accordance with the Mental Capacity Act 2005.
  • Ensure that the staff to patient ratio is adjusted to reflect changing patient dependency.
  • Review the ‘Stop the Line’ procedures and whistle blowing procedures, to improve and drive an open culture within the trust.
  • Standardise and improve the dissemination of lessons learnt from incidents to support the improvement of the provision of high quality care for all patients.
  • Ensure that all appropriate patients receive timely referral to the palliative care service.
  • Ensure action is taken to improve the communication with patients, to ensure that they are involved in decision-making in relation to, their care treatment, and that these discussions are reflected in care plans.
  • Review mechanisms for using feedback from patients, so that the quality of service improves.

In addition, the trust should:

  • Review the checking of resuscitation equipment in the A&E department, and across the trust, to ensure that it occurs as per policy.
  • Take action to reduce the overburdensome administration processes when admitting patients into the acute assessment unit (AAU).
  • Review intentional rounding checks to ensure that they cover requirements for meeting patient’s nutrition and hydration needs.
  • Involve patients in making decisions about their care in the A&E department.
  • Review the training given to staff, and the environment provided, for having difficult discussions with patients.
  • Review translation usage in A&E, to ensure that patients receive information appropriate to their needs.
  • Provide adequate training on caring for patients living with dementia, to improve the service to patients living with dementia.
  • Discontinue the practice of adapting day rooms in rehabilitation wards to use as additional inpatient bed spaces.
  • Review the clinical pathways for termination of pregnancies in the acute medical area.
  • Review the policy on moving patients late at night.
  • Review the out-of-hours arrangements for diagnostic services, such as radiology and pathology, to ensure that patients receive a timely service.
  • Review mechanisms for fast track discharge, so that terminally ill patients die in a place of their choice.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.