An acute trust which had previously struggled with both financial and performance problems will come out of special measures following a Care Quality Commission inspection.
NHS Improvement has confirmed that Wye Valley Trust will exit special measures following a recommendation from the CQC’s chief inspector of hospitals.
The trust had been rated inadequate since October 2014, but there was strong evidence that Wye Valley Paddy improved its operation.
Progress made at the trust led to it being rated good for such areas as critical and end of life care.
However, as with most assessments there are still areas of improvement required by the trust, and thus it was rated inadequate for the level of responsiveness demonstrated.
Surgery, gynaecology and outpatient appointments also require attention.
But the Care Quality Commission was satisfied that sufficient progress had been made for the trust to be removed from special measures, with a process of assessment ongoing in accordance with this recommendation.
CQC Chief inspector of hospitals, Professor Sir Mike Richards, outlined the view of the commission.
“There clearly remain areas where further work is needed, in particular with regard to the trust’s responsiveness in accident and emergency, bed occupancy concerns and referral to treatment times, but we found considerable and positive change had taken place. Morale had significantly improved and there was a sense of pride amongst staff towards working in the hospital who felt respected and valued.”
Richards went on to state that those working at Wye Valley Trust deserve accreditation.
“The trust’s staff and leadership should be proud of their achievement so far and they know what to do now to ensure those changes takes place. We will continue to monitor the trust and this will include further inspections.”
NHS Improvement delivery and improvement director, Jeffrey Worrall, was equally keen to acknowledge the developments and progress made by the trust.
“Today’s news shows just how far the trust has come and recognises the hard work of staff at all levels of the organisation. We have to make sure that the trust can build on the excellent progress that’s been made in improving services and ensure the trust is sustainable in the longer term. Strengthening the partnership between Wye Valley and South Warwickshire NHS Foundation Trust is an important step forward.”
Trust chief executive Richard Beeken reflected on a job well done, while also outlining plans for the future.
“This outcome is great news for the residents of Herefordshire and those across our borders who use our services. The report confirms that substantial improvements have been made in many areas – and once again our quality of care has been rated as good throughout the trust. However, these improvements are only part of the answer to the sustainable delivery of high quality, safe services in the county.”
NHS Improvement is the operational name for an organisation that brings together: Monitor, NHS Trust Development Authority, Patient Safety (from NHS England), National Reporting and Learning System, Advancing Change Team and Intensive Support Teams, formed on 1st April this year.
Norfolk and Suffolk Foundation Trust has been removed from special measures after demonstrating a serious improvement in its performance.
The FT had been in the unenviable position of being the only mental health trust to receive the lowest Care Quality Commission rating back in October 2014.
Following this inspection, the trust was placed in special measures in February 2015.
NHS Improvement has now indicated that it will remove the special measures mandate, after the Norfolk and Suffolk Foundation Trust improved in several categories.
Nonetheless, the trust was still rated inadequate for whether services are safe.
NHS Improvement and the trust will now agree an action plan to address the safety concerns, which include:
– a number of environmental safety concerns including ligature points;
– mixed sex accommodation not meeting national guidance;
– concerns about the design of seclusion and places of safety, and seclusion not being managed within the Mental Health Act code of practice; and
– staffing levels being insufficient on inpatient wards.
NHS Improvement’s delivery and improvement director for the East of England, Frances Shattock, outlined some of the positive progress made by the trust since it has been reported on so damningly.
“There is clearly much more to do to ensure that the trust sustains and builds on these improvements. We will continue to provide the trust with extensive support to ensure it is able to give the standard of care patients expect.”
Following further inspections at the trust in July and August, CQC investigators discovered that “considerable progress” had been made, in line with the recommendations of the inspectorate.
And Chief Inspector of Hospitals, Professor Sir Mike Richards, recommended the trust be taken out of special measures after finding it had “clearly gained from the intensive support of the regime”.
Richards was pleased that the mental health trust is heading in the right direction.
“Our return to Norfolk and Suffolk Foundation Trust showed significant improvement had taken place. There clearly remain areas where further work is needed, in particular with regard to how the trust manages risks to people’s safety, but we found considerable and positive change had taken place”.
The Chief Inspector of Hospitals particular noted the improvement in the perspective of staff.
“Morale had significantly improved, there were better systems for recording and learning from incidents and people’s needs were assessed, with care and treatment planned to meet those needs.”
Chief executive of the Norfolk and Suffolk Foundation Trust, Michael Scott, noted that “what we have done is engage much more with our workforce – that has been the secret of our success. That has allowed us to deliver the quality improvements the CQC have seen. What we done already is a significant cultural change, that’s what’s most pleasing.”
The first NHS hospital to be placed completely under private management has been rated as good as following two years in special measures.
But regulators still ruled that Hinchingbrooke Hospital must improve its emergency care.
Hinchingbrooke was placed in special measures in September 2014.
At that time it was run by Circle Health, but the hospital returned to NHS control in April 2015.
But the Care Quality Commission (CQC) inspected the hospital back in May, and discovered that significant improvements have been made to the condition of service.
Hospital chairman Alan Burns believes that the verdict of the Care Quality Commission represents “a terrific vote of confidence in our staff”.
While the Accident and Emergency department still requires improvement, Burns stated that the rapid escalation in the number of patients, coupled with national staff shortages, had scuppered attempts at Hinchingbrooke to improve the situation.
But in assessing the quality of care at the hospital, the commission discovered that there is outstanding practice at the trust.
The CQC report particularly focused on its end-of-life care for patients at a local prison and the employment of an Admiral Nurse to support people with dementia.
Inspectors also reported that the quality of conduct from staff had impressed them, with a caring and compassionate attitude particularly prevalent.
Management of the hospital also received praise, despite the criticism of Accident and Emergency.
The A&E department “is as good as any around,” sccording to the aforementioned Burns.
And the Chief Executive suggested that the 50,000 patients it was forced to deal with over the last year is simply unrealistic and has led to difficulties.
Indeed, Burns went as far as praising those working in A&E at the hospital, assessing that they “have done remarkably well shifting the department from inadequate to needs to improvement”.
The hospital chairman commented that “[demand] has gone up 8% this year and we have two-and-a-half consultants on our books, compared to the six we should have. The problems here are problems in every A&E department in the country”.
CQC deputy chief inspector of hospitals Edward Baker stated that “the trust leadership knows what it must do now to ensure further positive change takes place.”
Recent statistics have indicated that very few organisations in the existing NHS have been able to acquire an outstanding rating from the Care Quality Commission.
Some experts have thus criticised the assessment process of inspecting organisations as being excessively stringent.
Inspection by the Care Quality Commission has resulted in a major NHS service being placed into special measures.
England’s Chief Inspector of General Practice found that the performance of the Peterborough out-of-hours service was below the required standard, and instantly imposed the extraordinary conditions with the hope of improving the situation.
The out-of-hours service provides urgent medical care outside of normal GP hours.
Inspections of the service found that it was utterly inadequate, with safety, efficiency and leadership problems all cited as being problematic.
There was only one crumb of comfort for the Peterborough-based service; it was rated as good for providing caring services.
This does at least suggest that the fundamental purpose of the organisation is being met to a certain degree.
However, the report from the Care Quality Commission identifies a number of areas where improvements must be made.
Nurses did not have access to adequate guidance and there was no evidence that they had been properly trained to deal with certain types of demanding calls.
There were also massive problems with recruitment procedures, and staff files were not kept up to date adequately.
Inspectors were also concerned that the service failed to deliver efficient and timely care and treatment to patients, with response times also rather inconsistent.
And despite the inadequate service that the out-of-hours service is currently providing, there was no evidence of a coherent plan to improve the situation.
Following the inspection, the Care Quality Commission shared its concerns and conclusions with numerous key stakeholders including Trust Development Authority, NHS England and Cambridgeshire and Peterborough CCG.
The trust has already submitted an action plan in response to these concerns, which attempts to address the issues raised by those who inspected the facility.
Commenting on the issue, Janet Williamson, Deputy Chief Inspector of General Practice and Dentistry in CQC’s Central region, provided her take on the problems.
“We found that patients were at risk because systems were not always in place to keep them safe. The provider must ensure that all staff who triage patients have been adequately trained to make clinical decisions by telephone and have been assessed. The service must ensure that the time patients wait for thorough clinical assessment is properly monitored to ensure patient care does not suffer. There must be enough staff on site to keep people safe.”
Williamson also outlined what the commission expects to see achieved in the future.
“Clear arrangements must be put in place to ensure that managers have effective oversight of the performance of the out-of-hours service at all times so that they can take appropriate action to minimise the risks to patients. It is important that the people who use the GP out-of-hours service for Peterborough and surrounding area can rely on getting the high quality care which everyone is entitled to.”
And concluded by explaining the situation going forward.
“We will continue to monitor this service and we will inspect again in six months to check whether improvements have been made. I hope that the service will take the necessary steps, but if we find that the service remains inadequate, we will consider taking further action.”
Dr Neil Modha, Chief Clinical Officer for the Cambridgeshire and Peterborough CCG, acknowledged the problems and resolved to make improvements.
“The CCG has worked closely with CCS since the inspection to ensure implementation of their recovery plan and we have been pleased with the progress and improvements in areas where quality of care were of concern. We will continue to monitor this progress so we can be assured that patients are receiving the high standard of out-of-hours care that we expect.”
Health sector regulator Monitor has placed Norfolk and Suffolk NHS Foundation Trust into special measures – the first mental health trust in the country to have had such action taken against it.
Monitor has acted following a Care Quality Commission’s (CQC) inspection earlier this month which gave the trust an overall rating of ‘inadequate.’
The CQC identified a number of serious problems, including concerns about the safety of services, staffing levels and the leadership at the trust.
“Patients in Norfolk and Suffolk deserve to receive the highest possible care, and so the failings that the CQC has identified in the trust’s services are disappointing”, said Katherine Cawley, Regional Director at Monitor.
“We are pleased that the trust has already started to address some of the issues raised by the CQC, but much more needs to be done. That’s why we have put Norfolk and Suffolk into special measures, to ensure that it gets the extra help and support it needs to make the improvements that are required.”
Norfolk and Suffolk NHS Foundation Trust has agreed to put Monitor’s plans into action to address the care quality concerns identified by the CQC. Monitor has also imposed a new condition on Norfolk and Suffolk’s licence which enables the health sector regulator to take further action if improvements are not made quickly.
Katherine Cawley: “We will continue to work closely with the trust and monitor its progress in making the improvements that patients in Norfolk and Suffolk expect to see.”