Pennine Acute Hospitals Trust has been rated inadequate by the Care Quality Commission.
The inadequate rating followed the first inspection of its facilities.
Staffing levels, infrastructure, systems, culture and leadership were all considered cause for concern by the regulator.
Pennine Acute Hospitals Trust operates services across four sites in Greater Manchester.
Inadequate services were reported at both North Manchester General Hospital and Royal Oldham Hospital.
Fairfield General Hospital was rated as requiring improvement, while Rochdale Infirmary and the trust’s community services were considered to be good.
The Care Quality Commission was particular critical about the levels of safety and leadership demonstrated by the trust.
Already the Pennine Acute Hospitals Trust Has acquired over £9 million worth of financial support from local commissioners and regional and national health and social care partners.
It is hoped that this will play a major role in improving the safety and reliability of the way services are delivered at the trust.
CQC deputy chief inspector of hospitals Ellen Armistead reflected on the issues which had led to the inadequate verdict.
“We had serious concerns about the systems and procedures that are in place to keep people safe and free from harm. The trust did not have a robust understanding of its key risks at departmental, divisional or board level. In a number of services including A&E, maternity, children’s and critical care, key risks were not recognised, escalated or mitigated effectively.”
It is already well known that major concerns have been raised regarding such issues during an impromptu inspection which was conducted earlier this year.
Sir David Dalton of Salford Royal Foundation Trust was subsequently installed as the interim Chief Executive as a result of problems which were identified at that time.
The Care Quality Commission has now confirmed that the organisation will be placed into special measures as a result of these ongoing difficulties.
Dalton accepted the findings of the Care Quality Commission in a statement:
“The CQC report doesn’t make comfortable reading and whilst staff will be very disappointed with the trust’s overall rating, we welcome this report which I believe is a fair assessment of the issues facing the trust. The CQC report is holding up a mirror to the organisation and reflects very much what staff have been saying for some time on issues related to staffing pressures, inadequate systems, culture, leadership and resources.”
Recent data indicated that the Care Quality Commission has tended to file scathing and critical reports on trust across England, with a relative handful of organisations being considered outstanding.
Reports have indicated that bed occupancy in acute trusts has already raised winter levels.
The unusually high bed occupancy rates have left chief executives in acute trusts concerned with winter provisions.
Typically demand for beds in hospitals rises at this time of the year.
Senior figures in the acute service have already warned that existing occupancy levels are extremely serious.
Based on current reports from the acute trust, at least 50 patients every day have been admitted who are medically fit for discharge and consequently cannot be discharged.
Bosses have admitted that this is a massive problem, yes there is no evidence of the NHS making inroads into the issue.
And chief executives from acute trusts have stated that winter schemes have been running throughout the year without making an impression on the situation.
This is yet another indication that the NHS is struggling to cope with demand, and underlines many of the debates currently occurring with regard to the health service.
Some trusts have already had to open extra beds in order to cope with existing admission levels, indicating that they will potentially be massive problems during the winter period.
Existing levels of admissions are generally considered to be in line with December and January figures from previous years.
James Paget University Hospital Trust recently sent out a ‘black alert’ because all of its beds were full.
The picture across acute trusts in the NHS suggests that the recent plans of the Conservative government to switch to a seven-day culture in the health service could be under serious threat.
Indeed, it seems increasingly facile to assert that the health service is already struggling to deal with capacity simply related to its existing arrangements.
Meanwhile, the closure of care homes follows inspections by the Care Quality Commission, with more than one trust struggling to move patients out of hospital.
The overall picture is one of serious challenges for the NHS in dealing with the critical winter period.
Many acute trusts are already reporting occupancy of 99 per cent, meaning that the normal seasonal service that can be expected in winter will be extremely difficult to cope with.
The closure of services at various trusts, longer lengths of stay for those awaiting nursing homes and social care, combined with increasing complexity of diagnosis and treatment have all contributed to the existing situation.
With NHS services expected to run up deficits in the region of £2 billion by the end of the financial year, the lack of beds combined with serious fiscal difficulties will unquestionably be a massive problem for the health service in the immediate future.
The Conservative government has already conceded that there is a deficit of £30 billion in NHS funding that needs to be met by the end of the decade, but suggest that most of this can be achieved via efficiency savings.
Increasingly, this opinion looks to be ill-founded at best.
Monitor has confirmed that a new leadership team has been appointed at one of the most prominent NHS trusts.
The Heart of England NHS Foundation Trust has agreed to appoint a new interim leadership team, after the trust conceded that it was in breach of its license.
According to Monitor regulations, NHS trust services must operate in accordance with regulatory licenses.
And in the case of the Heart of England NHS Foundation Trust, Monitor recommended that the trust should reorganise its managerial hierarchy.
The trust board has agreed to the action required by the regulator.
Jacqui Smith, the former Labour MP, is currently the Chair at University Hospitals Birmingham (UHB), and will now become interim Chair of the trust.
Smith replaces Les Lawrence who has decided he will step down from the trust at the end of November.
Meanwhile, Dame Julie Moore – currently Chief Executive at UHB – has been appointed interim Chief Executive of Heart of England.
Moore replaces Andrew Foster whose secondment finishes at the end of October.
It has been announced that Smith will continue in her existing role of Chair at UHB while also carrying out her duties relating to Heart of England.
Dame Julie Moore will spend the vast majority of her time at Heart of England while fulfilling the Interim CEO role.
In addition, the board at the trust has made a clear commitment to Monitor that they will take time to develop and implement both short and long-term financial plans in order to improve the fiscal situation of the organisation.
The Heart of England NHS Foundation Trust is just one of many NHS trusts facing fiscal challenges in what is an extremely difficult financial period for the National Health Service.
Commenting on the issue, Dr David Bennett, Chief Executive of Monitor, pointed to these economic issues as being central to the decision to appoint new executives.
“Heart of England NHS Foundation Trust has significant financial problems, having run up a £29.5 million deficit already this year. It is clear urgent action is needed,” Bennett stated.
Bennett went on to point out that the individuals recruited already had an excellent reputation in the eyes of Monitor.
“By appointing two people whose leadership at University Hospitals Birmingham has been rated as outstanding by the Care Quality Commission, we can provide the trust with the strong leadership it needs to live within its means and keep delivering the care patients need,” Bennett asserted.
It is estimated that the NHS will accumulate a deficit of £2 billion by the end of the financial year, and the decisions made by Monitor in this instance will probably not be the last example of re-organisation among NHS trusts.
A new hospital acquisition approved by the health regulator for the NHS will benefit patients and the general public in Devon.
In particular, thousands of patients located in South Devon are set to benefit from more integrated healthcare after the move by Monitor.
South Devon Healthcare NHS Foundation Trust has acquired Torbay and Southern Devon Health and Care NHS Trust, effectively merging the two organisations.
As the two trusts already collaborated on a close basis, indeed already sharing some back office functions, the potential for the two to cooperate on a wider basis is obvious.
Resulting from the decision will be a joint healthcare provision in the South Devon region, with the two trusts jointly providing acute, community and social care services.
Although Monitor has already approved this transaction, the process of assessing its legitimacy is nonetheless ongoing.
The health regulator has particularly requested the newly created trust to continue making improvements with regard to patient flow.
Both A&E and routine procedures are affected by this ongoing monitoring, and the health regulator has also requested the trust to improve its existing plans to integrate care.
Speaking on the subject of the South Devon acquisition, Miranda Carter, Executive Director of Provider Appraisal at Monitor, was keen to point out that this was a logical move, and beneficial for patients in the region.
“South Devon Healthcare provides valued services for patients across South Devon and Torbay, including general, elective and emergency care. By integrating these services with Torbay and Southern Devon’s community and social care services it will be able to provide local people with care that is more convenient, closer to home, and with a greater focus on keeping people healthy and out of hospital,” Carter pointed out.
In addition, Carter suggested that the model acquisition which has been created in South Devon could act as a template for other regions in the United Kingdom.
“This is a good example of the kind of innovative change that will help trusts to improve care for patients, whilst also offering better value for money services and meeting the challenges faced by the NHS,” Carter noted.
The Executive Director of Provider Appraisal at Monitor was also keen to outline to the newly created trust that it has certain responsibilities.
“Now that we have approved this acquisition we expect the trust to press ahead with plans and ensure services integrate smoothly for patients and staff,” Carter reminded the newly created trust.
Following the merger, the trust will be called Torbay and South Devon NHS Foundation Trust.
The health sector regulator, Monitor, has taken action against at NHS trust in Cambridge.
Cambridge University Hospitals NHS Foundation Trust has been placed into special measures, as the regulatory body continues to assess its ability to deliver services to patients.
Monitor is also looking for improvements to be made by the trust with regard to financial organisation.
The regulator was forced to act following an investigation into the fiscal performance of the Cambridge trust.
Governance arrangements within the trust were also investigated diligently.
The latest reports indicate that the Cambridge University Hospitals NHS Foundation Trust expects to run up a deficit of £64 million during the financial year; effectively an overspend of around £1.2 million per week.
An investigation carried out by Monitor concluded that the Cambridge trust overall lacks adequate financial control and sufficient fiscal direction.
Monitor had already warned the Cambridge University Hospitals NHS Foundation Trust to implement financial control methods, but these have evidently not been put in place adequately.
At the time of writing, Monitor is of the opinion that there is no credible plan in place to address the rapidly expanding deficit at the organisation.
In addition to these problems, the Cambridge trust also failed to properly estimate the expense and challenges related to implementing its new ‘e-Hospitals’ electronic patient records system.
e-Hospitals had a significant impact on the provision of healthcare for patients in the Cambridge region, and the trust made insufficient preparation for the increased requirements.
The failure to address these issues led to significant cost increases within the Cambridge trust, and ultimately diminished the positive impacts of the new system.
Having investigated the trust in some depth, the Chief Inspector of Hospitals deemed the Cambridge trust to be ‘inadequate’ when it proffered its overall rating.
Concerns about staffing levels, delays in outpatients treatment, and governance failings where central to the verdict.
With monitor having taken action against the body, the Cambridge University Hospitals NHS Foundation Trust will now implement a series of steps with the aim of becoming financially sustainable.
In particular, the trust has agreed to:
– develop and implement a recovery plan to address its deficit
– finalise and deliver a plan to improve the quality of care for its patients
– undertake a thorough review of how the trust is managed
– strengthen its executive leadership
Stephen Hay, Managing Director of Provider Regulation, had the following to say about the verdict.
“Patients treated at Cambridge University Hospitals NHS Foundation Trust deserve to receive the highest possible care, and so the failings that we and the Care Quality Commission (CQC) have identified in the trust’s services are disappointing.
It’s reassuring that the trust has already started to address some of the issues raised by the CQC and our investigation. But much more needs to be done and the trust’s leadership needs to act quickly to resolve these issues.
Putting the trust into special measures will ensure it gets the extra help and support it needs and we will closely monitor the trust’s progress in making the improvements that its patients expect to see.”
More information on special measures can be found on the NHS Choices website.
The Monitor regulatory body has deferred the foundation trust application of an NHS trust based in Liverpool.
Monitor has delayed a decision on the Royal Liverpool and Broadgreen University Hospitals NHS Trust’s application to become a foundation trust for 12 months.
This trust provides specialist and acute services to more than 465,000 people across Liverpool.
Monitor carried out a stringent assessment on the trust, and concluded that financial planning within the body needs further attention.
The regulatory agency therefore took the decision to delay the application of the Merseyside-based trust for another year.
The Royal Liverpool and Broadgreen University Hospitals NHS Trust must now work on improving the deficiencies that Monitor established in its assessment of the organisation.
However, it wasn’t all bad news for the Liverpool trust. Monitor did conclude that the body had shown significant improvement with regard to the way that it manages the quality of care.
It seems that the concerns of Monitor were largely related to the fiscal situation of the health trust, and could have been exacerbated by the general state of the NHS.
Many trusts across the United Kingdom have experienced financial difficulties over the last few years, and indeed Monitor is currently assessing the efficacy of several such bodies and organisations.
Monitor also acknowledged that the Royal Liverpool and Broadgreen University Hospitals NHS Trust had made significant progress with its attempts to strengthen its board, but that the organisation still had important steps to take in order to ensure that the trust was viable.
In particular, the regulatory body stressed the need for the Liverpool-based organisation to further develop robust plans in order to provide good value-for-money services for patients in the longer-term.
Commenting on the decision of the regulatory organisation, Miranda Carter, Executive Director of Provider Appraisal at Monitor, explained he context of deferring the decision on whether Royal Liverpool and Broadgreen should become a foundation trust for a year.
“In light of the new hospital it is building we want to give the trust more time to improve its financial plans. The next year will also give the trust time to induct new board members and to develop its plans to participate in Healthy Liverpool to improve care across Liverpool,” Carter explained.
The existing NHS structure encompasses 151 trusts spread across their entirety of England, which accounts for 60 per cent of all the trusts in the NHS as a whole.
Foundation trust status enables patients to have a greater and more direct to say in their specific healthcare.
Additionally, foundation trusts were conceived in order to enable these organisations to have greater freedom in crafting services to match the needs of individual regions.
NHS foundation trusts are effectively free from central government control, able to retain any surpluses for further investment, and intended to be directly accountable to local communities.
It is also notable that local people serve as members and governors in such bodies.
Although the Royal Liverpool and Broadgreen University Hospitals NHS Trust has been denied this honour and responsibility for the time being, the verdict from Monitor suggests that there is light at the end of the tunnel for the NHS trust.
A recent Monitor investigation has discovered that Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) has not breached NHS commissioning regulations.
But the CCG will be suspended from carrying out further duties as the next phase of the investigation is concluded.
Monitor has since published the results of the investigation, after question marks were raised regarding the process for selecting community service providers in east Devon.
The sector regulator for health services in England was called upon to explore how commissioner selected Royal Devon and Exeter NHS Foundation Trust as its preferred provider of community services for adults with complex care needs.
But the investigation revealed that the commissioner did indeed satisfactorily consider patient needs and the service improvements required.
The process designed by the commissioner was thus deemed to be satisfactory to enable an adequate number of proposals to be considered appropriately.
However, the CCG still has further work to do in order to establish that the requisite level of value for money is being achieved before finally confirming the contract.
Catherine Davies, Executive Director of Co-operation and Competition at Monitor, noted that “patients are likely to be better off as a result of our investigation because the CCG will do further work before awarding the contract, especially around ensuring value for money.”
Monitor found that the CCG’s process was entirely proportionate, and thus the provider selected from the available options was appropriate according to Monitor’s conclusions.
Thus, the CCG’s process did not breach transparency requirements. “Having set out its vision for community services in the local area, NEW Devon CCG chose between providers in a way that was tailored to its needs,” Davies explained.
However, the Executive Director did point out that this particular process might not be applicable in other cases. “The approach NEW Devon CCG took won’t work in all cases, but it shows that commissioners can be flexible in their processes for selecting providers,” Davies opined.
In conclusion, Monitor found that there was no discriminatory or unequal treatment of potential providers in the process, and that it was unaffected by conflicts of interest.
Monitor had begun an investigation after it received a complaint from Northern Devon Healthcare NHS Trust.
The trust is currently responsible for community services in the region, having been awarded the contract to provide them.
Northern Devon Healthcare NHS Trust claimed than the CCG had carried out a process that was inadequate and unfair, but this notion has ultimately been rejected by Monitor.