East Yorkshire Hospitals Told To Improve By Health Watchdog
The hospital trust which runs Hull Royal Infirmary and Cottingham's Castle Hill hospital has been told improvements still need to made.
Improvements still need to be made at Hull Royal Infirmary and Cottingham's Castle Hill Hospital - that's the findings of a latest inspection by the Care Quality Commission.
An inspection in May this year found patients attending the city's A & E department are still experiencing higher than average waiting times, delays in treatment, along with concerns over nursing staff shortages.
It comes a year after Hull and East Yorkshire Hospitals NHS Trust - which runs the two hospitals - was first told to improve by CQC inspectors.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“The quality of the services provided by Hull and East Yorkshire Hospitals Trust was mixed. There were some areas of very good practice. Generally we found services to be caring and saw staff being respectful and compassionate when interacting with patients. There had also been significant progress made by the trust with their work to address the issue of the bullying culture identified at our February 2014 inspection.
“But clearly the trust is under pressure. Some people have to wait too long for their treatment. Bed occupancy has been very high, with poor patient flow through both hospitals, and too many patients having to be accommodated on the non-specialist wards, or simply waiting to be discharged.
“I recognise that there are competing demands for resources, but it is clear that the trust will need to continue to work with partners and commissioners to anticipate and respond to the increasing demand for its services and to address the areas for improvement that we have identified in this inspection.”
“People deserve to be treated in services which are safe, compassionate, effective, and responsive to their needs. We will continue to monitor the trust closely and will carry out an early re-inspection to check that action has been taken and improvements are being sustained.” The reports highlight several areas of good practice, including:
• The opening of the new emergency department represented a substantial improvement in the facilities for the hospital so that emergency care and treatment was provided in a suitable environment. • The trust had appointed an internal anti-bullying Tsar (a doctor) to lead the trust’s anti-bullying work. Inspectors received many positive comments about the tsar and their approach to the role.
The inspection found a number of areas where the trust must make improvements, including:
• The trust must address the breaches to the national targets for A & E and referral-to-treatment times to protect patients from the risks of delayed treatment and care. It must also continue to take action to address excessive waiting times for new and follow up patients with particular regard to eye services and longest waits. • The trust must ensure that there are at all times sufficient numbers of suitably skilled, qualified and experienced staff in line with best practice and national guidance. • The trust must ensure the sustainability of the work to address the concerns raised regarding the bullying culture and the outcomes from the NHS staff survey data (2014). • The trust must ensure that all incidents are investigated in a timely manner, that lessons are learnt and that duty of candour requirements are effectively acted upon and audited. • The trust must ensure that systems and processes are in place and followed for the safe storage, security, recording and administration of medicines on the medical wards. • Call bells must be placed within reach of the patient at all times, especially on the medical wards and regular audits must be completed to monitor compliance. • The trust must review its patient pathways and patient flow through services to reduce the number of patient bed moves ‘out of hours’ (unless for clinical reasons) and ensure more timely discharges of patients. • The trust must take action to ensure that patients’ nutrition and hydration is maintained in a timely manner; including the effective use of the ‘red top’ water jug system across all medical wards and the accurate recording of fluid balance and food charts for patients. • The trust must ensure that there is an effective and timely system in place, which operates to respond to, and act on, complaints
The Chief Executive of Hull and East Yorkshire Hospitals NHS Trust has responded to the latest reports to be published on the Trust’s two main hospitals.
Inspectors from the Care Quality Commission (CQC) first visited Hull Royal Infirmary and Castle Hill Hospital in February 2014 to look at areas including maternity and urgent care, and subsequently awarded an overall rating for the Trust of ‘Requires Improvement’*.
Chris Long, Chief Executive of Hull and East Yorkshire Hospitals NHS Trust, says that despite the overall rating not having changed, things are moving in the right direction:
“The CQC inspection team visited us at a very difficult time, when we were experiencing particular difficulties in meeting some of our key performance targets. Our staff did a great job of maintaining business continuity whilst the inspection was going on, and I would first of all like to pay tribute to them for this.
“The re-inspection was carried out to look specifically at those areas which had been highlighted in 2014 for further work or where concerns had been raised. As a result, inspectors were not particularly looking for areas of innovation or best practice, and the report does not focus on these; this is disappointing for staff, however, as it fails to reflect much of the good work which goes on here.
“The inspection visit was carried out in May and the report is largely written based on information gathered at that time. We have moved on significantly since then in many areas. The number of both nurse and consultant vacancies has reduced, the number of incidents not investigated within 14 days has fallen dramatically between May and August, as has the number of medical patients being transferred between sites for non-clinical reasons.
“The latest reports do note some areas of ongoing concern, and in some respects we would echo these. We are having difficulties in meeting the 18 week referral to treatment target in some specialities, for example, and we know we must do more to investigate and share the learning from incidents in a timely manner; these are matters we are working to improve but realistically these are not things which can or will be changed overnight.
“What has been really encouraging for us all, however, is the CQC’s acknowledgement that efforts we have been making to improve the culture have been effective. The original report noted a high incidence of bullying and harassment back in 2014 and, again, whilst issues such as culture cannot be resolved straight away, many staff now feel this is a better place to work, which is essential in making lasting improvements to the care we provide.
“Whilst we would obviously have liked our overall rating to improve, we knew this would be unlikely given some of the well-documented performance difficulties we have faced, such as surgery cancellations and meeting the 4 hour ED target, and this is reflected in the ‘Inadequate’ rating we have been given in the ‘Responsiveness’ domain specifically.
“We are not naïve and we know we still have much to do, but we can still take some positives from the reports published today. In the five months since the re-inspection, we have either resolved or continued to make in-roads into many of the areas the report identifies for improvement. The CQC notes the quality of care and the facilities within our new ED are good, plus we’re making the Trust a more attractive place to work, and the reduction in the number of vacancies we’re carrying is testament to this.”