CQC tells The Newcastle upon Tyne Hospitals NHS Foundation Trust to make improvements
The Care Quality Commission (CQC) has told The Newcastle upon Tyne Hospitals NHS Foundation Trust they must make improvements following inspections in June, July and September that see its overall rating drop from outstanding to requires improvement.
Unannounced inspections were carried out in surgery, services for children and young people, and medical care at the Freeman Hospital and the Royal Victoria Infirmary (RVI), as well as urgent and emergency care at the RVI. The trust’s patient transport service (known as NECTAR) was also inspected. These were part of CQC’s continual checks on the safety and quality of healthcare services at the trust.
A further targeted inspection took place in the cardiothoracic surgery department at the Freeman Hospital in September, in response to concerns raised by whistleblowers regarding the culture, specifically about bullying and harassment and safety concerns.
The findings from this inspection can be found in a report published on CQC’s website. As this was a focused inspection, it was not re-rated and remains requires improvement overall.
CQC also carried out an unannounced focused inspection of maternity services at the RVI in response to whistleblowing concerns about safety and culture.
Inspectors also looked at how well-led the trust was overall.
Following this inspection, the overall rating for The Newcastle upon Tyne Hospitals NHS Foundation Trust has declined from outstanding to requires improvement. How well-led the trust is has declined from outstanding to inadequate. Safety has dropped from good to requires improvement, effective and responsive have declined from outstanding to requires improvement. Caring has dropped from outstanding to good. Individual service ratings can be found in the notes to editors
CQC have also used its enforcement powers and placed conditions on the trust's registration. These require the trust to make specific improvements within a specified timescale and to submit monthly reports to CQC showing progress, and action taken to improve quality and safety. The conditions include the trust implementing an effective governance system.
Ann Ford, CQC’s director of operations in the north, said:
"When we visited The Newcastle upon Tyne Hospitals NHS Foundation Trust, we found a significant deterioration in how well the trust was being led. Our experience tells us that when a trust isn’t well-led, this has a knock-on effect on the standard of services being provided to people.
“We found leaders had the skills and abilities to run the trust but they weren’t using them to always manage the priorities and issues they faced in a timely way. Also, the board had a lack of oversight at all levels to effectively manage and reduce risks to people.
“We were also concerned to hear the trust didn’t have an open culture where staff could raise concerns without fear of blame or punishment. Some staff told us that bullying was a normal occurrence, and they were encouraged to ‘turn a blind eye’ and not report this behaviour. This is completely unacceptable and must be addressed by the leadership team as a priority to enable staff to provide the best possible experience to people.
“I want to thank the staff who came forward to give feedback, I know speaking up in these circumstances isn’t easy, but it’s really important because it helps us understand where organisations may need to focus its attention to identify and address any issues.
“Although we found a number of concerns across the trust, we also found staff were proud to work for the organisation and were providing good care.
“Inspectors also found some outstanding practice. For example, in children and young people’s services at both hospitals, staff were exceptional in supporting families and loved ones to understand a child’s condition and they knew when to escalate concerns, so the child received appropriate care as soon as possible.
“Since these inspections, a new chief executive and other senior leaders have joined the trust and know where improvements need to be made.
“We will continue to monitor the trust and will return to carry out another inspection, to ensure the necessary improvements have been made and embedded so people receive the safe care they deserve.”
Inspectors found:
The trust did not always store and manage medicines safely.
Not all staff reported incidents in a consistent and standardised way. Staff CQC spoke to did not always receive feedback or learning from incidents.
Care and treatment were not always delivered in accordance with national guidance or evidence-based practice.
Managers did not always monitor the effectiveness of the service they were providing or always work well together for the benefit of people.
Staff did not always feel respected, valued, and supported.
The trust did not always promote equality and diversity in daily work.
Although governance processes were in place, they did not always operate effectively across the trust to ensure risk and performance issues were identified, escalated appropriately, managed, and addressed promptly.
However:
Staff treated people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
Staff had training in key skills and understood how to protect people from abuse.
There were ongoing examples of innovation and research.
The report will be published on CQC’s website on Wednesday 24 January.
The report for the further targeted inspection of cardiothoracic surgery will be published on CQC’s website on Wednesday 24 January.
RESPONSE
Newcastle Hospitals’ new chief executive, Sir James Mackey, said:
“We fully accept the CQC’s reports.
“Their clear recommendations for attention and improvement are being worked on as a matter of urgency and I am confident we can fix this by working together across the organisation and focussing on what matters to patients and staff.
“A detailed programme of activity is already underway and will continue until we, and the CQC, are assured the issues have been addressed. This will involve some tough decisions but it’s important we get this right and that people can see change happening.
“Of course, it is a huge disappointment that our overall rating has been reduced and to hear of the difficulties experienced by some colleagues.
“I know from speaking to many staff over the last few weeks that providing the best possible patient care remains an absolute priority for everyone at Newcastle Hospitals.
“While this is a challenging time, it’s important to emphasise that the inspectors saw and highlighted the compassion and kindness of our teams and rated ‘caring’ as ‘good’.
Newcastle Hospitals’ improvement programme is themed around:
• A full review and test of the systems, checks and balances in place to monitor quality, safety and risk. Progress against this will be reported monthly to the CQC.
• Having an open and honest incident reporting system where staff are supported to speak up, share their ideas and report issues when they see or feel something could be done differently. Staff will be heard and responded to, and we will learn and share information to improve how we work.
• Creating the best possible environment for staff and patients which includes continuing a significant piece of work with colleagues from across the organisation looking at how we work together, our relationships and our culture.
Sir James added: “Our time and energies are focussed on making swift progress in the areas we know need to improve further, creating the best possible environment to care and work in, and making sure our hospitals are running smoothly and successfully.
“We will also identify where it would be best to take a partnership approach to address some of our challenges, with a focus on collaboration and developing more integrated services, locally and regionally.
“A heartfelt thank you to all colleagues who continue to work incredibly hard at a time of ongoing challenges and increasing demand on the NHS. We should not lose sight of the good work happening across Newcastle Hospitals – many of our teams are leaders in their field and we need to build back that confidence and pride.”