West Cumberland Hospital Is UnsafeOn the 10th July, the Governments NHS watchdog published their findings from inspections carried out at Whitehaven's West Cumberland Hospital. It doesn't make for pretty reading.
Key Findings By The Commission:
- Since our last inspection and the Keogh review, there had been a significant improvement in mortality rates, which were now within expected limits.
- Patients whose condition might deteriorate were identified and escalated appropriately.
- The hospital was clean throughout. Staff generally adhered to good practice guidance in the prevention and control of infection.
- Infection rates were within expected limits.
Food And Hydration
- Patients had a choice of nutritious food and an ample supply of drinks during their stay in hospital. Patients with specialist needs were supported by dieticians and the Speech and Language Therapy Team (SALT).
- There was a period over mealtimes when all activities on the wards stopped, if it was safe for them to do so. This meant that staff were available to help serve food and assist those patients who needed help. We also saw that a red tray system was in place to highlight which patients needed assistance with eating and drinking.
- Medicines were provided, stored and administered in a safe and timely way.
Medical And Nurse Staffing
- Care and treatment was delivered by committed and caring staff who worked hard to provide patients with good services. However:
- There were numerous consultant vacancies that were adversely affecting timely treatment for patients and effective support for junior doctors in a number of core services.
- Nurse staffing levels, although improved, remained of concern and there was a heavy reliance on staff covering extra shifts, and bank and agency staff to maintain adequate staffing levels. Adequate staffing levels were not consistently achieved in all core services.
- There had been changes to the functions within both accident and emergency and surgical services regarding the management of trauma, high risk general surgery and colorectal cancer patients, which began in June 2013. This care has now transferred to the Cumberland Infirmary in Carlisle. This has led to routine elective work being regularly cancelled at the Cumberland Infirmary, but the transfer of routine work to West Cumberland has not been as systematic as anticipated, as patients prefer to wait to have their procedure at Carlisle. The distance between the two sites appears to be a major factor in patients’ decisions regarding where to have their surgery rather than the care delivered.
- This had exacerbated the trust’s inability to meet referral to treatment time (RTT) targets for admitted patients, particularly in orthopaedics. The distance between the two sites was a major factor in patients’ decision making.
Staff Concerns And Whistleblowing
- Communication from the executive team to the staff on the wards and departments had improved. Staff were positive about the executive team for the direction they have communicated regarding the future of services.
- However, we were concerned about the lack of openness of the culture within the trust as we received a high number of anonymous whistleblowing concerns about this hospital before, during and after the inspection. This indicated that staff felt unable to share concerns with the trust despite the concerns being about patient safety and the quality of services provided.
- Care and treatment was not always provided in accordance with best practice guidance.
- Care and treatment was not always delivered in accordance with national expectations.
- Poor patient flow meant patients were placed in areas not best suited to their needs.
- The provision of case notes and records was inconsistent across the hospital. Storage and retrieval of patient records was poor, which meant some patients did not have a consultation at their appointments because the records could not be traced. This was particularly important because of the use of agency staff.
- Nurse record-keeping was poor in the paediatric ward.
- We did not see a formal plan in place for a replacement for the Liverpool Care Pathway for patients at the end of life, although the trust has since informed us that it has a formal plan in place.
- Audit data was incomplete in some areas and the application of learning from incidents and complaints lacked consistency.
Importantly, The Trust Must:
- Ensure that there are sufficient numbers of suitably qualified, skilled and experienced nurses to meet the needs of patients at all times.
- Ensure medical staffing is sufficient to provide appropriate and timely treatment to patients at all times.
- Ensure that all departments within the hospital have the required skills to meet the needs of patients at all times.
- Improve the support given to junior medical staff.
- Take action to ensure that the planning and delivery of patient care and treatment is consistently carried out in
- accordance with published research and guidance issued by professional and expert bodies.
- Take action to protect the health and welfare of children and young people with mental health needs by ensuring that timely health and social care support is provided in collaboration with other providers.
- Take action to improve the patient flow through the hospital to cope with the routine workload and reduce patient waiting times.
- Work towards achieving the target of no more than 18 weeks wait from referral to treatment.
- Improve the standard of nursing records in the paediatric service.
- Develop clear action plans to assess and manage the impact of the lack of a dedicated second theatre and no provision for urgent obstetric/gynaecology surgery at the hospital.
- Take action to ensure that patient records are fully complete and up to date and made available in a timely way for all outpatient clinic appointments.
- Develop a formal End of Life Care standard framework to assure safe, effective care at the end of life. Plans need to be in place to formally replace the Liverpool Care Pathway by July 2014.
- Ensure the safety and security of all patients, staff and visitors who attend the A&E department by training all the staff on the procedures to follow in the event of a security or safety incident.
In Addition The Trust Should:
- Improve the management of people with diabetes, stroke and people with a diagnosis of dementia in line with national guidance.
- Ensure that staff have the opportunity to regularly discuss their personal development and any issues or concerns they may have.
- Ensure the security roles and responsibilities of the portering staff when dealing with violence and aggression are within the acceptable parameters of legal restraint.
- Improve access to CT/MRI scanning to ensure patients receive a scan quickly.
- Improve reporting times for radiology and CT scans so that patients receive timely results to improve the quality of treatment outcomes.
- Ensure the maternity service has the ability to undertake grade 3 caesarean sections.
- Ensure the trust’s information regarding ‘How to make a complaint’ is accurate.
- Ensure the infrastructure is in place before establishing additional outpatient clinics.
- Ensure there is a clear vision and strategy for end of life care and provide clear leadership for end of life care, both at director and non-executive director levels.
- Provide training for staff to enable care bundles to be implemented.
- Review the lack of standardisation across trust locations, such as the availably of evening clinics for early pregnancy advice and access to termination of pregnancy clinics.
- Continue to develop robust audit processes to verify that staff are adhering to the ‘five steps to safer surgery’ checklist.
- Review the lack of standardisation across trust’s locations, such as the availably of evening clinics for early pregnancy advice and access to termination of pregnancy clinics.
North Cumbria Health Trust Response:Commenting on the CQC report, chief executive Ann Farrar said:
Today marks another important milestone in our improvement journey and we wholeheartedly welcome the CQC report and recommendations. I am immensely proud of our staff who have been recognised by the CQC for the care and compassion they show our patients every single day in very challenging circumstances.
Despite the challenges we continue to face, we must never lose sight of putting patients at the heart of everything we do and every decision we take. Everyone working for North Cumbria can today take real pride in the acknowledgement of their tireless efforts to look after our patients and provide high quality care.
We are also very pleased to see many examples of good services within the CQC report and of course welcome the extra scrutiny on where further improvements still need to be made right across our organisation so that the Trust can be taken out of special measures.
What is clear from the CQC report is that some improvements, such as those relating medical records and outpatients, are within the gift of the Trust to deliver. Other problems, such as those linked to recruitment, will require NHS system wide solutions to ensure we can sustain services at West Cumberland Hospital and this must be addressed in the development of our five years strategies with NHS Cumbria Clinical Commissioning Group.
We are under no illusions on the work that still needs to be done, however our staff, patients and the public should take confidence in today’s CQC report and the significant progress which we have made in the past 12 months to bring our mortality rates to within expected range and improve quality of care – this progress should not be underestimated is again down to the hard work and sheer determination of all our staff.
We have always been very clear that this is a journey of improvement and today’s CQC report is another important step for us. The support we have had so far from Northumbria Healthcare has been invaluable and acquisition, once it takes place, will make us even stronger and further support our journey of continuous improvement.Later this year, North Cumbria University Hospitals will open a new centralised patient contact centre which will allow the Trust to standardise booking processes, prevent overbooking of outpatient clinics and help ensure that all patients have their appointments within nationally recommended timescales.
Whilst outpatients reception desks in both hospitals will remain in place and continue to play a vital role, a new centralised contact system, similar to the successful model in place at Northumbria Healthcare will be introduced to manage over 200,000 outpatient appointments every single year.
The aim is to make care as seamless as possible for patients and having one central point of contact will not only improve patient experience making it easier for people to access our appointments team, but also means we can implement a robust system to manage all patient bookings. Similar plans are also being developed to create a long term sustainable plan for the future of medical records management across the Trust.