Chief Inspector of Hospitals recommends Heatherwood and Wexham Park Hospitals NHS Foundation Trust should be placed into special measures
1 May 2014 03:41 PM
England's Chief Inspector of Hospitals,
Professor Sir Mike Richards, has recommended that Heatherwood and Wexham
Park Hospitals NHS Foundation Trust should be placed into special
measures.
The
trust has been rated as inadequate following an inspection in February under
the new inspection regime introduced by the Care Quality Commission to provide
a much more detailed picture of care in hospitals than ever
before.
Overall, the inspectors conclude that the quality of
care provided by Wexham Park Hospital at Slough was inadequate, although the
children's department and critical care unit were both providing a good
service. Heatherwood Hospital at Ascot was rated as Good. Full reports of
the inspection have been published on the CQC website.
Inspectors found unsafe staffing levels were a
consistent theme throughout the trust with a shortage of doctors, nurses
and other healthcare professionals, and a heavy reliance on agency staff who
were often unfamiliar with the wards where they were working.
Wexham Park Hospital was also failing to consistently
meet national targets to admit, transfer or discharge patients from the A&E
department within four hours. Although the trust had opened extra beds to
meet demand, inspectors found there was little evidence of initiatives to try
to reduce unnecessary admissions.
Patient discharges were delayed while they waited days
for X-rays or other assessments, taking up beds which should have been used for
patients having surgery, meaning that a significant number of operations had to
be cancelled on the day. Outpatients also faced long delays for
appointments.
In
the children's and young people's department and the critical care
unit, staff were expected to report incidents and learn from them as a matter
of routine. But the inspectors found that elsewhere there was no real
safety culture, with little encouragement to staff to report incidents because
they felt there was little subsequent change.
While staff were seen to be kind and compassionate, they
were often too busy to support patients properly. The inspectors were
disappointed by the lack of clinical engagement and their apparent acceptance
of poor patient experience. Consultants were found to lack
ownership of patients and there were several departments where staff appeared
to be working against each other rather than together to improve standards of
care. In addition inspectors said that accusations of harassment and
bullying were heard throughout the organisation.
The
Care Quality Commission has identified 18 areas for improvement,
including:
- The
trust must improve staff engagement across clinical and managerial disciplines
to promote a learning and safety culture where patient experience is
paramount.
- Patients must be properly risk-assessed particularly for
falls and pressure ulcers - including patients who are in the A&E
department for a prolonged period.
- Patient flow must be addressed as a priority to improve
the poor waiting times in A&E, the high number of surgical cancellations
and delayed discharges from the critical care unit.
- The
hospital property must be fit for purpose, with repairs and maintenance
planned and dealt with in a timely manner.
- A
robust system must be introduced to assess the numbers and skill mix of medical
and nursing staff for all wards, with establishment numbers increased to
reflect this.
- Workforce recruitment and retention plans must be
addressed to reduce the dependency on locum and agency staff.
- Where agency and locum staff are employed, relevant
background and competency checks must be undertaken, with local induction
before they start work.
- The
trust must encourage and support an incident reporting culture at all levels,
which is seen as a mechanism to learn rather than attribute
blame.
- The
radiology service must be able to meet the needs of patients in a timely
way.
- The
trust must improve the booking and appointments system, waiting times and the
cancellation of clinics to prevent delays and to improve access to
treatment.
- All
staff must be able to respond to the needs of vulnerable groups such as people
with dementia or a learning disability.
The
Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
"We know that Wexham Park Hospital has had a long history of problems -
and the legacy of these problems is all too apparent in the safety culture, the
staffing levels, and the overflowing wards.
“There are some positives - notably in critical care and in the
children's department - and the trust has responded to recent inspections
by making some improvement in some areas, such as cleanliness for instance
which we note is much improved recently.
“But there is a lot more to do, and the staff can't go on
firefighting, reacting to the latest pressures, without a clear vision about
the hospital's future direction.
“This cannot go on. It is clear to me that the trust leadership, in
its present form, is not equipped to bring in the deep and long-lasting changes
that are needed to turn round Wexham Park Hospital, which is why I’ve
recommended that the trust should be placed in special measures.
This should give it the support it needs to tackle the issues it faces and
deliver the quality of services that the public are entitled to
expect.”
An inspection team which included doctors, nurses, and hospital managers,
trained members of the public, CQC inspectors and analysts spent two days at
Wexham Park Hospital and Heatherwood Hospital in February. They examined
the care provided in accident and emergency, medical care (including older
people’s care), surgery, intensive/critical care, maternity and family
planning, children’s care, end of life care and outpatients.
Inspectors also visited Wexham Park out of hours unannounced on three
occasions.
Ends
For media enquiries, contact the CQC press office on 020 7448 9401 /media.team@cqc.org.uk during office hours or out of hours on
07917 232 143.
For general enquiries, call 03000 61 61
61.
Notes to editors
The
Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading
significantly larger inspection teams than before, headed up by clinical and
other experts including trained members of the public. By the end of 2015, CQC
will have inspected all acute NHS Trusts in the country with its new inspection
model. Whenever CQC inspects it will always ask the following five questions of
every service: Is it safe? Is it effective? Is it caring? Is it responsive to
people’s needs? Is it well-led?
The Care Quality Commission has already presented its findings to a local
Quality Summit, including NHS commissioners, providers, regulators and other
public bodies. The purpose of the Quality Summit is to develop a plan of action
and recommendations based on the inspection team’s findings.
This report describes our judgement of the overall quality of care provided by
this trust. It is based on a combination of what we found when we inspected,
information from our ‘Intelligent Monitoring’ system, and
information given to us from patients, the public and other
organisations