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CQC issues further warning to James Paget University Hospitals NHS Foundation Trust following latest inspection
25 November 2011
Regulator demands that hospital trust takes robust action to improve and meet patient needs.
The Care Quality Commission (CQC) has issued a second formal warning to James Paget University Hospitals NHS Foundation Trust saying it must do more to improve standards of care or face further action.
The warning follows the CQC’s latest inspection at the trust which highlighted gaps in how the trust was monitoring and assessing its own care, particularly in relation to improvements it made to meet people’s nutritional needs.
A previous warning was issued to the trust in September when it was found the nutritional needs of patients were still not being met, despite earlier concerns raised as part of CQC’s Dignity and Nutrition Review.
The Dignity and Nutrition Review took place at 100 hospitals in England this year and examined whether elderly people were receiving the essential standards of care. It particularly focused on whether peoplewere treated with dignity and respect and whether they received food and drink that met their needs.
On 14 October inspectors visited James Paget Hospital, in Great Yarmouth, again to check on what progress had been made since the issue of the warning notice in September.
Inspectors found that improvements had been made in relation to meeting the nutritional needs of patients and new systems had been introduced by the trust, meaning it was now compliant with this particular standard.
However, inspectors observed the new systems were not being properly monitored and were not always effective. This meant that standards were still falling short of what people should be able to expect.
This is why CQC has issued a second warning notice to the trust demanding that improvements are made, this time in relation to the assessment and monitoring of the quality of service provision at the trust.
Frances Carey, regional director for the East of England, said: "We were pleased to see the trust had taken action regarding our previous warning and put measures in place to help patients receive the food and drink they required. However we were once again disappointed because we observed that these new systems were not being consistently carried out. This meant that patients were still not always receiving the help they needed when eating and drinking.
“It is a basic requirement that vulnerable people who are trying to recover in hospitals receive the assistance they need to get the correct nutrition.
“Systems may be in place to achieve this at James Paget Hospital, but these can fail if they are not being effectively monitored or assessed to ensure they work. This is why we have issued a warning notice to the trust.
“This is not about paperwork for paperwork’s sake but the trust must assure itself that all patients requiring its support get the care they deserve.
“The trust has to make sure it is checking its own systems and processes are working effectively."
On CQC’s most recent visit to the hospital inspectors found:
- A new system using different coloured trays and jugs, to help staff identify people who need assistance with their food and drink, was not working effectively.
- Inspectors observed that some of those given the coloured trays received little or no help.
- One person with dementia and identified, via the tray system, as needing help was seen to have a hot meal, uncovered, in front of them for up to 90 minutes without receiving any assistance. By this time the meal would have gone cold.
- A list of patients to tell staff who needed different coloured trays and jugs, so they could be assisted at mealtimes, was found to be inaccurate.
- Inspectors saw people who did not need help with their meals were listed while there were others whose names were not listed that clearly required help.
- Nutritional risk assessments and dietary intake records for patients were incomplete or inaccurate.
Frances Carey added: “The law says that these are the standards that everyone should be able to expect. Providers have a duty to ensure they are compliant.
“We will be returning to the hospital to follow up on progress and, when we do, we will expect the trust to be able to demonstrate it has made further improvements.
“CQC has a range of legal powers it can use if it is found the required progress has not been made. Where necessary we will use these powers to protect the people who use this service.
“This warning sends a clear message that James Paget University Hospitals NHS Foundation Trust needs to address this issue or face serious consequences.”
James Paget Hospital, in Lowestoft Road, Gorleston on Sea, Great Yarmouth, is a 544 bed acute hospital covering a population of 230,000 with a significant proportion being aged over 75.
For further information please contact Louise Grifferty, Regional Communications Manager, on 07717 422917 or the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.
Notes to editors
The report of our inspector’s most recent visit, that took place on 14 October, will be published and on CQC's website on Friday, 25 November.
The warning notice finds that James Paget University Hospital NHS Foundation Trust is in breach of Regulation 10 (1)(a) and (b) and 10 (2)(b)(iii), (v) and (vi), Health and Social Care Act (Regulated Activities), assessing and monitoring the quality of service provision.
A deadline of 1 December 2011 has been given for improvement. If this deadline is not met, CQC has a range of enforcement powers which include restricting the services that a provider can offer, or, in the most serious cases, suspending or cancelling a service. CQC can also issue financial penalty notices and cautions or prosecute the provider for failing to meet essential standards. Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeal processes.