The Care Quality Commission
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  • NHS hospital

Queens Hospital

Overall: Requires improvement read more about inspection ratings

Belvedere Road, Burton-on-trent, DE13 0RB (01283) 56633

Provided and run by:
University Hospitals of Derby and Burton NHS Foundation Trust

Important: This service was previously managed by a different provider - see old profile
Important: We are carrying out a review of quality at Queens Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

22 August 2023

During an inspection looking at part of the service

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at Queens Hospital.

We inspected the maternity service at Queens Hospital as part of our national maternity services inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

Queens Hospital Burton is the principal provider of acute hospital services for the residents of Burton upon Trent and surrounding areas including South Staffordshire, South Derbyshire and Northwest Leicestershire. It provides a range of maternity services including both antenatal and postnatal ward as well as an antenatal clinic. There are approximately 2700 deliveries each year, with caesarean sections and options for pool-based birth.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

The trust is part of the University Hospitals of Derby and Burton NHS foundation trust.

We reviewed the rating of the location therefore our rating of this hospital stayed the same

Queens Hospital is rated requires improvement in Safe and Well-Led and good in Effective, Caring and Responsive.

We also inspected 1 other maternity service run by University Hospitals of Derby and Burton NHS Foundation Trust. Our reports are here:

Royal Derby Hospital - https://www.cqc.org.uk/location/RTGFG

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited Maternity assessment Unit (Triage) Labour ward / Delivery Suite the antenatal and postnatal wards.

During the inspection we spoke with 20 staff including the Head of Midwifery, Obstetricians, Doctors and Midwives. Attended handover meetings and reviewed 6 records.

We received more than 307 ‘give feedback’ on care forms through our website, with 58% (n177) of the feedback being positive with the remainder 42% (n130) being negative. Feedback received indicated women and birthing people had mixed views about their experience. There were themes around negative experiences and interactions with staff, lack of consent, staff causing women to feel anxious or burdensome, long wait times and limited information on their treatment. We received feedback about women and birthing people reported being asked to remain at home instead of attending the Maternity Assessment Unit (MAU) but after they had attended, they were told they should have attended earlier. Positive comments described staff as knowledgeable and attentive, with the ability to act decisively when required in order to ensure women and babies were kept safe.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

30 July 2020

During an inspection looking at part of the service

We carried out a short notice announced focused inspection at Queens Hospital Burton on 30 July 2020. During the inspection, we inspected falls assessment and management across both the medicine and surgery core services. This was in response to concerns which were initially raised following serious incidents that had happened at the trust.

We also reviewed discharge processes as a result of concerns raised prior to the inspection about communication upon discharge.

We visited medical wards, ward 4, 5 and 8 as well as the discharge lounge and ward 19, which was a trauma and orthopaedic ward. We chose these locations based upon intelligence received prior to our inspection. We spoke with 18 members of staff, including healthcare support workers, nurses including ward manager grade and therapy staff. We did not speak to any patients. We reviewed 16 patient records and 10 discharge records and observed staff providing direct care to patients.

Focused inspections can result in an updated rating for any key questions that are inspected if we have inspected the key question in full across the service and/or we have identified a breach of a regulation and issued a requirement notice or acted under our enforcement powers. in these cases, the ratings will be limited to requires improvement or inadequate.

Previous ratings were not all updated during this inspection. However, the ratings for safe and effective (in medicine and surgery services), and therefore the overall ratings went down. We rated these areas as requires improvement. Please refer to the ‘areas for improvement’ section for more details.

Our rating of services went down. We rated them as requires improvement because:

  • Staff did not always undertake mental capacity assessments in line with the Mental Capacity Act. Staff did not consistently follow the Mental Capacity Act requirements when patients were deprived of their liberty.
  • Patients at risk of falls were not always supervised in line with the trust policy. It was not always possible to identify patients who were at a risk of falls without reviewing electronic records. Patients could not always reach their call bells.
  • Some nursing notes were not detailed enough. Staff did not always find it easy to locate specific information in the electronic records. Staff did not always keep detailed or contemporaneous records of patients’ care and treatment.
  • Staff did not always follow risk assessment recommendations when using bedrails.
  • Not all staff were trained in relevant mandatory training modules in line with the trust’s training target.
  • Lessons learned from outside of the direct ward area, were not always shared with all staff. Due to COVID-19, staff had fewer opportunities to meet, discuss and learn from the performance of the service.
  • Not all staff were aware of the support systems in place (falls group) to ensure effective care packages were received by patients.
  • Some processes related to falls were not yet consistent across the trust. Many actions taken to reduce falls were still in progress at the time of our inspection. The trust gave inconsistent information about how staff should manage some risks.
  • We found inconsistencies in the information that was cascaded to staff from senior leaders about incidents. Some senior staff were not fully aware of their accountabilities in line with managing serious incidents.
  • Not all staff were wearing personal protective equipment in line with national guidance.

However, we also found:

  • Leaders were using systems to identify and escalate falls risks and review falls performance to reduce their impact. They were working towards implementing and embedding effective governance procedures throughout the service in relation to falls.
  • The design of facilities, premises and equipment kept people safe. Staff were trained to use the equipment. Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • There was enough rostered staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Staff kept records of patients’ care and treatment. Electronic records were stored securely and available to staff providing care.
  • Staff recognised and reported incidents and near misses. Managers investigated incidents. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Manager supported staff to become competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Where patients had capacity to consent to care and treatment, staff supported patients to make informed decisions about their care and treatment.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff mostly made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

From 29 January 2019 to 15 March 2019

During a routine inspection

We have not taken the previous ratings of services at Burton Hospitals NHS Foundation Trust into account when aggregating the trust’s overall rating. CQC’s revised inspection methodology states when a trust acquires or merges with another service or trust in order to improve the quality and safety of care, we will not aggregate ratings from the previously separate services or providers at trust level for up to two years. During this time, we would expect the trust to demonstrate that they are taking appropriate action to improve quality and safety.

We rated them as requires improvement because:

  • Patients could not always access care and treatment in a timely way. Waiting times for treatment and arrangements to admit, treat and discharge patients were worse than the England average and national standard.
  • Mandatory training, safeguarding training, mental capacity act training and role specific training rates were variable across all staff groups.
  • Morbidity and mortality governance was variable with sporadic representation from some teams and inconsistent evidence of investigation and lessons learned.
  • Some services did not have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. There was a reliance on temporary staff to cover staff vacancies in some areas
  • Changes to the leadership and governance structures since the acquisition were not yet fully embedded; information technology systems had not been integrated, service guidelines and standard operating procedures were not always up to date or aligned to the new trust and systems to extract and separate data were not well developed.
  • Medicines and medicines stationery were not always stored securely and managed in accordance with local policies.
  • Some services did not have suitable premises and patient’s security had not been considered. However, the trust took immediate action and put into place measures to ensure premises were secure. In critical care there were unmitigated fire safety and security issues despite on-going escalation through annual risk assessments.
  • Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms did not always contain sufficient evidence that mental capacity assessments had been carried out or considered.
  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. However, staff did not fully understand the new structure since the acquisition and were not aware of future plans for the service.
  • The approach to continually improving the quality of some services and safeguard high standards of care was not robust, however we saw plans in place to make improvements.
  • Culture was variable across some services.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The majority of services, controlled infection risk well. Staff kept themselves, equipment and the premises clean. They mostly used control measures to prevent the spread of infection.
  • Staff cared for patients and women with compassion. Feedback from patients and women confirmed that staff treated them well and with kindness.
  • Most services managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Most services provided care and treatment based on national guidance.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action.
  • Managers at all levels, and in most areas, had the right skills and abilities to run a service providing high-quality sustainable care.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Services took account of patients’ individual needs and staff were committed to meeting patient’s personal and emotional needs in addition to their clinical needs.