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Chief Inspector of Hospitals finds that Great Western Hospitals NHS Foundation Trust requires improvement
England's Chief Inspector of Hospitals has told Great Western Hospitals NHS Foundation Trust that it must improve the quality of some of its services following an inspection by the Care Quality Commission.
Overall, the trust has been rated as Requires Improvement, although the trust was rated Good for caring. The main acute hospital in Swindon was rated as Requires Improvement, with maternity and gynaecology services and end of life care rated as Good overall. All four community services inspected were rated as Good in all key questions with services for children and young people rated as Outstanding.
During the inspection in October a team of inspectors and specialists including doctors, nurses, managers and experts by experience visited the Great Western Hospital in Swindon, Chippenham Community Hospital, Savernake Hospital, and Warminster Community Hospital while also looking at services delivered in clinics and people’s homes. Full reports on all core services are available on this website.
Professor Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, said:
“Great Western Hospitals NHS Foundation Trust provides a range of essential services to the people of Swindon and Wiltshire. The staff are caring, committed and compassionate, but I know that the trust has been under some financial pressure, and this may well have had an impact on patient care.
“We found a marked variation in the quality of the services between the acute hospital at Swindon and the services based in the community.
“There were particular concerns with staffing levels and how this compromised patient safety in the emergency department where people were queuing in corridors. The trust has not found it easy to manage the access and flow of patients through the Great Western Hospital. Both the acute and community hospitals faced a high number of patients who were fit for discharge, but had no care package in place.
“Although these issues were recognised and known, we found that the necessary improvements had not been made or sustained. However, the trust leadership was open about the challenges they faced and listened to our concerns. They must now work hard to meet the demands required.
“People are entitled to services which are consistently safe, effective, caring and responsive to their needs. We will continue to monitor the trust’s performance and return in due course to check that the improvements that we have identified on this inspection have been made.”
Inspectors found the trust had struggled to manage the access and flow of patients through the main hospital. Despite a bed occupancy rate higher than the England average there were fewer cancelled operations than the average. But, there were high numbers of patients who could not be discharged because there were no suitable places for them to go to. While not designed for that purpose, the day surgery unit was frequently used to accommodate patients overnight.
There were concerns with staffing and how this impacted upon patient safety. Within the emergency department the design and layout meant that waiting patients, including children, were not adequately observed. The physical isolation of the observation unit and lack of environmental safeguards posed unacceptable risks to patient and staff safety. Staffing levels did not take into account the requirement to care for patients who queued in the corridor or the sub-waiting room.
There were also concerns about the level of staffing within the children’s emergency department. The midwife to patient ratio did not meet recommended levels and one to one care for women in established labour was not achieved all of the time.
The report notes that patients were treated with compassion, kindness, dignity and respect. Staff within the children and young people’s community teams were focused on the needs of the children and young people, putting them at the heart of everything they did. Care was delivered with empathy and honesty.
The Care Quality Commission has identified 26 specific areas for improvement, including:
- The access and flow of patients must be improved in order to reduce delays from critical care for patients being admitted to wards and reduce occupancy to recommended levels.
- Nurse staffing levels and skill mix must be reviewed in the emergency department including children’s ED, the ED observation unit and minor injury units, using a recognised staff acuity tool.
- The trust must ensure the provision of single sex accommodation.
- Patients with mental health issues on medical wards must be appropriately managed.
The trust must monitor the time self-presenting patients wait to be assessed in the emergency department and take appropriate action to ensure their safety. This must include taking steps to improve the observation of patients waiting to be assessed so that those who are seriously unwell are seen promptly. The reports highlight several areas of outstanding practice including:
- In the critical care unit inspectors were given examples of staff going the extra mile for their patients, including a patient attending a family wedding in London, with transport being arranged by the unit and staff escorting the patient for the day.
- The children and young people's community teams had excellent multi-disciplinary and multi-agency working. This extended across the local communities they served, health and social care as well as the ministry of defence to support children of military families.
- Two consultants provided bespoke training on some of the community hospital wards. This was well received and attended by staff. They felt this enhanced the feeling of working in partnership to ensure the best care and support is provided for the patients
- Children were treated with respect and their ability to give consent for their own treatment was taken seriously.
The reports which CQC publishes today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.
On 18 January the Care Quality Commission will present 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.
For further information please contact CQC Regional Engagement Manager John Scott on 07789 875809 or 0191 233 3548 or, for media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the duty press officer is unable to advise members of the public on health or social care matters.) For general enquiries, please call 03000 61 61 61.
- Last updated:
- 29 May 2017
Notes to editors
The Great Western Hospitals NHS Foundation trust provides acute hospital services at the Great Western Hospital which has a total of 450 beds. It also provides community health services across Wiltshire. These services include community hospitals, community nursing teams, therapists and children’s and young people’s services. There are four wards spread across three community hospitals; Chippenham, Warminster and Savernake.