Chief Inspector of Hospitals finds progress at Buckinghamshire Healthcare NHS Trust but trust needs to make further improvements

England’s Chief Inspector of Hospitals has rated Buckinghamshire Healthcare NHS Trust as Requires Improvement following an inspection by the Care Quality Commission. A team of inspectors has found that the trust is rated as 'requires improvement' for safe, effective, responsive and well-led services. The trust was rated ‘good’ for providing caring services.

The inspection team visited Stoke Mandeville Hospital and Wycombe Hospital as part of an unannounced inspection of urgent and emergency care and end of life care services following its last inspection in 2014. The team also undertook a comprehensive inspection of the trust’s community health services.

Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RXQ.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"A year ago, following a period of some improvement, I recommended that Buckinghamshire Healthcare NHS Trust should come out of special measures. I am pleased to report that our latest inspection has found that the trust is still making headway in many areas.

“On this inspection we have found significant improvements in both emergency care and end of life care services which were previously of concern. However, there is still a way to go. Both High Wycombe and Stoke Mandeville Hospitals are rated as requires improvement. The pace of change has been rapid and clinically led. However, we still have concerns about medical staffing levels at night and weekends in some areas. We would also like to see a more consistent level of service across emergency care and end of life care.

"In community health services, we found that these need further development to ensure there is integration between the acute and community care. There were some concerns for inpatient services and in children’s services, although community end of life care was good.

“While I am satisfied that the trust is heading in the right direction, I look forward to further improvements being implemented and fully embedded upon our next inspection.“

The team of 35 inspectors and specialists including doctors, nurses, managers and experts by experience, visited the hospitals and community services over four days during March 2015.

Overall inspectors found the trust had made significant improvements in end of life care. Nursing and medical care had improved and patients received better pain relief. Patients and relatives gave examples of compassionate nursing care and felt involved and informed regarding their care and treatment.

CQC found services were being planned based upon the needs of the local population and in response to demands, the trust was working more in partnership with health and social care partners across Buckinghamshire.

There were new services in place to speed up the treatment of patients and the trust had planned staffing levels after identifying peak attendance times in the emergency department. The new services included an initial assessment and treatment centre in the Emergency Department, an assessment and observation unit (AOU), a short stay acute medical unit, and an ambulatory care service. Some patients were still delayed in the Emergency Department so it meant these still weren’t functioning as effectively they could be across the hospital.

Overall, the community health services varied. The trust’s main strategy was around the integration of the acute and community services. This strategy was developing in adult community services, end of life care and community inpatient services.

But inspectors found the strategy was undeveloped in children, young people and families services. Inspectors found the leadership of the children, young people and families services was ‘inadequate’ with some managers demonstrating inappropriate behaviours with some service staff describing a culture of feeling “pressured” and sometimes “bullied” by some staff. Patients were complimentary about community services although some concerns were indicated in some of the community hospitals.

The inspection identified a number of areas for improvement, including:

• There must be a timely replacement for the Liverpool Care Pathway and all staff must follow the current interim policies.
• There are timely GP discharge summaries following a patient admission to the Emergency Department.
• Staff in acute hospitals complete the end of life care plans (Hearts and Minds – end of natural life) appropriately to NICE guidelines for holistic care and they are followed.
• In community children’s services, staff are able to freely raise any concerns about being unable to deliver services safely and that this is heard and acted on by management.
• Staff can appropriately identify and respond to patient risks
• Staffing levels are assessed and reviewed using an evidence-based tool and meet recommended guidelines.
• Patients in community adults services are protected against the risks of unsafe or inappropriate care and treatment arising from inaccurate patient records or records which cannot be located promptly when required.
• In community inpatient services all staff have the skills and knowledge required to care for all patients admitted to the community hospitals.
• There is effective and supportive leadership throughout the service in community inpatient services.

The reports highlight several areas of outstanding practice including:

• Community adult health services were available to patients 24 hours a day, seven days a week. This included nurses caring for patients in their homes at night.
• Staff from the respiratory team told us there was a single point of access seven days a week for specialist nursing services provided by their team. Patients, GPs, community nurses and staff from the hospital’s inpatient wards could ring the team on a dedicated phone number for advice and support.
• The specialist palliative care nurses provided a daytime service with telephone advice and support out of hours. Face to face support was available out of hours from the district nurse team. The children’s team worked flexibly and provided a 24 hour service when a child was approaching the end of their life.
• Patients were given an individualised, multidisciplinary risk assessment regardless of the service they used.
• The trust provided a community diabetes service which offered two hour clinics twice a week for non- English speaking patients, and provided interpreters. Clinics could be accessed by appointment or drop in. There was also a three week education session provided over Ramadan for healthcare professionals and a drop-in programme for patients who had diabetes to help patients make adjustments to their medication while fasting.

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. The reports which CQC publish 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.

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