England’s Chief Inspector of Hospitals has rated Weston Area Health NHS Trust as Requires Improvement following a comprehensive inspection by the Care Quality Commission.
A team of inspectors has found that the trust provided services that were Good for being caring. Overall, safety was rated Inadequate. The trust required improvement for providing effective, responsive and well led services.
During the inspection in May and June the team of inspectors and specialists – including doctors, nurses, managers and experts by experience, visited Weston General Hospital and the specialist children's services provided by the trust at Weston super Mare and Clevedon.
At Weston Hospital, services for children and young people, maternity and gynaecology, end of life care and outpatients and diagnostic imaging were rated Good. Medical care was found to be Inadequate, while critical care, surgery and urgent and emergency services were rated as Requires Improvement. Community health services were rated Good and specialist community mental health services for children and young people were Outstanding.
Inspectors found concerns about safety in urgent and emergency care and in medical services at Weston General Hospital.
At busy times, patients attending the emergency department were not always assessed or prioritised as soon as they should be. While they were waiting in the corridor to be admitted to the department patients were not adequately monitored by hospital staff, although ambulance staff were with them.
On the high care unit on Harptree ward, there were not enough suitably qualified nurses to care for high dependency patients. Shortly after the inspection CQC raised its concerns with the trust asking them to take urgent action.
Throughout the hospital there were not enough senior doctors in post. Inspectors found there were high numbers of vacancies for consultants. Some junior doctors said that at times they felt pressured to undertake tasks unsupervised. Some said they had been asked to perform tasks that they did not feel fully competent to perform.
Across the trust every service was found to be caring. The inspection team found staff had a patient focus, and were committed to doing their best for patients. Care for children and young people was rated as Outstanding within Weston General Hospital and in the specialist community mental health services.
Although there were some concerns about nursing vacancies, most shifts seemed to be covered and nursing leadership was strong.
Volunteers played a key part in the life of the hospital undertaking a number of roles involving direct and indirect support to patients such as greeting visitors and patients at the front desk, helping ward clerks and nursing staff, and befriending patients.
Professor Sir Mike Richards, Chief Inspector of Hospitals, said:
"It is well known that Weston Area Health NHS Trust is the smallest NHS trust in England – which I recognise can present its own challenges. The current uncertainty over the trust's future has inevitably been unsettling, although many staff we met talked about their pride in the hospital and their colleagues, and in the care that was provided. We were especially impressed by the community mental health services for children and young people, which were outstanding.
"But we also heard that consultants were under great pressure due to the high number of vacancies. Even though they have been working very hard to cover, there was a clear feeling of discontent among junior doctors who reported high levels of stress, and a lack of confidence that their concerns were being dealt with.
"Shortly after the inspection we raised our immediate concerns with the trust, asking them to take urgent action to address our findings about safety in urgent and emergency care and on the high care unit. The response that we received showed that the trust had taken urgent action.
"We will return in due course to check that the trust has sustained those improvements. In the longer term we will continue to monitor how Weston Hospital deals with those other requirements we have identified."
The inspection identified a number of areas where the trust must improve including:
- The trust must ensure that patients arriving by ambulance are fully monitored and assessed for priority when in the corridor awaiting admission to the department.
- All patients must receive timely assessment in line with College of Emergency Medicine guidance to ensure that they receive suitable and timely treatment.
- There must be suitable numbers of staff with the qualifications, skills and experience to meet the needs of patients within the high care unit.
- The trust must take action to improve doctors' staffing levels and skill mix in the emergency division to ensure that people receive safe care and treatment at all times.
- The hospital must ensure the medical cover in surgery services, out-of-hours and, specifically, at night is safe and the staff on duty meet the requirements of the out-of-hours policy.
The reports highlight several areas of outstanding practice:
- Staff had demonstrated a good depth of knowledge and sensitivity for people with different needs in helping deal with the anxieties of a patient with a learning disability who was coming into the day surgery unit.
- The care for children, young people and their families and for specialist community mental health services for children and young people.
- Various examples of multidisciplinary working between the different professional groups within the community children's and young people’s services team and also with external agencies and professionals.
- The outpatients’ manager responded to incidents that originated outside the department. As an example, the senior plaster technician in the orthopaedic clinic had devised a teaching programme to improve the skills of other clinical staff in applying plaster casts.
- The trust’s tissue viability specialist had been awarded Pressure Care Nurse of the Year in March 2015 by the British Journal of Nursing in recognition of an innovative campaign using gingerbread men to raise awareness of the risk of pressure ulcers.
The four 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.
Next month 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.
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