Chief Inspector of Hospitals rates The Princess Alexandra Hospital NHS Trust following comprehensive inspection

England's Chief Inspector of Hospitals has told The Princess Alexandra Hospital NHS Trust that it must make improvements following an inspection in July by the Care Quality Commission.

The Princess Alexandra Hospital NHS Trust was rated as ‘Requires Improvement’ overall. The trust was rated as Good for whether its services were caring and rated as Requires Improvement for whether its services were safe, responsive, effective and well-led. The core service of maternity and gynaecology was rated as Outstanding in relation to whether it was caring.

The Princess Alexandra Hospital NHS Trust is based in Harlow, Essex and provides a comprehensive range of district acute, community and specialist services to a local population of 258,000 people. Inspectors visited the Princess Alexandra Hospital and St Margaret’s Hospital sites.

Inspectors found that the trust had significant capacity issues and was having to reassess bed capacity at least three times a day. The pressure on beds meant that patients were allocated the next available bed rather than being treated on a ward specifically for their condition. Staff shortages meant that wards were struggling to cope with the numbers of patients.

The lack of administrative staff and poor systems meant that patients waiting for outpatient appointments were often double or triple booked. This meant that patients were often waiting in the department for excessive amounts of time.

Despite these concerns and capacity issues, it was noted that staff were exceptionally caring and went the extra mile for patients despite the added pressures on their workloads.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Our inspectors found that some improvements were needed at The Princess Alexandra Hospital NHS Trust. The outpatients’ service was rated inadequate overall because patients were not consistently offered timely access to services and there was a significant backlog of patients waiting for appointments. The managers of this area were aware of the issues and had plans in place to address them. However, at the time of our inspection these had not been addressed.

“The trust did not appear to have a structured method of assessing and responding to risk as there were several ways of reporting risks in place at Board level.

“We have seen, however, that some progress has already been made across several areas and we found many areas of good practice that staff should be proud of.

“We were particularly impressed by the professionalism and efficiency of the maternity and gynaecology department which we rated as good overall. The service provided outstanding care to women and feedback from people who used the service was all positive. Women said that staff went the extra mile and the care they received exceeded their expectations.

“Since our inspection we have been monitoring the trust and working closely with the Trust Development Authority and other stakeholders, such as the local Clinical Commissioning Group and NHS England.

“The trust leadership knows what it needs to do to bring about improvement and our inspectors will return at a later date to check on what progress has been made.”

Full reports for the trust will be published on CQC’s website today at the following link: www.cqc.org.uk/provider/RQW.

Across the trust, the inspection team found several areas where improvements must be made, including:

• The trust must ensure that all staff are appropriately trained, appraised and inducted for their roles, including agency and temporary staff.
• All guidelines and policies within the children’s accident and emergency high dependency room must be up to date with current practice.
• The trust must ensure that disposable items of equipment are not reused on patients.
• The maternity unit must be secure and there must be an effective system in place to ensure the safety of babies from abduction from the unit.
• Equipment must be checked in accordance with trusts policy, including resuscitation equipment.

Inspectors also witnessed some outstanding practice across the trust, including:

• The acting ward manager for the Dolphin Children’s Ward had made a significant improvement in a short time and showed outstanding leadership and determination.
• The outcomes for women in the maternity service were outstanding and comparable with units in the top quartile of all trusts in England.
• The teenage zone within the children’s ward was outstanding and was responsive to the needs of teenagers.
• The gynaecology outpatient and emergency service, including the termination of pregnancy service, was outstanding and provided a responsive service which met the needs of women.
• The play specialist providing dedicated time to fundraise in order to purchase toys and set up playgroups for the children.

CQC’s inspection team informed the trust of its findings immediately after the inspection so that it could take steps to make any improvements.

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.

A team of CQC inspectors and specialists including doctors, nurses, managers and experts by experience spent four days at the trust in July 2015. CQC has published separate reports on the services provided by the trust and full reports including ratings for all core services are available at: www.cqc.org.uk/provider/RQW.

Under its inspection model, CQC has given individual ratings to each of the core services at the trust; urgent and emergency services, medical care, surgery, critical care, maternity and gynaecology, services for children and young people, end of life care and outpatients and diagnostic imaging.

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