Chief Inspector of Hospitals rates The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust as Requires Improvement

England's Chief Inspector of Hospitals has told The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust that it must make improvements following an inspection in October by the Care Quality Commission.

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation 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 Robert Jones and Agnes Hunt Orthopaedic and District Hospital is part of The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust. The hospital is one of the UK’s five specialist orthopaedic centres. It provides specialist and routine orthopaedic care to its local catchment area and specialist orthopaedic care regionally and nationally.

Patients told inspectors that there were long waiting times in the outpatients department. Clinics were not planned in a co-ordinated way to ensure that demand for support services was managed. This impacted on patient experience.

Governance arrangements were in place but not applied in a systematic and consistent manner. A recent external report had identified issues with the governance arrangements around referral to treatment target times.

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

The leadership of the organisation was in the midst of significant change at the time of the inspection. The trust executives were almost all in an interim position or about to move to other organisations. It was therefore difficult to assess the capability and capacity of the executive team going forward but there was a willingness to do the right thing and support staff at the trust.

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

“Our inspectors found that some improvements were needed at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust.

“Whilst we found many examples of safe practice within medical care, there were inconsistencies across the service. For example, the varied and incomplete reporting and monitoring of near misses and patient safety incidents that could cause patient harm.

“The outpatients’ service was also a concern because it was not offering patients timely access to services and there was a significant backlog of patients waiting for appointments. In addition, staff, particularly consultant medical staff were not following national best practice to reduce the risk of infection.

“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 surgical department which we rated as good overall. Patients we spoke with told us they had been well cared for, were shown respect, treated with dignity and their privacy was protected. They were full of praise for all the staff.

“Since our inspection we have been monitoring the trust and working closely with Monitor 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/RL1.

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

• All incidents, including non-clinical incidents must be reported by staff. Learning points from complaints and incidents should be shared across directorates and all action plans monitored to improve the quality of care and develop services.
• The hospital must improve hand hygiene standards and ensure that staff in all areas are adhering to policy. The trust must also audit hand hygiene practices, using methods that are robust and improve signage of isolation procedures, hand washing instructions, and use of hand sanitisers in all clinical areas and corridors.
• The hospital must ensure that there are robust and suitable arrangements to provided paediatric medical cover during the evenings, overnight and at the weekend to ensure that they can respond in an appropriate, safe and timely way to deteriorating and seriously ill children.
• The hospital should ensure that outpatient clinics are planned in such a way to prevent excessive demand on support services or other clinic areas which in turn impacts adversely on patient waiting times.

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

• In the High Dependency Unit, staff enabled patients to maintain contact with their loved ones via the unit’s portable phone which was brought to the patients' bedside. This enabled patients to keep in touch especially if the patient lived some distance from the hospital and relatives were not able to visit.
• In July 2015, a National Patient Safety Award for clinical leadership was won by the Ward Manager of The Midland Centre for Spinal Injuries for building sustainable systems and processes. Staff sickness levels at the centre had reduced from 27% to 0.2% during 2014-2015. This was largely attributed to the strong leadership of the ward manager which had positively impacted on the team and reduced reports of stress related sickness.

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 October 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/RL1.

Under its inspection model, CQC has given individual ratings to each of the core services at the trust; medical care, surgery, critical care, children & young people’s services and outpatients and diagnostic imaging.

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