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Chief Inspector of Hospitals recommends Cambridge University Hospitals NHS Foundation Trust is placed into special measures
England's Chief Inspector of Hospitals has recommended Cambridge University Hospitals NHS Foundation Trust should be placed into special measures after a Care Quality Commission (CQC) inspection resulted in it receiving an overall rating of Inadequate.
Following inspections in April and May, CQC inspectors found the trust, which is one of the largest in the country with over 1,000 beds, needed to make a number of improvements to ensure it was consistently delivering care which was safe, effective, caring, and responsive to people’s needs.
Inspectors found a significant shortage of staff in a number of areas, including critical care services. This often resulted in staff being moved across different services, with gaps back-filled by bank or agency staff. Staff were therefore sometimes working in services where they lacked proper skills and training, presenting a risk to patient safety. The trust has already taken steps to address these concerns.
Pressure on surgical services meant routine operations were frequently cancelled and patients were waiting longer for operations. Some patients were experiencing long delays in getting outpatient appointments, for example, the longest wait for a first appointment for ophthalmology was 51 weeks.
Although there were some excellent maternity services, pressures led to regular closures and inspectors highlighted serious concerns.
For example, high levels of nitrous oxide were detected in the Rosie Birthing Centre; an issue which senior managers had apparently been aware of for over two years. However, the only action taken to address this risk was to advise staff to open windows where possible. The situation is expected to be resolved by December and staff have been given guidance on minimising exposure.
Important messages from the clinical divisions were not highlighted at trust board level. We were concerned that identified risks were not always being addressed, for example, some risks had been on the risk register since 2006 and there was a lack of action plans and ownership for the risks identified.
There was a disconnect between what was happening on the front line and the senior management team. Staff satisfaction was poor and plans to support staff and improve the culture were not robust.
CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“We found a number of serious problems when we inspected the services run by Cambridge University Hospitals NHS Foundation Trust and I have made a recommendation to Monitor that the trust should be placed into special measures.
“We made Monitor aware of our concerns following the inspection and it has begun to work with the trust to make sure these are appropriately addressed and that progress is monitored.
“We were concerned that in some services, staff were caring for people in areas unfamiliar to them, meaning patient safety and welfare was placed at risk. However, staff were hard working, passionate and caring throughout the trust, prepared to go the extra mile for patients, but having to swim upstream against the pressures they faced. Because of the quality of care delivered by the staff, we rated the trust as Outstanding for caring.
“The trust has a vision, values and strategy for front line care. However, this was heavily focused towards research, academia and specialist service provision. Staff felt that senior managers were unaware of the issues they faced. Ward staff felt well supported by their local managers but reported that they did not see the senior management team, apart from the chief nurse, in ward areas
“There was a significant disconnection between the values of the board and the values of the frontline staff which must be addressed. For example, the chief executive stated that the trust was a tertiary specialist hospital and not a district general hospital. However, ward staff believed that they were a district hospital with specialist services.
“The trust managers have told us they have listened to our inspectors’ findings and have begun to take action where it is required. We have maintained close contact with the trust since the inspection and will undertake further inspections, including unannounced visits to check that the necessary improvements have been made.”
The inspection highlighted a number of concerns and areas where the trust must improve, including:
- All patients awaiting an outpatient appointment must be assessed for clinical risk and prioritised according to clinical need.
- Systems or processes must be established and operated effectively to enable the outpatients department to assess, monitor and improve the quality and safety of services.
- Services around end of life care must be reviewed to allow for fast track or rapid discharges to be undertaken in a timely way.
- Patients must be discharged from critical care units to the wards in a timely manner in order to minimise the number of patients being discharged after 10pm.
- Consistent foetal heart rate monitoring must be provided in maternity services.
- Medicines must be managed in line with national guidance and the law.
Despite the overall rating of Inadequate, inspectors identified a number of areas of Outstanding practice across the trust, including:
- The allergy clinic had a one-stop allergy service that provided diagnosis and management of a wide range of allergic disorders. This clinic was dynamic and comprehensive.
- Virtual clinics had been set up in a number of areas, each consisting of a multidisciplinary team of staff including nurses and consultants. The purpose of the clinic was to review patient tests to make treatment decisions without the need for the patient to attend an appointment.
- The chaplaincy and bereavement service offered a one-stop appointment where bereaved relatives could see all trust staff that they needed to see in one visit. Bereaved relatives were also invited back six weeks after the death to enable staff to provide emotional support and answer any questions.
- The online educational resource developed by the trust’s neurological critical care team, is a repository of educational resources for trainees, both locally and internationally.
- The birthing unit in The Rosie Hospital had state-of-the-art facilities, including; ten birthing rooms with en-suite bathrooms, mood lighting and music systems, as well as access to a sensory garden and comfortable equipment.
- Team working in the critical care unit was outstanding. Given the limited resources, all members of the multidisciplinary team worked collaboratively to ensure patients received kind and compassionate care. Nursing staff were observed doing everything they could to ensure patients’ carers were well informed of their loved ones’ condition.
An inspection team, including doctors, nurses, midwives, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent four days at the trust in April and one day in May. The trust was judged as Inadequate with regard to whether services were safe, responsive and well-led, it was rated Requires Improvement for whether services were effective and rated Outstanding regarding whether services were caring.
Cambridge University Hospitals NHS Foundation Trust comprises of 12 locations registered with CQC. There are two main sites, Addenbrooke’s Hospital and the Rosie Hospital (women’s hospital) which we inspected. The other sites are satellite and outreach sites at other NHS locations.
Addenbrooke’s Hospital and the Rosie Hospital in Cambridge provide healthcare and specialist services such as transplantation, treatment of rare cancers and neurological intensive care. Both hospitals were rated as Inadequate overall.
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- Last updated:
- 29 May 2017
Notes to editors
Monitor is responsible for, and makes the formal decision on, whether foundation trusts are placed into special measures. A statement will be issued later today announcing the outcome of CQC’s recommendation.
Hospitals are put into special measures when there are problems with the quality of care provided to some or all patients that the leadership of the trust cannot fix in a reasonable time without additional help. Often the decision that a hospital is providing poor care is made following an inspection by the CQC’s Chief Inspector of Hospitals.
The Chief Inspector of Hospitals will normally make a recommendation if he thinks a hospital needs to be placed in special measures. At that stage, Monitor decides whether NHS foundation trusts go into special measures while the NHS TDA decides for other trusts. Further information about special measures.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?
The Care Quality Commission has already presented 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.
Since 1 April, providers have been required to display their ratings on their premises and on their websites so that the public can see their rating quickly and easily. Further information on the requirement for providers to prominently display their CQC ratings.