1 May 2014
England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has recommended that Heatherwood and Wexham Park Hospitals NHS Foundation Trust should be placed into special measures.
The trust has been rated as inadequate following an inspection in February under the new inspection regime introduced by the Care Quality Commission to provide a much more detailed picture of care in hospitals than ever before.
Overall, the inspectors conclude that the quality of care provided by Wexham Park Hospital at Slough was inadequate, although the children's department and critical care unit were both providing a good service. Heatherwood Hospital at Ascot was rated as Good. Full reports of the inspection have been published on the CQC website.
Inspectors found unsafe staffing levels were a consistent theme throughout the trust with a shortage of doctors, nurses and other healthcare professionals, and a heavy reliance on agency staff who were often unfamiliar with the wards where they were working.
Wexham Park Hospital was also failing to consistently meet national targets to admit, transfer or discharge patients from the A&E department within four hours. Although the trust had opened extra beds to meet demand, inspectors found there was little evidence of initiatives to try to reduce unnecessary admissions.
Patient discharges were delayed while they waited days for X-rays or other assessments, taking up beds which should have been used for patients having surgery, meaning that a significant number of operations had to be cancelled on the day. Outpatients also faced long delays for appointments.
In the children's and young people's department and the critical care unit, staff were expected to report incidents and learn from them as a matter of routine. But the inspectors found that elsewhere there was no real safety culture, with little encouragement to staff to report incidents because they felt there was little subsequent change.
While staff were seen to be kind and compassionate, they were often too busy to support patients properly. The inspectors were disappointed by the lack of clinical engagement and their apparent acceptance of poor patient experience. Consultants were found to lack ownership of patients and there were several departments where staff appeared to be working against each other rather than together to improve standards of care. In addition inspectors said that accusations of harassment and bullying were heard throughout the organisation.
The Care Quality Commission has identified 18 areas for improvement, including:
- The trust must improve staff engagement across clinical and managerial disciplines to promote a learning and safety culture where patient experience is paramount.
- Patients must be properly risk-assessed particularly for falls and pressure ulcers - including patients who are in the A&E department for a prolonged period.
- Patient flow must be addressed as a priority to improve the poor waiting times in A&E, the high number of surgical cancellations and delayed discharges from the critical care unit.
- The hospital property must be fit for purpose, with repairs and maintenance planned and dealt with in a timely manner.
- A robust system must be introduced to assess the numbers and skill mix of medical and nursing staff for all wards, with establishment numbers increased to reflect this.
- Workforce recruitment and retention plans must be addressed to reduce the dependency on locum and agency staff.
- Where agency and locum staff are employed, relevant background and competency checks must be undertaken, with local induction before they start work.
- The trust must encourage and support an incident reporting culture at all levels, which is seen as a mechanism to learn rather than attribute blame.
- The radiology service must be able to meet the needs of patients in a timely way.
- The trust must improve the booking and appointments system, waiting times and the cancellation of clinics to prevent delays and to improve access to treatment.
- All staff must be able to respond to the needs of vulnerable groups such as people with dementia or a learning disability.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
"We know that Wexham Park Hospital has had a long history of problems - and the legacy of these problems is all too apparent in the safety culture, the staffing levels, and the overflowing wards.
“There are some positives - notably in critical care and in the children's department - and the trust has responded to recent inspections by making some improvement in some areas, such as cleanliness for instance which we note is much improved recently.
“But there is a lot more to do, and the staff can't go on firefighting, reacting to the latest pressures, without a clear vision about the hospital's future direction.
“This cannot go on. It is clear to me that the trust leadership, in its present form, is not equipped to bring in the deep and long-lasting changes that are needed to turn round Wexham Park Hospital, which is why I’ve recommended that the trust should be placed in special measures. This should give it the support it needs to tackle the issues it faces and deliver the quality of services that the public are entitled to expect.”
An inspection team which included doctors, nurses, and hospital managers, trained members of the public, CQC inspectors and analysts spent two days at Wexham Park Hospital and Heatherwood Hospital in February. They examined the care provided in accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, maternity and family planning, children’s care, end of life care and outpatients. Inspectors also visited Wexham Park out of hours unannounced on three occasions.
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Notes to editors
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. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model. 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.
This report describes our judgement of the overall quality of care provided by this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations