England's Chief Inspector of Hospitals has recommended Norfolk and Norwich University Hospital NHS Foundation Trust is placed into special measures following a Care Quality Commission (CQC) inspection which sees it rated as Inadequate overall.
Between 10 October 2017 and 28 March 2018, a team of CQC inspectors visited the trust and inspected urgent and emergency care, surgery, end of life care, outpatients and diagnostic imaging services.
The inspection highlighted a number of concerns and a general deterioration in how the trust was being run - following its previous inspection (in April 2017) the trust was rated as Requires Improvement overall.
All CQC’s comprehensive inspections of NHS trusts now include inspection of the well-led key question, as there is a strong link between the quality of overall management of a trust and the quality of its services. CQC inspected the well-led key question at Norfolk and Norwich University Hospital NHS Foundation Trust between 15 and 16 November 2017.
Additionally, following information of concern from whistle blowers, CQC undertook a number of announced and unannounced inspections with regard to this key question between January and March 2018.
As a result the trust is now rated as Inadequate for whether its services are well-led.
The trust is also rated as Inadequate for whether its services are safe, Requires Improvement for whether its services are effective and responsive and Good for whether its services are caring.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“It is extremely disappointing to see a trust that not only hasn’t improved since our last inspection, but where there has been an obvious deterioration in how the services are run.
“Although staff at the trust were clearly caring and committed to helping patients, and we found some areas of outstanding practice, we were very concerned by how the trust is being led and with many of its systems and processes.
“We received a significant number of reports through whistle blowing following our initial inspection and this showed that a bullying culture remained at the trust, and one of fear of reprisal amongst staff if they should raise concerns. I would like to thank all those staff who raised concerns with our inspection team. They have made a major contribution to the recognition of the problems at the trust, which is the essential foundation for any improvement.
“Our inspection showed there was much work the trust needs to do. This is why it is now rated as Inadequate and why I am recommending it is placed in to special measures, so that it can receive the support it needs to improve and ensure people receive the care they should be able to expect.
“We will continue to monitor the trust’s progress and this will include further inspections.”
There are a number of areas where the trust must make improvements.
Bed management and site management processes need to be reviewed in order to increase capacity and patient flow, and to ensure there are effective processes which ensure patient safety.
The relationship and culture between the site management team and the senior nursing and clinical teams must improve so that patient safety is equally weighted against operational pressure to reduce risk to patients and staff.
Processes for whistleblowing must be reviewed and the trust’s leadership must take definitive steps to improve the culture, openness and transparency throughout the organisation.
Mandatory training attendance must improve so that all staff are aware of current practices and the trust must review the knowledge, competency and skills of staff in relation to the Mental Capacity Act and Deprivation of Liberty safeguards.
The completion of staff annual appraisals must improve and there needs to be an effective process for quality improvement and risk management across all departments.
CQC’s inspection also found some areas of outstanding practice. Inspectors found there were impressive pathways for the management of stroke and fractured neck of femur patients. The urgent and emergency service worked with the trust’s specialist teams, even in the ambulance bay, to assess and treat patients quickly and effectively as possible with regard to these conditions.
The cardiology outpatients’ department had a physiotherapy cardiology breathing pattern disorder clinic and, through this, had produced significantly improved the outcomes for patients.
A forum for outpatient staff, established in 2017, provided opportunities for networking and communication across divisions, grades and specialties and, as part of this, staff explored shared issues and set up project groups to resolve those issues. The forum had improved engagement with the executive team, who had attended meetings and taken part in open discussions with staff.
Some outpatient areas were offering innovative treatments. This included the dermatology outpatient area which offered the ‘gold standard’ treatment for basal cell carcinoma (BCC), known as Mohs surgery. This procedure allows for the removal of all cancerous cells for the highest cure rate while sparing healthy tissue and leaving the smallest possible scar.
Full details of the ratings, including a ratings grid, are given in the report published on our website.
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“It is extremely disappointing to see a trust...where there has been an obvious deterioration in how the services are run.
Professor Ted Baker, Chief Inspector of Hospitals