England's Chief Inspector of Hospitals has recommended The Princess Alexandra Hospital NHS Trust should be placed into special measures after a Care Quality Commission inspection rated the trust as Inadequate overall.
Following inspections carried out in June and July, CQC found the trust - which provides acute hospital and specialist services for around 350,000 people living in Harlow, Essex, and the surrounding areas - needed to make improvements to ensure it was consistently delivering care which was safe, effective, caring, responsive to people’s needs and was well-led.
Inspectors observed deterioration in the quality of some services provided since the previous inspection last year. There was a lack of management oversight in some departments and staff concerns were not always escalated to board level.
During the inspection, the trust had significant capacity issues and was having to reassess bed capacity at least three times a day. The bed shortages meant that patients were allocated the next available bed rather than being treated on a ward specifically for their condition.
In addition, inspectors were concerned that some agency nurses on duty were administering intravenous fluid care without the trust knowing if they were competent in this area.
CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“We found a number of concerns when we inspected the services run by The Princess Alexandra Hospital NHS Trust and I have made a recommendation to NHS Improvement that the trust should be placed into special measures.
“Long waits in the emergency department and capacity issues in the wards meant that patients were not always seen in a timely manner, with many patients in the emergency department breaching four hour targets.
“Ambulance handover delays were also much worse than expected for the emergency department.
“The vision for the trust was not clearly articulated by the senior team and staff. The executive team provided us with different visions, risks and strategies for the future, which did not assure us that the team were working cohesively.
“We made NHS Improvement aware of our concerns following the inspection and it has started to work with the trust to make sure these are appropriately addressed and that progress is monitored.
“It is hoped that the trust will make significant improvements through receipt of support from the special measures regime prior to our next inspection.
“However, we found that in many areas staff were dedicated and committed to patient care despite the pressures of staff shortages and building which are ageing and in need of repair.
“We were particularly impressed by the early pregnancy and termination of pregnancy services in the maternity service which we rated outstanding overall.
“The trust was also rated good overall for being caring. Staff across the trust provided care that was compassionate, involved patients in decision making and provided good emotional support to patients and those close to them.
“The trust has responded to our inspection findings and we will return to 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:
- Fit and proper persons processes must be ratified assessed and embedded across the trust board and throughout employment processes.
- Risk management processes, including board assurance processes, must be reviewed urgently to enable improved management of risk from ward to board.
- Safeguarding children’s processes must be improved urgently and learning from previous incidents must be shared.
- Staff must be provided with appraisals that are valuable and benefit personal development.
- Staff must be knowledgeable of and provide care and treatment that follows the requirements of the Mental Capacity Act 2005.
Inspectors also found a number of areas of Outstanding practice, including:
- The ward manager for the Dolphin children’s ward had significantly improved the ward and performance of children’s services since our last inspection.
- The tissue viability nurse in theatres produced models of pressure ulcers to support the education and prevention of pressure ulcer development in theatres. This also helped to increase reporting.
- The advanced nurse practitioner groups within the emergency department were an outstanding team, who worked to develop themselves to improve care for their patients.
- The outcomes for women in the maternity service were outstanding and comparable with units in the top quartile of all trusts in England.
- The lead nurse for dementia was innovative in their strategy to improve the care for people living with dementia.
An inspection team, including doctors, nurses, midwives, trained members of the public, a variety of specialists, CQC inspectors and analysts spent four days at the trust between 28 and 29 June as part of an announced inspection. An unannounced inspection was also carried out on 2 and 5 July.
The trust has four sites. The main site is The Princess Alexandra Hospital. There are also smaller sites where services are provided including St Margaret’s Hospital, Herts and Essex Hospital and the Rectory Lane Clinic. CQC only inspected the main Princess Alexandra Hospital site.
The trust was rated as Inadequate for being safe, effective and well-led and rated as Requires Improvement for being caring and responsive. The trust’s maternity and gynaecology department was rated as Outstanding.
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In many areas staff were dedicated and committed to patient care despite the pressures
Professor Sir Mike Richards, Chief Inspector of Hospitals,