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CQC rates Plymouth Hospitals NHS Trust Outstanding for caring – but overall trust Requires Improvement
England’s Chief Inspector of Hospitals has rated Plymouth Hospitals NHS Trust as Requires Improvement following an inspection by the Care Quality Commission.
A team of inspectors has found that the trust provided services that were effective and well led. The trust was found to be Outstanding for being caring, but Requires Improvement for providing safe care and Inadequate for providing responsive services.
During the inspection in April and May the team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Derriford Hospital and Mount Gould Hospital. Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RK9.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
"Plymouth Hospitals NHS Trust sets out to be one of the country’s leading specialist centres delivering excellent care, teaching, training and research.
"We found that the current leadership team has promoted a positive open culture, which aspires to put patients first, despite the significant financial pressures in Devon. It is a credit to all the staff that we found caring to be Outstanding overall, but especially in maternity and gynaecology, children and young people's services and end of life care.
“Plymouth is a major trauma centre providing a service across the Peninsula and we found the overall situation for patients in A and E to be unacceptable. The trust will need to work with partners to ensure that as far as possible, patients who are medically fit to leave hospital are supported to do that in a timely way. There is also work to be done to ensure that people attending A&E are being cared for in the most appropriate place.”
“However there is too much variation in the quality of services. I am particularly concerned at the backlog of patients waiting for the results of their diagnostic scans and in the number of patients awaiting follow up. Some people have been unable to get initial appointments as soon as they should, delaying their diagnosis, or treatment, or they are waiting too long for surgery. This has had very serious consequences in some cases. This must be addressed.”
“Each and every patient is entitled receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. We will return in due course to check that the improvements that we have identified have been made.”
Overall, the inspectors found that most patients received good outcomes, with care and treatment delivered in accordance with national guidelines and best practice. Inspectors found many examples where staff had demonstrated outstanding support for patients and their families.
The trust had been especially busy since December 2014, with increasing numbers of patients requiring attention in the emergency department. Staff were sometimes stretched in coping with the numbers of additional patients, who at times were cared for in corridors. The standard that requires 95 per cent of patients to be discharged, admitted or transferred within four hours of arrival in A&E was consistently not being met and had not been met for months throughout the winter.
At peak times, there had been up to 100 medical patients being cared for on surgical wards. May non-urgent operations had to be cancelled, and the trust was not always meeting the targets for rebooking patients within 28 days.
People were frequently unable to book initial appointments with specialists soon enough. A shortage of doctors was leading to a large backlog of patients waiting for follow up appointments or for the results of their diagnostic scans. Inspectors found a number of cases where patients had come to harm because of the delays. While the trust had introduced a programme to prioritise patients who may be at higher risk, it was recognised that this would take time to achieve.
The hospitals were predominantly seen to be clean and well maintained, although the maternity delivery suite required improvement in the fabric of the building as it was difficult to clean and not all hand wash basins met the required standard.
The reports highlight several areas of outstanding practice including:
The care and support provided to patients at the end of their lives was outstanding. Patients and relatives said that they felt involved in decisions about care and treatment, and they had been treated as individuals, with their choices listened to and respected.
Hospital staff worked well to integrate care with community services, which meant that discharges were managed quickly to meet patients’ needs. The specialist palliative care team worked with the local hospice to improve patient support.
Staff on the delivery suite and maternity and gynaecology wards provided outstanding care to patients. Staff in all professions and grades demonstrated kindness, compassion, dignity and respect. Specialist professional counselling was available from midwives and a clinical psychologist supported women with difficult or complex decisions.
The advice and support offered by the acute care team within critical care in responding to deteriorating patients was recognised by other staff, particularly the surgical and medical wards. They were seen as quick to respond, highly experienced and knowledgeable.
The inspection found a number of areas where the trust must improve including:
There must be enough suitably qualified and experienced nursing and medical staff on duty to ensure the safety of patients at all times. This applies to the emergency department, children’s services, outpatients and diagnostics, maternity services and medical services.
Systems for booking operation theatre slots must be coordinated across the trust so that theatre time is used to provide a timely and consistent service. The trust must introduce a system which ensures that patients whose operations are cancelled at short notice are rebooked for surgery within 28 days.
Systems must be put in place to manage the backlogs of follow-up appointments and of imaging reporting, reducing the risks to patients of delayed diagnosis and treatment.
The critical care service must reduce the high levels of patients whose discharge is delayed, or who are discharged during the night.
The three reports which CQC publish 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 including Healthwatch.
On 29 July the Care Quality Commission will present 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.
For further information please contact CQC Regional Engagement Manager John Scott on 07789 875809 or, for media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here (Please note: the duty press officer is unable to advise members of the public on health or social care matters).
For general enquiries, please call 03000 61 61 61.
- Last updated:
- 29 May 2017
Notes to editors
The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading inspection teams that include CQC inspectors, doctors, nurses, managers and experts by experience (people with personal experience of using or caring for someone who uses the type of services we were inspecting). By March 2016, CQC will have inspected and rated all acute NHS Trusts in England. 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.
Since 1 April, providers have been required by law to display their ratings on their premises and on their websites so that the public can see their rating quickly and easily. This should be done within 21 days of publication of their inspection report. For further information on the display of CQC ratings, please visit: www.cqc.org.uk/content/display-ratings.