England's Chief Inspector of Hospitals has recommended that Sherwood Forest Hospitals NHS Foundation Trust should remain in special measures after a Care Quality Commission (CQC) inspection resulted in it receiving an overall rating of Inadequate.
Following inspections in June 2015, CQC inspectors found the trust, which provides acute services for people living across north and mid-Nottinghamshire, as well as parts of Derbyshire and Lincolnshire, 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.
The trust was rated as Inadequate overall. Both Kings Mill Hospital and Newark Hospital were rated as Inadequate overall. Medical care at Mansfield Community Hospital was rated Requires Improvement.
The trust was placed into special measures two years ago by Sir Bruce Keogh because of concerns about mortality rates and standards of care. An inspection was carried out by CQC in April 2014 and although some improvements had been made, the CQC recommended the trust remain in special measures.
Professor Sir Mike Richards, the Chief Inspector of Hospitals, said:
“We found a number of serious problems when we inspected the services run by Sherwood Forest Hospitals NHS Foundation Trust. Rather than getting better, our latest inspection shows a noticeable decline in ratings.
“The trust’s special measures action plan had 18 high level action points to be completed by March 2015. Only one of these areas had been completed by the June inspection, although there has been some progress in other areas.
“The trust is now rated inadequate for safety and being well-led. This is extremely concerning, both in terms of the quality of care that people can expect from the trust, and for what it says about the trust’s ability to improve. This situation must not be allowed to continue and we are considering, along with partner agencies, the best option available in order to improve services rapidly for the local population.”
Professor Richards is writing to the Secretary of State for Health to outline his concerns because the trust has been in special measures for more than 18 months.
There have been longstanding concerns about the management of patients with sepsis. This is a severe infection which spreads in the bloodstream. The death rate for patients with this diagnosis from April 2014 to February 2015 was almost double the national average. Whilst the trust had performed analysis, the actions taken had not reduced mortality.
Inspectors found evidence that the trust did not always report incidents to the appropriate agencies in an open and transparent way. NHS managers have a personal and professional responsibility to be open and transparent.
Essential lifesaving equipment was missing from one of the three resuscitation bays at Newark Hospital. Inspectors had to ask staff to replace this urgently as it meant that in the event of a cardiac arrest, essential equipment would not have been available.
Professor Richards continued:
“At the time of the inspection, mortality rates continued to be above expected limits. This had been reported to the trust board and was one of the top three objectives for improvement. A particular concern was the trust’s management of patients with sepsis, with just 17 percent of inpatients receiving care and treatment in accordance with national guidance.
“There was a strategy for Newark Hospital but staff were frustrated by lack of pace to deliver this vision and felt there was poor leadership. We found little evidence of the progress made with implementing the vision and strategy.
Morale amongst staff, particularly those in more junior levels was poor at Newark Hospital.
“Generally, staff were proud of the care they delivered and reported good leadership at a local level. Some staff reported that executive leadership in the hospital needed improvement and highlighted a lack of clear direction. Despite these obstacles, staff were hard working, passionate and caring and because of the quality of care delivered by the staff, we rated the trust as good for caring.
“Executive leaders in the trust were not always sighted on the risks that we had identified, or where they had they did not consider them to be significant.
When concerns were raised or things went wrong, the approach to reviewing and investigating causes was insufficient. There was limited evidence of wider learning from events or action taken to improve safety.
“It is clear that the trust cannot solve these important issues on its own, and will require continued support for the foreseeable future. Others with a responsibility for health services in the area need to help address the problems the trust cannot deal with on its own. In these circumstances, it would not be appropriate to recommend that the trust leave special measures.”
CQC has told the trust it must make improvements in a number of areas, including:
- All patients over the age of 75 must receive a cognitive assessment when arriving in the emergency department at Kings Mill Hospital.
- Lifesaving equipment in the maternity service at Kings Mill Hospital must be checked regularly and consistently to ensure it is safe to use and properly maintained.
- Staff must receive effective and appropriate guidance and training about the assessment and treatment of sepsis.
- Staff at Newark Hospital must have the appropriate qualifications, competence, skills and experience to care for and treat children safely in the minor injuries unit.
- Staff must have opportunities to learn from incidents across the trust.
- The trust must ensure that medication is monitored, in date and fit for purpose in all clinical areas of the children’s and young people’s service.
- Care plans must be individual and specific to the patient to ensure staff are aware how to deliver care to patients which meets their needs.
- Systems and processes to prevent and control the spread of infection are operated effectively and in line with trust policies, current legislation and best practice guidance.
Sherwood Forest Hospitals NHS Foundation Trust comprises of four locations; King’s Mill Hospital in Sutton-in-Ashfield, Newark Hospital, Mansfield Community Services and an outpatient service at Ashfield Health Village (this service was not inspected).
Full reports including ratings of all core services have been published on the CQC website.
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