The Mid Yorkshire Hospitals NHS Trust rated as Requires Improvement by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has rated the services provided by The Mid Yorkshire Hospitals NHS Trust as Requires Improvement following an inspection by the Care Quality Commission in June 2015.

Overall, the trust’s services were rated as Good for being caring, but as Requires Improvement for being effective, responsive and well led, and as Inadequate for being safe.

CQC also rated each hospital individually. Pinderfields Hospital, Pontefract Hospital and Dewsbury and District Hospital were each rated as Requires Improvement, although maternity services, services for children and young people, and outpatients and diagnostics at all three hospitals were rated as Good.

The inspection team, which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts, spent three days at the trust to follow up on improvements required as a result of CQC’s previous inspection in 2014. Inspectors made a separate unannounced visit to Pontefract General Infirmary as part of the inspection, and a further unannounced visit to Pinderfields Hospital in response to information of concern.

Full reports from the inspection, including ratings for all core services that were reviewed will be available from 00:01 on Thursday 3 December at: www.cqc.org.uk/provider/RXF.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“When we inspected the hospitals run by the Mid Yorkshire Hospitals NHS Trust, we saw that the trust had made some clear improvements to improve the safety and quality of services since our previous inspection in June 2014.

“I was particularly impressed with the action taken to address the backlog of patients awaiting outpatient appointments.

“However there is still work for the trust to do to ensure that people using its services consistently receive good quality care and treatment. Where action has been taken in response to concerns the trust must monitor and sustain that action in order to reduce risks moving forward.

“The trust must continue to tackle staff shortages and ensure patients receive the care they need. I know that the senior managers have acknowledged the importance of these challenges and I believe the trust has the potential to improve their services along these lines.

“We will return in due course to check that the improvements we have identified have been made.”

Inspectors saw that staff were caring and compassionate, and treated people with dignity and respect. The majority of patients told inspectors that they were happy with the care and treatment they received and the attitude of staff.

The trust had made clear progress in addressing the backlog of patients waiting for outpatient’s appointments. A policy for the management of the outpatient waiting list had been introduced to minimise the clinical risk to patients who were waiting for a follow up appointment. Work had also been undertaken by the trust to ensure more robust processes for managing medicines and to strengthen the process for reporting incidents through an electronic reporting system.

Inspectors found that the trust had responded to previous concerns around staffing levels and was actively recruiting to fill posts. However, there were not enough nurses on some wards and this was impacting on patient care and treatment, particularly on the medical wards, community inpatient services and services provided by the specialist palliative care team.

At a follow up inspection of Pinderfields Hospital in September 2015, CQC found that the trust had taken action to provide additional nursing support on the acute respiratory care unit (Gate 20) and on the three acute elderly care wards (Gates 41, 42 and 43).

Although most areas of the trust visited were clean, inspectors found some areas at Pinderfields Hospital and Dewsbury and District Hospital where infection control procedures had not been followed.

Patients continued to experience delays between being referral and receiving treatment, patients awaiting medical care were being placed on surgical wards as a result of bed shortages.

CQC identified a number of areas where the trust must make improvements, including:

• The trust must ensure there are sufficient numbers of suitably skilled, qualified and experienced staff on duty at all times in line with best practice and national guidance taking into account patients’ dependency levels.
• Systems in place to regularly assess and monitor the quality of care provided to patients must be strengthened.
• The trust must ensure there are improvements in the monitoring and assessment of patient’s nutrition and hydration needs to ensure patients’ needs are adequately met.
• The trust must ensure that infection control procedures are followed in relation to hand hygiene, the use of personal protective equipment and cleaning of equipment.
• The trust must ensure there are improvements in referral to treatment times and accident and emergency performance indicators to meet national standards to protect patients from the risks of delayed treatment and care. The trust must also ensure ambulance handover target times are achieved to lessen the detrimental impact on patients.

Inspectors also identified good practice, including:

• The trust had standardised processes in their outpatient services, following up on the backlog of outpatients and compliance with performance targets. As a result, the backlog of 9,501 overdue outpatient appointments found on inspection in July 2014 had reduced to three patients in June 2015.
• The trust had introduced its “listening into action” programme which aimed to support staff to transform their services by identifying and removing barriers that get in the way of providing the best care to patients and their families.
• Most staff felt that the culture within the organisation had changed and that there was a desire to improve from the senior management team. Management was stronger, communication had improved and there was more clinical engagement.

The Care Quality Commission will present its findings to a local Quality Summit later this month. The Quality Summit will involve NHS commissioners, providers, regulators and other public bodies to develop a plan of action and recommendations based on the inspection team’s findings.

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