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North Cumbria University Hospitals NHS Trust is ready to come out of special measures providing it maintains its focus on quality, says CQC
England's Chief Inspector of Hospitals has recommended that North Cumbria University Hospitals NHS Trust should come out of special measures, after an inspection by the Care Quality Commission (CQC).
If the recommendation is accepted, North Cumbria will be the final NHS trust to exit special measures, out of the original 11 that were placed in the regime by Sir Bruce Keogh in July 2013 as part of his review of trusts with high mortality rates. This was before CQC had introduced its new way of inspecting hospitals, led by the Chief Inspector of Hospitals, Prof Sir Mike Richards.
Across England, there are currently 12 NHS trusts (including North Cumbria) in special measures and 19 trusts have exited, following findings from CQC’s inspections.
During CQC’s inspection of North Cumbria last December 2016, CQC found improvements in the trust’s West Cumberland Hospital and Cumberland Infirmary sites – such as to the patient environment and cleanliness and around the changes to the trust’s senior management and approach.
In recognition of this, CQC has made its recommendation to NHS Improvement for the trust to exit special measures; however, it retains its overall rating of Requires Improvement as CQC has concluded that further work is still needed to ensure that patients receive consistently safe, effective and well led healthcare.
In particular, CQC identified ongoing concerns around nursing and medical staff vacancies (including a reliance on locum cover and unfilled shifts), around patient flow from A&E to other departments (including the four-hour target not being met) and around cancelled elective surgeries (including at short notice).
CQC will continue to monitor North Cumbria University Hospitals NHS Trust’s progress and it will return in future for a further re-inspection to check that the necessary improvements have been made.
Professor Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission (CQC), said:
“It is now almost four years since North Cumbria University Hospitals NHS Trust was placed into special measures because of concerns about mortality rates and standards of care."
“In the past two years there have been significant changes to the senior management team; they have worked well together, with external support, to address the issues identified in both Sir Bruce Keogh’s Review and in our subsequent inspections. I am now pleased to be able to recommend they come out of special measures."
“Although there has been progress, particularly in the effectiveness of the services being provided, there is still a lot of work to do."
“The senior team are aware of the challenges and issues within the organisation and have developed strategies to meet these challenges, but these still need embedding."
“I note that despite ongoing recruitment campaigns, staffing is still a concern in some areas of the trust including surgery, and services for children and young people."
“However, there have been some staffing improvements within medical care at West Cumberland Hospital, with the trust securing long-term locum contracts and implementing a staffing support agreement with Cumberland Infirmary.”
Full reports are available on our website.
Some of the main findings from the inspection include:
- Nursing and medical staffing had improved in some areas since the last inspection. However, there were still a number of nursing and medical staffing vacancies throughout the trust. The trust had systems in place to manage staffing shortfall as well as escalation processes to maintain safe patient care. However, a number of registered nurse shifts remained unfilled despite these escalation processes.
- The standard of environmental cleanliness was good across all wards inspected. The trust also scored higher than the national average in a survey filled in by patients about the hospital environment.
- There is a reliance on locum support which leaves the trust vulnerable to changes or departures. There were more doctors at West Cumberland Hospital, with the trust securing long-term locum contracts and implementing measures to support staff at Cumberland Infirmary.
- Access and flow across the emergency department, medical care, surgical services, and outpatients remained a significant challenge.
- The trust had failed to meet the target to see and treat 95% of emergency patients within four hours of arrival.
- Between 2015 and 2016 the trust cancelled 1,410 elective surgeries. Of these, 12% were not rescheduled and treated within 28 days which impacts negatively on the experience of patients.
There are a number of areas where the trust must make improvements, including:
- The trust must meet the target to see and treat 95% of emergency patients within four hours of arrival.
- Further steps must be taken to resolve the flow of patients into and out of the hospital.
- There must be enough numbers of suitably qualified, competent, skilled, and experienced persons are deployed across all divisional wards.
- The trust must improve the rate of short notice cancellations for non-clinical reasons specifically for ear nose and throat, orthopaedic, and general surgery.
There were several areas of outstanding practice:
- There were real achievements of multi-disciplinary team working affecting positive patient outcomes in the stroke service.
- The expert patient programme in the renal business unit showed a real commitment to listening to the patient and acting on their feedback.
- There were innovative and progressive frailty unit projects at Cumberland Infirmary looking at how to improve care for frail patients.
- The implementation of dance-related activities for vulnerable patient groups to stimulate social interaction, patient involvement, family partnerships, and exercise.
For further information please contact CQC Regional Engagement Officer Kerri James by email email@example.com or by phone on 07464 92 9966.
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- Last updated:
- 29 May 2017
Notes to editors
These reports follow a focused inspection on the quality of services provided at North Cumbria University Hospitals NHS Trust in December 2016. Inspection teams include a range of clinical and other experts including experts by experience.
Inspectors look at eight of the trust’s core services at this inspection:
- Accident and emergency
- Medical care (including older people’s care)
- Critical care
- Maternity and gynaecology
- Services for children and young people
- End of life care
North Cumbria University Hospitals NHS Trust serves a population of around 320,000 people, mostly from rural communities.
In March 2017, CQC reported on its findings from the first comprehensive inspection programme of every NHS acute trust in England
This report follows a focused inspection on the quality of services provided at North Cumbria University Hospitals NHS Trust.
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to people’s needs?
- Are they well-led?