The Care Quality Commission (CQC) has told Kettering General Hospital NHS Foundation Trust to make improvements following an inspection of four services at Kettering General Hospital in December.
The unannounced inspection was carried out following information of concern highlighted to the commission regarding the safety and quality of medical care and surgery services. Inspectors also checked to see if improvements had been made at urgent and emergency care and children and young people’s services.
The services were rated:
- Children and young people’s services: the overall rating has gone up from inadequate to requires improvement. Safe and well-led have gone up from inadequate to requires improvement, effective and responsive are rated requires improvement again and caring is rated good again.
- Urgent and emergency care: this has been rated requires improvement overall again. Safe is rated inadequate again, effective, responsive and well-led are rated as requires improvement again and caring has gone down from good to requires improvement.
- Medical care: this has been rated requires improvement overall again. Safe, effective and well-led are rated requires improvement again, responsive has gone down from good to requires improvement and caring is rated good again.
- Surgery: this has been rated requires improvement overall again. Safe and responsive are rated requires improvement again, effective and well-led have gone down from good to requires improvement and caring is rated good again.
The overall rating for the trust remains as requires improvement.
Charlotte Rudge, CQC deputy director of operations in the Midlands, said:
“When we inspected Kettering General Hospital NHS Foundation Trust, we saw that the quality of leadership had declined which was having an impact on the quality of services. Although we saw some improvement in children and young people’s services, there is still much more to do there and across medical, surgery and urgent and emergency services.
“We saw several issues with the urgent and emergency service environment which could be a potential risk to people’s safety. It was clear the demand on the service had outgrown the size of the department and we saw people sitting on floors or standing due to insufficient space. Sometimes, relatives had to alert staff to people’s conditions deteriorating due to nurses not being able to see everyone in the waiting area which was placing people at the risk of harm.
“In addition, the children’s waiting area wasn’t always separated from the adults. We heard examples where children had witnessed high risk patients being treated which could have been traumatic for them.
“However, it was positive that some improvements had been made at children and young people’s services. Staff were better at identifying sepsis and there was clear evidence of timely escalation to the medical team once someone had shown symptoms.
“Staff had access to rapid assessment with child and adolescent mental health services (CAMHS) when needed and Skylark, the children’s ward worked closely with them. We saw examples of positive and regular communication with the service to support young people as quickly as possible when needed.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can receive safe and appropriate care.”
In urgent and emergency services inspectors found:
- People presenting with acute mental health concerns didn’t have access to a dedicated room which met national guidance relating to the provision of a safe environment
- There wasn’t a consistent process for staff to follow to assess people being brought in by ambulance
- Staff described a culture of learning from incidents in the department while others described a culture of blame where staff didn’t acknowledge or talk about their mistakes for fear of ridicule.
In children and young people’s services:
- Staff knew how to identify adults and children at risk of significant harm and worked with other agencies to protect them
- Skylark ward had a play area and sensory room to help distract children and meet their sensory needs
- Managers accurately calculated and reviewed the number and grade of nurses, nursing assistants and healthcare assistants needed for each shift.
In medical care:
- The service didn’t always have enough nursing and support staff to keep patients safe
- Staff didn’t always make sure the needs of people with a learning disability or autistic people were assessed to ensure they were provided with person centred care
- However, staff were able to demonstrate a good knowledge of the needs of people living with dementia and the support needed for their family.
In surgery:
- Staff were concerned that people weren’t always assessed by senior medical staff when they were showing signs of deterioration
- Staff said they felt the staffing levels weren’t sufficient and this added extra pressure to ensuring safe care
- Staff gave examples of when they had raised safeguarding concerns and how they had actioned them.