Updated 21 April 2021
Our rating of the trust stayed the same. We rated it as requires improvement because:
We rated the trust as requires improvement for safe, effective, responsive and well led. We rated caring as good. We rated seven of the trust’s services at this inspection. In rating the trust, we took into account the current ratings of the services not inspected this time.
We rated well-led at the trust level as requires improvement this has improved since the last inspection.
Our decisions on overall ratings take into account, for example, the relative size of services and
we use our professional judgement to reach a fair and balanced rating.
- Services had not always completed and updated risk assessments for patients. We found that risk assessments such as those for falls or pressure ulcers had not always been completed where required. Staff did not always comply with the requirements of the surgical safety checklist and so were not minimising risks in this area.
- Medical and allied health professional staffing numbers were not always sufficient for the number of patients being cared for in services.
- Services did not always control infection risk well, with staff not always using control measures to protect patients, themselves and others from infection. There were areas that were not clean and clinical waste was not always disposed of appropriately.
- The trust did not always have suitable premises and equipment. Some areas and equipment were not properly maintained or fit for purpose. The design of the environment did not always follow national guidance or best practice.
- Although there was a system in place for tracking and monitoring deprivation of liberty safeguards applications and when they had expired, this was not robust as staff were not aware of it.
- Services did not ensure staff had the knowledge, skills or ability to care for patients with mental health needs or patients who lacked capacity. Not all staff had completed training in key skills and compliance with intermediate life support and other key modules were low in some services.
- People could not always access the service when they needed it and referral to treatment times were consistently below the national average. The service did not discharge patients in a timely way and did not minimise the number of patient moves between wards at night. There were not effective arrangements for medical staff to review any medical patients who were not on medical wards. There were times when patients were cared for in corridors in urgent and emergency services. There were a high number of cancelled operations which were not rescheduled within 28 days.
- Whilst the culture at the trust had improved since the last inspection and medical engagement had improved, there were still areas were staff did not feel supported and valued. Some staff reported they had limited opportunity to engage with the service and wider organisation to influence service developments and improvements. The visibility of executive staff in services was mixed.
- Although the trust had improved some systems to review deaths to improve learning, there were delays in the trust undertaking mortality reviews to help improve standards in care and there was a risk that senior managers were unaware of how reviews were progressing as no timeframes had been identified in policies.
- Leaders and teams did not always use systems to manage performance effectively. Whilst they identified and escalated relevant risks and issues, agreed plans had not reduced their impact and issues identified at the previous inspection were still apparent in some services.
However:
- The service had effective arrangements in place to recognise and respond appropriately to patients. Staff followed systems and processes when safely prescribing, administering, recording and storing medicines.
- Staff understood how to protect patients from abuse and the service worked with other agencies to do so. Staff received training in safeguarding.
- It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
- Staff assessed and monitored patients and gave pain relief in a timely way in the majority of services. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
- The trust had developed appropriate strategies which directly linked to the vision and values of the trust.
- Services managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
Our full Inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website – .