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Provider: East Suffolk and North Essex NHS Foundation Trust Requires improvement

On 08 January 2020, we published a report on how well East Suffolk and North Essex NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Not rated
  • Combined rating: Not rated

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 January 2020

Our rating of the trust stayed the same. We rated it as requires improvement because:

  • We rated the overall key questions of safe and responsive as requires improvement and effective, caring and well-led were rated as good. Our rating for the trust took into account the current ratings of the core services we did not inspect this time.
  • We rated four of the 14 core services we inspected as requires improvement and nine as good. We rated children and young people’s services as outstanding overall.
  • Our decision on the overall ratings take into account the relative size of the service and we use our professional judgement to reach fair and balanced ratings.
  • We rated well-led of the trust overall as Good.
Inspection areas

Safe

Requires improvement

Updated 8 January 2020

  • Not all services had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

  • The trust was in the process of providing mandatory training in key skills to all staff. This had been challenging post-acquisition/merger due to different recording systems and mandatory training programmes. At the time of our inspection, the trust was still aligning systems and programmes. This meant that some of the information submitted prior to inspection and within this report did not reflect an accurate picture of training performance. After our inspection, the trust sent us updated information that demonstrated an improving picture of compliance for nursing staff at 92% across the trust as of June 2019. However, the trust did not ensure sufficient numbers of medical staff completed mandatory training in key skills. Medical staff did not meet the trusts compliance target in most courses.

  • Staff understood how to protect patients from abuse and the services worked well with other agencies to do so. However, staff had not consistently undertaken training on how to recognise and report abuse.
  • We observed several examples where systems and processes to maintain cleanliness and control infection were not being implemented effectively. Staff did not use control measures consistently to protect patients, themselves and others from infection. Effective processes were not in place to indicate when equipment was clean and ready for use.
  • The design, maintenance and use of facilities, premises and equipment did not always keep people safe.
  • Risks to patients who used services were not always assessed, monitored and managed on a day-to-day basis. In the emergency departments staff did not always complete risk assessments and environmental risk assessments for each patient in a timely manner, particularly for patients with mental health needs.
  • Staff did not always keep appropriate records of patients’ care and treatment. Within the emergency department at Ipswich Hospital, staff did not keep detailed records of patients’ care and treatment. Records were not always clear, up-to-date, stored securely or easily available to all staff providing care.

However:

  • Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • The services mostly managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents, but lessons learned were not always shared with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The services generally used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.

Effective

Good

Updated 8 January 2020

Our rating of effective stayed the same. We rated it as good because:

  • The services provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients who were subject to the Mental Health Act 1983.
  • The services made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. In most services, they used the findings to make improvements and achieved good outcomes for patients. Some services such as endoscopy at Ipswich Hospital had been accredited under relevant clinical accreditation schemes.
  • The services made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff mostly supported patients to make informed decisions about their care and treatment.

However,

  • Staff did not always support patients who lacked capacity to make their own decisions. We found that in critical care and the emergency department at Ipswich Hospital staff were not consistently applying the Mental Capacity Act in relation to assessment and care of patients.
  • We also found that in critical care at Ipswich Hospital and urgent and emergency care at Colchester hospital outcomes and recommendations from audits were not always used to improve services for patients.
  • In medical care, staff were not always completing nutrition and hydration risk assessments to ensure that patients had enough food and drink to meet their needs and improve their health.

Caring

Good

Updated 8 January 2020

Our rating of caring stayed the same. We rated it as good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. In the end of life care service, we found that there was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs. In the end of life care service, we observed very caring interactions between staff and patients. Staff would hold a patient’s hand and offer comfort.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. In the end of life care service, we found that people’s emotional and social needs were seen as being as important as their physical needs. Staff recognised and respected the totality of people’s needs.

Responsive

Requires improvement

Updated 8 January 2020

Our rating of responsive stayed the same. We rated it as requires improvement because:

  • People could not always access services when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards. We found particular issues with admission and access and flow across the surgery services and within the emergency departments.
  • Access to external mental health services in the emergency department within Ipswich Hospital was pressured out of hours and was not always available in a timely fashion 24 hours a day, seven days a week.

However,

  • The services were inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • The services planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • 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. The services included patients in the investigation of their complaint. However, complaints were not always consistently managed in a timely manner.

Well-led

Good

Updated 8 January 2020

Our rating of well-led improved. We rated it as good because:

  • Leaders had the skills and abilities to run the trust and the services. They understood the priorities and issues the trust and services faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The trust had a clear vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress. The trust philosophy of ‘Time matters’ to improve patient experience and achieve strategic objectives was embedded at all levels.
  • Staff felt respected and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However

  • Three of the core services we inspected were rated as requires improvement in well-led. This was for specific issues that the trust were sighted on and had identified as potential risks prior to the merger. This included strengthening and aligning the governance and risk management processes and improving the provision of mental health services. The trust provided assurances that they would continue to work on improving these areas at pace.
  • We found that systems within the emergency department, critical care and maternity services governance processes were not always effective. Staff at all levels were not always clear about their roles and accountabilities.
  • We found in urgent and emergency care, medical care, critical care and maternity services that leaders had not effectively escalated the risks that they were aware of. They had not always identified and escalated relevant risks and issues and identified effective actions to reduce their impact.
  • The information systems were not yet integrated. Data was not consistently submitted to external organisations as required.
Checks on specific services

Community health inpatient services

Good

Updated 8 January 2020

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of most patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services.

However:

  • Managers did not always make sure all staff completed required mandatory training. Not all staff had training on how to recognise and report abuse.
  • The ward environment in all three community hospitals did not support patients living with dementia and other complex needs