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Provider: Royal Cornwall Hospitals NHS Trust Requires improvement

Following a recent review of Royal Cornwall Hospitals NHS Trust, the report below was published. We will update the information on this page to reflect this report shortly.

Following a recent review of Royal Cornwall Hospitals NHS Trust, the report below was published. We will update the information on this page to reflect this report shortly.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 26 February 2020

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

  • We rated safe and responsive as requires improvement. Effective, caring and well-led were rated as good.
  • Urgent and emergency services remained the same and were rated as requires improvement overall. Safe and responsive stayed the same and were rated as requires improvement. Effective went down one rating and was rated as requires improvement. Caring and well-led stayed the same and were rated as good.
  • Medical care remained the same and was rated as requires improvement overall. Safe and responsive were rated as requires improvement. Effective, caring and well-led were rated as good. Responsive and well-led both improved one rating.
  • Surgery remained the same and was rated as requires improvement overall. Safe and responsive were rated as requires improvement. Effective, caring and well-led were rated as good. Effective and well-led both improved one rating.
  • Maternity improved one rating to good overall. Effective, caring, responsive and well-led were rated as good. Safe was rated as requires improvement. Well-led improved one rating.
  • End of life care improved one rating to good overall. Safe, effective, caring responsive and well-led were rated as good. Safe, effective, responsive and well-led improved one rating.
  • Outpatients improved one rating to good overall. Caring, responsive and well-led were rated as good. Safe was rated as requires improvement. Effective was not rated. Responsive and well-led improved one rating.
  • The remaining core services were not inspected at this inspection and their previous ratings are therefore unchanged.
Inspection areas

Safe

Requires improvement

Updated 26 February 2020

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

  • In urgent and emergency services, the mental health assessment room did not meet recommended guidance for safety, emergency equipment was not always checked, and training was not always up-to-date. However, there were sufficient staff to keep people safe, infection risk was well-controlled, patient records were detailed, and patient safety incidents were well-managed.
  • In medical care, there were not enough staff with the right qualification, skills and training to keep patients safe and risk assessments were not always completed. Facilities, premises and equipment did not always keep people safe and not all staff had completed mandatory and/or safeguarding training. However, staff understood how to protect patients from abuse and managed infection risk well. Staff identified and acted on patients at risk of deterioration and patient safety incidents were managed well.
  • In surgery, there were not always enough staff with the right qualification, skills and training to keep patients safe and mandatory training was not always up-to-date. However, staff understood how to protect patients from abuse and managed infection risk well. Staff identified and acted on patients at risk of deterioration and patient safety incidents were managed well.
  • In maternity, infection risk was not always controlled well, medical staff compliance with mandatory and safeguarding training was poor, and the WHO checklist was not completed consistently. However, staff understood how to protect women from abuse, completed and updated risk assessments for each woman and took action to remove or minimise risks, and had enough staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment.
  • In end of life care, mandatory training in key skills was provided to all staff and everyone completed it, staff understood how to protect patients from abuse and the service worked well with other agencies to do so, and staff completed and updated risk assessments for each patient and removed or minimised risks. The service 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 and used systems and processes to safely prescribe, administer, record and store medicines. However, palliative care consultants felt their workload was unsustainable and end of life documentation was not always fully completed.
  • In outpatients, infection risks were not always controlled well, and equipment was not always visibly clean. The maintenance and use of equipment did not always keep people safe, not all records were stored securely and shared learning from incidents was not always embedded. However, staff understood how to protect patients from abuse, the design and use of facilities and premises kept people safe, and there were enough staff with the right qualifications, skills, training and experience to keep patients safe. Staff kept detailed records of patients’ care and treatment and patient safety incidents were managed well.

Effective

Good

Updated 26 February 2020

Our rating of effective improved. We rated it as good because:

  • In urgent and emergency services, pain relief was not always given in a timely way, audit results often showed the service was not meeting the best outcomes, and not all staff had been appraised in the last year. However, treatment was provided in accordance with national guidance and evidence-based practice, staff were competent in their roles, and there was strong multidisciplinary working.
  • In medical care, treatment was provided in accordance with national guidance and evidence-based practice, pain relief was administered promptly, staff were competent in their roles and there was good multidisciplinary working. However, staff did not always protect the rights of patients subject to the mental health act.
  • In surgery, treatment was provided in accordance with national guidance and evidence-based practice, pain relief was administered promptly, staff were competent in their roles and there was good multidisciplinary working. However, key services were not available seven days a week to support timely patient care.
  • In maternity, care and treatment was based on national guidance and best practice, staff monitored the effectiveness of care and treatment, there was good multidisciplinary working and staff supported women to make informed decisions about their care and treatment. However, not all staff were aware of the doctors and nurses holding powers under the Mental Health Act and medical appraisal rates did not meet the trust target.
  • In end of life care, care and treatment was based on national guidance and evidence-based practice, staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way, and staff gave patients practical support to help them live well until they died. Staff supported patients to make informed decisions about their care and treatment and monitored the effectiveness of care and treatment. However, staff did not always document mental capacity assessments.
  • In outpatients, care and treatment was based on national guidance and evidence-based practice, staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way, staff were competent for their roles, and patients were supported to make informed decisions about their care and treatment. However, key services were not available seven days a week to support timely patient care.

Caring

Good

Updated 26 February 2020

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

  • In urgent and emergency, services patients were treated with compassion and kindness and had their privacy and dignity respected. Staff gave patients emotional support and involved patients, families and carers in decisions about care.
  • In medical care, patients were treated with compassion and kindness and had their privacy and dignity respected. Staff gave patients emotional support and involved patients, families and carers in decisions about care.
  • In surgery, patients were treated with compassion and kindness and had their privacy and dignity respected. Staff gave patients emotional support and involved patients, families and carers in decisions about care.
  • In maternity, women were treated with compassion and kindness and had their privacy and dignity respected. Staff gave women emotional support and involved women, families and carers in decisions about care.
  • In end of life care, patients were treated with compassion and kindness and had their privacy and dignity respected. Staff gave patients emotional support and involved patients, families and carers in decisions about care.
  • In outpatients, patients were treated with compassion and kindness. Staff gave patients emotional support and involved patients, families and carers in decisions about care. However, staff did not always treat patients in a way which respected their privacy and dignity.

Responsive

Requires improvement

Updated 26 February 2020

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

  • In urgent and emergency services, the facilities could not always cope with patient demand and did not always meet patients’ needs. Patients’ individual needs and preferences were not always considered, and patients could not always get a timely access to the service. However, the service was working with others in the wider system to plan and coordinate care and people could easily raise concerns and make complaints and while constitutional standards were not being met, the trust performed comparatively well nationally in its ED performance standard.
  • In medical care, people could not always access the service when they needed it and did not always receive the right care promptly. However, service was working with others in the wider system to plan and coordinate care and people could easily raise concerns and make complaints. Performance measures, such as referral to treatment times, gave a mixed picture with some measures performing as expected, others not as expected but better than the England average, and others not as expected and worse than the England average.
  • In surgery, people could not always access the service when they needed it and did not always receive the right care promptly. The service did not always plan and provide care in a way that met the needs of local people and the communities served. However, the service was inclusive and took account of patients’ individual needs and preferences and it was easy for people to give feedback and raise concerns about care received. Performance measures, such as referral to treatment times, gave a mixed picture with some measures performing as expected, others not as expected but better than the England average, and others not as expected and worse than the England average.” (‘Are services responsive?’ section).
  • In maternity, women received the right care promptly, care was planned and provided in a way that met the needs of local people and it was easy for people to give feedback and raise concerns about care. However, women could not always access the service when they needed it.
  • In end of life care, care was planned and provided in a way that met the needs of local people and the communities served, patients could access the specialist palliative care service when they needed it, and it was easy for people to give feedback and raise concerns about care received. However, audits did not provide assurance all patients near to the end of their lives received suitable, individualised care.
  • In outpatients, care was planned and provided in a way that met the needs of local people and the communities served, patients’ individual needs and preferences were considered, and it was easy for people to give feedback and raise concerns about care received.

Well-led

Good

Updated 26 February 2020

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

  • In urgent and emergency services, leaders had the integrity, skills and abilities needed to run the service. There was an open culture in which staff felt respected, supported and valued, and there were effective governance processes. Reliable data was collected and analysed to identify areas for improvement and staff were committed to continually learning and improving services. However, there was no strategy to turn the service’s vision into action.
  • In medical care, leaders had the integrity, skills and abilities needed to run the service. There was a clear vision with a strategy to support its delivery and there was an open culture in which staff felt respected, supported and valued. There were effective governance processes and reliable data was collected and analysed to identify areas for improvement and staff were committed to continually learning and improving services.
  • In surgery, leaders had the integrity, skills and abilities needed to run the service. Leaders operated effective governance processes and collected reliable data and analysed it. All staff were committed to continually learning and improving services and Staff were focused on the needs of patients receiving care. However, the service did not have a vision for what it wanted to achieve or a strategy to turn it into action and staff did not always feel respected, supported and valued.
  • In maternity, leaders had the integrity, skills and abilities needed to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action, staff felt respected, supported and valued, and Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services
  • In end of life care, leaders had the integrity, skills and abilities needed to run the service and staff felt respected, supported and valued. The service had a vision for what it wanted to achieve and a strategy to turn it into action, leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services, and all staff were committed to continually learning and improving services. However, palliative care consultants felt frustrated when they did not have the time to provide expert advice and support to add further pace and quality to improvement projects.
  • In outpatients, leaders had the integrity, skills and abilities needed to run the service and staff felt respected, supported and valued. The service had a vision for what it wanted to achieve and a strategy to turn it into action, and all staff were committed to continually learning and improving services. However, leaders and staff did not actively and openly engage with equality groups and the public.
Assessment of the use of resources

Use of resources summary

Good

Updated 26 February 2020

Our rating of use of resources improved. We rated it as good.

NHS England and NHS Improvement undertake the Use of Resources assessments. The report is available on our website.

Combined rating

Combined rating summary

Requires improvement

Updated 26 February 2020

Our rating of combined quality and resources stayed the same. We rated it as requires improvement.

Checks on specific services

Community health services for adults

Good

Updated 14 December 2018

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

  • Safe, effective, caring, responsive and well-led all remained the same and were rated as good.
  • The service had robust procedures in place to safeguard adults and children against abuse and staff were trained to deliver sexual health services to adults and children.
  • The environment, maintenance and use of facilities and premises kept patients who visited the service safe. Medicines were stored, administered and dispensed safely.
  • Risks to patients were assessed and their safety monitored and managed so that patients and staff were safe. The service ensured action was taken and learning taken when things went wrong.
  • The service carried out internal and external audits to ensure the care and treatment was in line with recognised legislation and best practice. The service collected appropriate data to ensure that patients received a good outcome.
  • Staff worked well within and across the trust and with external organisations to deliver effective care and treatment.
  • The service ensured consent to care and treatment was always sought in line with legislation and guidance.
  • Patients received a caring, compassionate and empathetic service and were able to make informed choices about their care and treatment. Staff provided or signposted patients to appropriate emotional support.
  • Patients were able to access care and treatment in a timely way in a variety of locations.
  • The leadership and management of the service ensured high quality care and treatment was delivered. There were clear responsibilities, roles and systems of accountability which supported good governance and management.
  • The strategy and forward planning for the development of the sexual health service was under review at the time of our inspection.

However:

  • Staff were not fully protected from the risk of infection as they did not use appropriate equipment or cleaning materials when cleaning spillages of bodily fluids.
  • Staff did not always have access to supplies of single use equipment when required.
  • Information maintained in patient records was not always an accurate reflection of the conversations, advice and treatment provided.
  • At times patients could not receive all required care and treatment at one clinic. This was due to not all nursing staff being trained to provide contraception and genitourinary care, despite this being an integrated service.