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Provider: North West Anglia NHS Foundation Trust Requires improvement

On 20 December 2019, we published a report on how well North West Anglia NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires improvement  
  • Combined rating: Requires improvement  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 December 2019

  • We rated safe, effective, responsive and well led as requires improvement and caring as good.
  • We took into account the current ratings of the eight core services across the three locations that we did not inspect this time.
  • We rated five services across the trust as requires improvement.
  • We rated eight core services as good.
  • We rated the well-led element of the trust as requires improvement.
  • The overall ratings for Peterborough City Hospital went down from good to requires improvement.
  • 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.

Inspection areas

Safe

Requires improvement

Updated 20 December 2019

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

  • Five of the core services we inspected at this inspection were rated as requires improvement for safe.
  • Staff in maternity did not always identify or quickly act upon patients at risk of deterioration. Although the trust, had taken steps to act on this.
  • Within some services the trust did not ensure sufficient numbers of staff completed mandatory training in key skills. Nursing and medical staff did not always meet the trust’s compliance target.
  • Medicines were not always managed consistently and safely. Medicines on the Peterborough City Hospital site were not stored in line with national guidance. Medicines could be accessed by staff who were not authorised to access them.
  • Staff did not always keep appropriate records of patients’ care and treatment. Within the emergency department, staff did not routinely complete patient safety checklists or undertake patient risk assessments, such as pressure ulcer risk assessments when they should have done.
  • Women were not always triaged in a timely manner in maternity services at Peterborough City Hospital.
  • Some services did not always control infection risk well.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • Staff understood their responsibilities to identify and report incidents and safeguarding concerns. Staff understood how to protect patients from abuse.

Effective

Requires improvement

Updated 20 December 2019

  • Three of the core services we inspected at this inspection were rated as requires improvement for effective.
  • Managers did not always appraise staff’s work performance and hold supervision meetings with them to provide support and development.
  • Within some services, policies and guidelines had not been reviewed and were out of date.
  • Within end of life care services, documentation around discussions relating to do not attempt cardiopulmonary resuscitation decisions (DNA CPR) was poor.

However:

  • Care and treatment was based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. The service 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.
  • Staff mostly monitored the effectiveness of care and treatment and used the findings to make improvements and achieve good outcomes for patients.

Caring

Good

Updated 20 December 2019

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

  • All of the core services we inspected at this inspection were rated as good for caring.
  • 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 for patients and those close to them.

Responsive

Requires improvement

Updated 20 December 2019

Our rating of responsive went down. We rated it as requires improvement because:

  • Three of the core services we inspected at this inspection were rated as requires improvement for responsive.
  • Within the core service of urgent and emergency care patients could not always access the service when they needed it and did not always receive 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.
  • In critical care, it was difficult to ascertain whether patients were admitted and discharged in line with national standards. For example, waiting times to be admitted were not monitored, and patients stayed in the department for longer than they needed to.
  • There was a lack of transition services and support in place within children and young people’s services at Hinchingbrooke Hospital
  • Staff did not have access to transition plans used to support young people moving on to adult services.

However:

  • Services were mostly planned, and care was provided in a way that met the needs of local people and the communities served.
  • Services were mostly inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.
  • It was easy for patients to give feedback and raise concerns about care received.

Well-led

Requires improvement

Updated 20 December 2019

Our rating of well-led stayed the same. We rated it as requires improvement because:

  • Three of the core services we inspected at this inspection were rated as requires improvement and two were rated as inadequate for well-led.
  • Governance processes were not always fully effective. Staff did not always have regular opportunities to meet, discuss and learn from the performance of the service.
  • Risks and issues were not always escalated promptly. Action was not always taken quickly to reduce their impact.
  • Five of the core services we inspected did not have a vision and strategy for what they wanted to achieve.
  • Within some of the core services we inspected there was a lack of clarity in leadership at a local level. Changes in leadership, for example in urgent and emergency care had impacted on the effectiveness to manage priorities and issues.
  • Within maternity services at Peterborough City Hospital leaders did not always understand and manage the priorities and issues the service faced. At the time of our inspection the senior leadership team were not aware and did not have oversight that several risk assessments were not being completed.
  • Within critical care, not all staff were committed to continually learning and improving services. They did not have an understanding of quality improvement methods and had not been equipped with the skills to improve quality. Leaders did not encourage innovation and participation in research.

However:

  • Equality and diversity in daily work was promoted throughout the trust. 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.
  • Leaders were mostly visible and approachable throughout the trust.
  • Staff mostly felt respected, supported and valued. They were focused on the needs of patients receiving care. The service provided opportunities for career development.
  • Staff were mostly committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 20 December 2019

Use of resources was rated as requires improvement. Please see the separate use of resources report for details of the assessment and the combined rating.

Combined rating

Combined rating summary

Requires improvement