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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

Reports


Inspection carried out on 30 July2019 to 4 September 2019

During a routine inspection

  • 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.


CQC inspections of services

Inspection carried out on 05 June to 12 July 2018

During an inspection looking at part of the service

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

  • We rated the overall key questions of safe, effective and well led as requires improvement and caring and responsive 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 nine core services we inspected as requires improvement and five as good.
  • 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 requires improvement.

Inspection carried out on 18-19 May 2015

During an inspection looking at part of the service

Peterborough and Stamford Hospitals NHS Foundation Trust was one of the first wave of NHS trusts to be authorised as a foundation trust in April 2004. The trust has approximately 633 beds and over 3,500 staff spread across two sites, Peterborough City Hospital (611 beds) and Stamford Hospital (22 beds). Peterborough City Hospital is a new building funded under the private finance initiative (PFI); it became fully operational only in December 2010, combining services previously supported on three separate sites. It provides acute health services to patients in Peterborough, Cambridgeshire, Lincolnshire and Leicestershire.

In addition, the trust provides a range of community services including community midwifery and Macmillan nursing as well as domiciliary visits undertaken by consultants. The trust provides rheumatology and neurology services at the City Care Centre and services in support of Sue Ryder in Peterborough, at HMP Peterborough and in local GP practices. We did not inspect these services during this inspection.

The CQC undertook a comprehensive inspection in March 2014 which found that the trust required improvement to ensure that services were safe, effective and responsive to the needs of patients. This focused inspection carried out between 18 and 19 May 2015 was to follow up in the areas where we had rated that services required improvement. These included:

  • Urgent and Emergency Services: Safe and responsive,
  • Medical Care including older peoples care: Safe, Effective, Caring, Responsive and Well Led,
  • Children's and young peoples services: Responsive,
  • End of Life services: Effective

We spoke with stakeholders prior to our inspection and did not receive any concerns about the trust apart from the concerns around the financial targets. Some stakeholders and members of the public raised concerns with us about the way in which complaints were handled at the trust and we reviewed these concerns with the staff responsible for complaints. 

Overall we found a trust that is improving and had addressed the issues we noted during our inspection in March 2014. We found that medical services still had some improvements to make across all domains and have rated this service as requiring improvement. However a number of services had improved and are now rated as good which rates the trust as good overall. Notable improvements were seen in governance processes and in the complaints team although further work needs to be undertaken in order to resolve relationship issues with external stakeholders to ensure that the patients they represent receive a good service. The trust did not have any outstanding complaints over 30 days which is a significant achievement given the backlog of complaints which the trust has had for some time. The culture of the trust and the leadership has also improved at all levels and staff we spoke with were generally positive about working at the trust. Overall we rated the trust as Good.

Our key findings were as follows:

  • An improvement in the stroke pathway in complying with national guidance despite performance not always meeting the national expectations.
  • A recent improvement in emergency department waiting times against the four hour target.
  • The trust vision and strategy was well embedded amongst senior management with a clear commitment to continuous improvement.
  • There was a robust governance structure in place with appropriate challenge and regular involvement in the quality assurance agenda by the non – executive directors.
  • Staff at all levels spoke highly of the new senior appointments. Senior staff were visible on the wards and around the trust.
  • Senior management had identified new patient pathways through a new medicines admission unit to improve patient flow and experience.
  • Complaints handling and responses were now more effective with responses now provided to people who had complained within 30 days. Work to rebuild the confidence of local stakeholders had begun.

We saw several areas of good practice including:

  • The trust had thoughtfully engaged with children and young people in the service development and improvement of children’s services.
  • A new transition projected had been agreed and was being supported by a CQUIN target for this year called “Ready Steady Go”. This project aimed to build confidence and the understanding of children, younger people and their families’ when transitioning into adult services.
  • The trust was now meeting face to face increasing numbers of patients to discuss concerns or complaints.
  • The Quality Assurance Committee was open to some external stakeholders including Healthwatch.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure records are accurate and updated to reflect the needs of patients and that care is given in line with records.

In addition the trust should:

  • Ensure that learning from incidents is disseminated consistently across different directorates and clinical areas.
  • Ensure that patients are adequately supported with nutritional needs on medical wards.
  • Ensure that medicines are stored correctly in all areas.
  • Ensure that call bells are answered in a timely way.
  • The trust should ensure that there are appropriate measures in place to further reduce falls and pressure ulcers.
  • The trust should ensure effective admission to the stroke unit for patients requiring specialist care.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4-5 March 2014 and 10 March 2014

During a routine inspection

Peterborough and Stamford Hospitals NHS Foundation Trust was one of the first wave of NHS trusts to be authorised as a foundation trust in April 2004. The trust has approximately 633 beds and over 3,500 staff spread across two sites, Peterborough City Hospital (611 beds) and Stamford Hospital (22 beds). Peterborough City Hospital is a new building funded under the private finance initiative (PFI); it became fully operational only in December 2010, combining services previously supported on three separate sites. It provides acute health services to patients in Peterborough, Cambridgeshire South Lincolnshire, North East Northants and Rutland.

In addition, the trust provides a range of community services including community midwifery and Macmillan nursing. The trust provides rheumatology and neurology services at the City Care Centre and services in support of Sue Ryder in Peterborough, at HMP Peterborough and in local GP practices. We did not inspect these services during this inspection.

The trust has had 10 inspections at its sites since registration in 2010. The most recent inspection took place at Peterborough and Stamford Hospitals NHS Foundation Trust on 10 July 2013, and the trust was found to be non-compliant with most of the outcomes inspected. Peterborough City Hospital was last inspected in April 2013; that inspection found the location to be non-compliant in respect of ‘Outcome 4: Care and welfare of people who use services’ and ‘Outcome 16: Assessing and monitoring the quality of service provision’. These regulations relate to the completion of patient documentation. These were found to be compliant on this inspection.

Stamford Hospital was last inspected in July 2013, when it was found to be non-compliant in respect of ‘Outcome 4, Care and welfare of people who use services’, ‘Outcome 13: Staffing’ and ‘Outcome 16: Assessing and monitoring the quality of service provision’. These relate to the assessment of patients’ needs, completion of care records and adequate staffing being available to provide care. At this inspection, we found that all actions required to address these breaches of regulation had been taken and that both hospitals were compliant.

We found that the trust provided safe, effective and caring services to most of its patients and that it was well led by the senior team, with staff supported by their local managers. However, we found that the trust was not always responsive to the needs of its patients: because of capacity issues, it did not achieve the national targets set in relation to treatment times in the accident and emergency (A&E) department or the times from referral to treatment. This meant that patients’ care was delayed.

Staffing

The hospital was in the process of reviewing the number of staff on every ward and was using the Safer Nursing Tool recommended by the NHS Institute for Innovation and Improvement. The initial review found that most wards were already functioning at the required level of staffing but a few wards needed further assessment of patient acuity (this is the complexity of needs of a patient). At our announced inspection, we found that most wards were appropriately staffed, but we heard that night times were a particular problem with regard to reduced staffing. We returned for our unannounced inspection during the late evening and found that staffing was appropriate to meet the needs of the patients on all the medical wards except one, where a member of staff had called in unwell. This gap was filled by a student nurse and, while this meant that staff were busy, patients remained safe during this night visit. Staffing at Stamford Hospital was appropriate to meet the needs of patients; the ward manager at the John Van Geest unit utilised her staffing budget in innovative ways to meet the needs of patients.

Cleanliness and infection control.

Both hospitals were found to be clean and infection was prevented and controlled through good use of cleaning schedules and monitoring systems. Each ward and department had audits displayed of the numbers of infections that had occurred and staff were aware of the need for good hand hygiene in preventing the spread of infections. However, at Peterborough City Hospital we found that a number of hand gel dispensers were empty and that on occasion people had to walk through several sets of doors to find a dispenser that had antibacterial hand gel in it. Hand gel dispensers at Stamford Hospital were found to contain gel on all occasions.

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Organisation Review of Compliance