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Archived provider: Ipswich Hospital NHS Trust Good

On 11 July 2018, we published a report on how well Ipswich Hospital NHS Trust uses its resources. The rating from this report is:

  • Use of resources: Requires Improvement  

Read more about use of resources ratings

Reports


Inspection carried out on 30 August to 13 October 2017

During a routine inspection

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

Safe was requires improvement, effective, caring, responsive and well led were good.

Our inspection of the core services covered Ipswich hospital and Community In patient services at Aldeburgh Community Hospital, Bluebird Lodge Community Hospital and Felixstowe Community Hospital. 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.

Ipswich hospital

  • Urgent and emergency care went down from outstanding to good overall. The question of safety went down from good to requires improvement. Responsive and Well Led went down from outstanding to good. There were concerns with safety aspects relating to equipment monitoring, maintenance, and risk assessment processes for the environment. Service performances against national standards were variable and the department was in the process of transition and was introducing a new model of nursing leadership.
  • Medicine services remained rated as good overall, with all five questions remaining good. Safety and delivery of the service and outcomes for patients remained good, with some innovative developments in older people’s services. Patients’ needs were met and treatment delivered by well-trained competent caring staff. However there were some improvements required with ensuring the accuracy of venous thromboembolism (VTE) assessments.
  • Services for children and young people had improved from requires improvement to good overall. The question of safety remained requires improvement, effective and well led had improved to good with caring and responsive retaining a good rating. There were concerns around medication storage, documentation completion by medical staff and safeguarding training to level three. However the trust had taken steps to improve the critical care pathway for children, with clarity now around patient flow and competent staffing to provide care to seriously ill children. A change in leadership had resulted in a more visible cohesive team.
  • End of life care remained rated as good overall, with the effective rating improved from requires improvement to good. The documentation was now in line with National guidance, individualised care planning had been introduced and discussions with patients and families regarding end of life care planning decisions had improved. However there were shortfalls in monitoring of incidents specifically relating to EoLC and how many patients achieved their preferred place of care and preferred place of death.
  • On this inspection we did not inspect surgery, critical care, maternity, and outpatients. The ratings we gave to these services on the previous inspection in January 2015 are part of the overall rating awarded to the trust this time.

Community Inpatient service

  • Community inpatient services had not been inspected and rated previously. Safe, effective, caring, responsive and well led were all rated as good. Care was provided in line with national and best practice guidelines. Patients’ needs were met and there was clarity regarding management responsibility with engaged local leadership. However we also found that IT systems, at the time of inspection, did not allow staff to access the trust intranet. In some locations the vacancy rate was high and not all risk management processes were embedded.
  • On this inspection we did not inspect community health services for adults or urgent care. These services had not been inspected previously therefore there is no rating provided.


CQC inspections of services

Service reports published 18 January 2018
Inspection carried out on 30 August to 13 October 2017 During an inspection of Community health inpatient services Download report PDF | 415.51 KB (opens in a new tab)Download report PDF | 2.02 MB (opens in a new tab)
Inspection carried out on 6-8 January 2015

During a routine inspection

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 6 and 8 January 2015. We also carried out an unannounced inspection on 12 and 15 January 2015. We carried out this comprehensive inspection at Ipswich Hospital NHS Trust as part of our comprehensive inspection programme. The trust was placed in band 6 following our intelligence monitoring tool surveillance, this is the lowest risk band.

The trust has one hospital which was first built around 1910, and has been expanded to cover 45 acres. The newest addition is the private finance initiative (PFI) wing, opened in 2007. It serves around 385,000 people from Ipswich and East Suffolk. We found that the trust had a relatively new executive team, who worked effectively together to highlight issues and address challenges within the hospital. We found the trust management team to be responsive and acted quickly to address issues highlighted to them during our inspection. The trust were aware of the issues faced on Sproughton Ward and highlighted this prior to our site visit. We also identified challenges on this ward, and the trust took action overnight to ensure that people received safe and effective care in this ward. We returned to this ward during our announced and unannounced inspections, and found that improvements made had been sustained.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall, the trust has a rating of 'Good.

Our key findings were as follows:

  • 'Never events' that had occurred were actively and imaginatively investigated, including using human factors analysis, and lessons were learnt.
  • Systems in place within the A&E department were assisting to effectively tackle the Winter pressures during our inspection.
  • Staff were caring and compassionate, and treated patients with dignity and respect.
  • The hospital was visibly clean and well maintained. Infection control rates in the hospital were lower when compared with those of other hospitals.
  • The trust performed better than average in a number of national audits, including the national hip fracture audit, the national bowel cancer audit, the national lung cancer audit data, the Sentinel stroke national audit, and the myocardial infarction national programme.
  • Managers and staff responded quickly and took appropriate actions to ensure patient safety where we identified issues on one ward within the medical service.
  • The trust had an ongoing recruitment and retention programme to address staffing shortfalls.
  • The critical care pathway for children was not well defined. Improvement was needed with regards to the provision of a children’s high dependency unit (HDU).

We saw several areas of outstanding practice, including:

  • The emergency department trigger tool, which was in place to ensure that the responsiveness of the emergency department was maintained when the department was beginning to see increasing pressures.
  • The chaplaincy service carried a trauma bleep in order to provide emotional support to the relatives of trauma victims.
  • Ipswich Hospital was one of only two trusts in the UK to participate in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), providing international benchmarking of patient outcomes.
  • There was a comprehensive outreach service in place, providing full 24/7 cover, including a 'patient activated' referral for the team.

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

Importantly, the trust must:

  • Review the end of life care paperwork to ensure that it is more individualised and providing a holistic approach in line with National Institute of Health and Care Excellence (NICE) guidelines.
  • Provide training to staff providing end of life care, on how to identify patients approaching the end of life, and on how to use the new care plans.
  • Ensure that discussions with patients and families regarding end of life care, or advanced care planning decisions, are clearly recorded in the person’s medical records.
  • Ensure that prior to undertaking a procedure, or completing an end of life care order, the person’s mental capacity is appropriately assessed in accordance with the Mental Capacity Act 2005.
  • Ensure that all clinical areas in outpatients, including the equipment in rooms, are cleaned regularly, and the cleaning is evidenced.
  • Ensure that the decontamination room in ear, nose and throat (ENT) outpatients is compliant with guidelines on decontamination Hospital Technical Memorandum.
  • Review medicines management within the south theatres, to ensure medicines are stored securely.
  • Clearly define a critical care pathway for children and review the provision of services for children requiring high dependency of care, including staffing numbers, competency and provision of registered sick children’s nurses (RSCN).

Professor Sir Mike Richards

Chief Inspector of Hospitals

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