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Provider: West Suffolk NHS Foundation Trust Requires improvement

Action is being taken against this provider. Find out more

  • We have served two fixed penalty notices on West Suffolk NHS Foundation Trust for failing to meet fundamental standards at West Suffolk Hospital, Bury St Edmonds on 09 September 2021. Fines totalling £2500 have been paid as an alternative to prosecution.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 January 2020

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

  • We rated safe, responsive and well led as requires improvement and effective and caring as good. Ratings for all five key questions, safe, effective, caring, responsive and well led had gone down. The rating for the well led question at trust level had gone down from outstanding to requires improvement.
  • We rated three of the trust’s five acute core services as requires improvement (maternity, medical care and outpatients) and two as good (urgent and emergency care and surgery). Overall ratings for urgent and emergency care and surgery had remained the same, medical care and outpatients had gone down. We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. In rating the trust, we took into account the current ratings of the three services not inspected this time. We rated all three community services as good overall, with safe, effective, caring, responsive and well led rated good. Community health services had not been rated previously.
  • Processes for identifying, recording, escalating and managing risks across the organisation were not always fully effective or undertaken in a timely manner . There were inconsistent approaches to managing safety. Not all services controlled infection risk well. Completion of patient risk assessments, documentation and record keeping varied. Medicines management, including security and storage of medicines was inconsistent. Staff training and compliance in key skills fell below trust target, specifically for medical staff. Clinical and internal audit processes were not always fully effective across all services.
  • Services do not always meet people’s needs. People could not always access services for assessment, diagnosis or treatment when they needed to. The trust continued to underperform across a large range of national access standards, in particular those related to the national 18 week referral to treatment (RTT) standard, the six week diagnostic standard and access standards related to suspected and confirmed cancer management. Action to address this were not effective and at a global trust level, the number of patients on the RTT waiting list was substantially higher than 12 months previously, reflecting a lack of systemic waiting list control.
  • Not all systems produced reliable information that supported staff to develop and improve performance. Ongoing issues with e-Care had impacted on the ability and accuracy to report service performance specifics, such as referral to treatment time and theatre utilisation.
  • Not all staff felt respected, supported and valued or felt that they could raise concerns without fear. Communication and collaboration to seek solutions had not always been effectively undertaken. An open culture was not always demonstrated
  • The style of executive leadership did not represent or demonstrate an open and empowering culture. There was an evident disconnect between the executive team and several consultant specialties. Whilst priorities and issues were known and understood these were not always managed in a consistent way.

However:

  • Services had enough staff to care for patients. 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 and supported them to make decisions about their care. Key services were available seven days a week.
  • 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 trust had a 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 in their work.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – .

Inspection areas

Safe

Requires improvement

Updated 30 January 2020

  • There was limited assurance that systems, processes and procedures across all services, were reliable or appropriate to keep people safe. Risks to patients who used services were not always assessed, monitored and managed appropriately, particularly within the maternity services and the emergency department.
  • Safety concerns were not consistently identified or addressed quickly enough. Incidents were not always reported in a timely manner and wider lessons were not identified or shared effectively to improve patient safety. Not all services used monitoring results to improve patient safety.
  • Within outpatient services there was lack of robust systems to identify and track patients requiring a follow up appointment or those on surveillance pathways. Actions had not been undertaken in a responsive manner once concerns were known. This had resulted in significant patient safety risk within the vascular service, and an extended period of time where potential risk across other specialties remained unknown.
  • Staff did not always keep appropriate records of patients’ care and treatment. Staff did not always complete risk assessments documentation which meant a delay in escalating, removing or minimising risks.
  • Medicines management was inconsistent. Processes to store medicines securely did not always follow relevant national guidance.
  • The design, maintenance and use of facilities, premises and equipment did not always keep people safe. This included community health services for children and young people where facilities for audiology assessments in the Ipswich child development centre were not fit for purpose.
  • Consistent and effective documentation for mortality and morbidity meetings was not recorded in all services. An internal review into learning from deaths identified that areas for improvement into wider learning and overview of themes remained.
  • Mandatory training compliance rates, specifically for medical staff, continued to fall below trust targets.

However:

  • Services had enough medical, nursing and support staff with the right qualifications, skills, training and experience to provide care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix.
  • 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.

Effective

Good

Updated 30 January 2020

Our rating of effective went down. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The majority of 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 subject to the Mental Health Act 1983.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. 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 multidisciplinary care.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

However:

  • Not all national audits had actions plans to address all areas of concern that required improvement.
  • There were concerns within maternity services there was a risk that not all women were receiving effective care or treatment. There was a lack of consistency in the effectiveness of the care, treatment and support that women received. Concerns included out of date guidelines, monitoring of women’s pain and ensuring staff were competent for their roles. Midwifery appraisal rates were not met and there were no supervision meetings in place to provide staff support and development.
  • Within the community inpatient services, staff were unaware of the monitoring that the trust performed for the effectiveness of care and treatment. They were unable to use the findings to make improvements in outcomes for patients.

Caring

Good

Updated 30 January 2020

Our rating of caring went down. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Across all services staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff gave patients and those close to them help, emotional support and advice when they needed it to minimise their distress. They understood patients' personal, cultural and religious needs.
  • Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment. A family centred approach was observed in the community children and young people service. Staff recognised the importance of confidentiality and enabling people to manage their own health and care where possible.

Responsive

Requires improvement

Updated 30 January 2020

Our rating of responsive went down. We took into account the current ratings of services not inspected this time. We rated it as requires improvement because:

  • People could not always access services for assessment, diagnosis or treatment when they needed to. Waiting times from referral to treatment varied, with some specialties better and some worse than national standards.
  • The trust continued to underperform across a large range of national access standards, in particular those related to the national 18 week referral to treatment (RTT) standard, the six week diagnostic standard and access standards related to suspected and confirmed cancer management.
  • There was no process in place for monitoring patients requiring a follow up appointment. The outpatients service were unaware of the number of patients who may have been lost to follow up. There was no process in place to monitor the average waiting times for a follow up appointment.
  • Delays in diagnostic test results meant that clinic appointments were often wasted.
  • Complaints were not investigated and closed within the deadline set in the trust’s internal policy.

However:

  • It was easy for people to give feedback and raise concerns about care received. Concerns and complaints were taken seriously, investigated and lessons learned shared with staff.

Well-led

Requires improvement

Updated 30 January 2020

Our rating of well-led went down. We took into account the current ratings of services not inspected this time. We rated it as requires improvement because:

  • The leadership, governance and culture do not always support the delivery of high quality person centred care. Leaders did not always use systems to identify and escalate relevant risks and issues. Actions were not always identified or monitored effectively to ensure mitigation was in place.
  • Within maternity services we raised concern over the skills and abilities of leaders to run the service. Leaders were not effective at implementing meaningful changes that improved safety culture within the organisation.
  • Not all staff felt respected, supported and valued or felt that they could raise concerns without fear. Communication and collaboration to seek solutions had not always been effectively undertaken. An open culture was not always demonstrated. Staff that raised concerns were not always appropriately supported or treated with respect. Concerns were not consistently investigated.
  • Risk, issues and poor performance were not always dealt with appropriately or quickly enough. The risk management approach was applied inconsistently. Clinical and audit processes were inconsistent in their implementation and impact.
  • Leaders and teams did not always use systems to manage performance effectively. Issues with the accuracy and availability of data, affected managers’ ability to manage performance effectively at times. Staff could not always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. Patient information systems were not fully integrated across the community services. Information used in reporting, performance management was not always accurate, valid or reliable.
  • Within the community services, the cascade of governance issues through team meetings were not always in place and there was a lack of clinical audit. Local processes to collect, analyse and review data to improve performance and patient care were not embedded.

However:

  • Across services leaders actively 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.
  • The trust had in place a clear vision, focused priorities and ambitions that were unchanged from our previous 2017 inspection. The vision, values and strategy had been developed with all relevant stakeholders and was understood by leaders and staff across the organisation.
  • 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.
Assessment of the use of resources

Use of resources summary

Good

Updated 30 January 2020

We rated use of resources as good because:

The NHS foundation trust compares well (nationally), across most productivity metrics covered in this assessment, which indicates better utilisation of its workforce and facilities. It has a good track record of managing expenditure within its financial plans and has achieved its control totals for each of the last three years, however at the time of the assessment the NHS trust was reporting an adverse variance to its financial plan and had identified significant risks to achieving its control total for 2019/20, which largely due to demand and workforce related cost pressures.

Please see the separate use of resources report for details of the assessment and the combined rating. The report is published on our website at www.cqc.org.uk/provider/RGR/Reports.

Combined rating

Combined rating summary

Requires improvement

Updated 30 January 2020

Combined quality and resources

We rated combined quality and resources as requires improvement because:

  • We rated safe, responsive and well-led as requires improvement; and effective and caring as good.
  • We took into account the current ratings of the three core services at West Suffolk hospital not inspected at this time.
  • We rated three services as requires improvement across the trust overall. We rated the remaining two acute services as good. We rated the three community health services as good.
  • The overall rating for the trust's acute location went down.
  • The trust was rated good for use of resources.
Checks on specific services

Community health inpatient services

Good

Updated 30 January 2020

We rated the service as good because:

Staff understood how to protect patients from abuse and assessed and managed patient risks well. The service controlled infection risk well and maintained a clean environment. Staff kept good care records and managed medicines well. The service managed safety incidents well, learned and shared lessons from them. Staff collected safety information and used it to improve the service. However, as no acuity tool was used it was difficult to assess to whether the were enough staff to keep patients safe and mandatory training compliance was inconsistent.

The service followed best practice based on national guidance and ensured staff were competent for their role. Staff ensured that patients had enough to eat and drink and provided pain relief to patients as needed. Staff worked well together for the benefit of patients, gave advise on how to lead healthier lives, and supported them to make decisions about their care. Managers monitored the effectiveness of the service.

Staff treated patients with compassion and kindness, respected their privacy and dignity and provided emotional support to patients and families. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

The service planned care to meet the needs of local people and coordinated care with other services and providers. The service ensured that patients and relatives could give feedback and treated concerns and complaints seriously. However, there was a lack of individualised care and needs.

The service was manged by leaders with the skills and abilities to run the service and who operated effective governance and risk management processes. Staff were clear about their roles and accountabilities and felt respected, supported and valued. Leaders managed services well using reliable information systems and supported staff to develop their skills. Staff were committed to improving services, however not all senior staff were aware how they could find the data they needed, to understand performance, make decisions and improvements.

Community health services for adults

Good

Updated 30 January 2020

We rated the service as good because:

  • The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. 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 collected safety information and used it to improve the service.
  • Staff checked patients had enough to eat and drink. Managers monitored the effectiveness of the service. 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 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 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 using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. 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 and all staff were committed to improving services continually.

Community health services for children, young people and families

Good

Updated 30 January 2020

We rated this service as good because:

  • The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. 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 collected safety information and used it to improve the service.
  • 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 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 understood the service’s vision and values, and how to apply them in their work. 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 and all staff were committed to improving services continually.

However:

  • Staff did not always complete the mandatory training required to ensure they maintained their knowledge and skills.
  • Patient information systems were not integrated and made it difficult for staff to maintain contemporaneous records. Data was not always available to enable staff to manage performance effectively.
  • Facilities for audiology assessments in the Ipswich child development centre did not meet national standards.