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Provider: University Hospitals of North Midlands NHS Trust Requires improvement

On 14 February 2020, we published a report on how well University Hospitals of North Midlands NHS 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 05 Jun to 01 Aug 2019

During a routine inspection

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

  • We found significant concerns regarding the care and treatment of patients in the emergency department at Royal Stoke Hospital.
  • We found serious issues in relation to the care and treatment of patients with mental health needs and patients who lacked mental capacity to make decisions. These concerns were mainly focussed within medical care and urgent care services. As a result of these concerns we took urgent enforcement actions to ensure patients were safe.
  • Governance systems although embedded were over complicated and unreliable. However, we found that the newly appointed chief executive was undertaking extensive work to improve these systems.
  • In rating the trust, we took into account the current ratings of services not inspected this time.

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 – www.cqc.org.uk/provider/reports.


CQC inspections of services

Inspection carried out on 3 October to 16 November

During a routine inspection

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

  • We rated safe and responsive as requires improvement, effective and well-led as good, and caring as outstanding. All ratings improved, apart from safe which stayed the same. We rated both hospitals as requires improvement.
  • 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.
  • We rated well-led at the trust level as good.
  • We saw the trust had taken steps to improve patient flow through both hospitals, including a range of initiatives in the Emergency Departments and in medicine.
  • Processes around the management of medicines had been improved.
  • Staff were very caring and compassionate, universally put the patient first despite facing huge pressure on capacity.
  • Staffing levels had improved and the trust had less reliance on temporary workers.
  • Services in critical care and end of life care had been transformed since our last inspection.

However;

  • We consistently observed that staff were not confident in relation to the Mental Capacity Act 2005 and were unsure of how to apply it.
  • Despite the trusts actions and initiatives to improve patient flow, the emergency department was consistently failing to achieve the 4-hour waiting time target and was well below the England average

Inspection carried out on April 2015

During a routine inspection

The University Hospitals of North Midlands NHS Trust was created on 1 November 2014, following the integration of University Hospital of North Staffordshire NHS Trust with Stafford Hospital from the Mid Staffordshire NHS Foundation Trust. The trust has strong links with Keele University and Stafford University and is a University teaching hospital. The trust continues to work towards foundation trust status, with a view to becoming a Foundation Trust by 2017-2019.

We recognise that the leadership of the new trust has had the significant task of bringing together two organisations at a challenging time. We have seen that progress has been made but there is still more to be achieved.

The trust provides general acute hospital services for approximately 700,000 people living in and around Staffordshire. The trust also provides specialised services, such as Trauma, for three million people in a wider area.

The trust has had a challenging winter managing its delivery of acute services, specifically in meeting the A&E targets. This has been the subject of a joint risk summit with stakeholders in January 2015.

We inspected this service in April 2015 as part of the comprehensive inspection programme. We inspected all core services provided by the trust at both hospital sites.

We visited the trust on 22, 23 and 24 April 2015 as part of our announced inspection. We also visited unannounced to the trust until Tuesday 5 May 2015. Our unannounced visit included A&E, Medical Care Services and Critical Care.

Overall we have rated this trust as requires improvement. We saw that services were caring and compassionate. We saw a number of areas that required improvement for them to be assessed as safe and effective. We saw that leadership of services at the trust also required improvement at both a local and an executive level. The responsiveness of services was assessed as inadequate.

Our key findings were as follows:

  • Staff were caring and compassionate towards patients and their relatives, we saw a number of outstanding examples of good care right across the trust.
  • There was a strong culture of incident reporting and staff were encouraged and supported by their managers to engage in this. This made staff feel empowered.
  • Achieving safe staffing levels was a constant challenge for the organisation and there was a heavy reliance on agency and locum staff to support this.
  • Systems and processes did not support patients flow through the organisation.

We saw several areas of outstanding practice including:

  • Outstanding work being done on the Specialised Neurological Unit at the County Hospital to improve the outcomes for patients.
  • A range of initiatives in services for children and young people to enhance their patient experience.

  • Diagnostic imaging services had received accreditation from the Royal College of Radiologists through the imaging services accreditation scheme (ISAS).

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

Importantly, the trust must:

  • Review systems and processes to ensure patients flow through the organisation in a timely manner.
  • Address high waiting times in the emergency department.
  • Review the capacity and adequacy of the critical care services.
  • Review the sustained use of recovery to accommodate critically ill patients.
  • Implement the individualised care plan as soon as possible so that patients who are actively dying are supported holistically. This would also support the nursing staff to meet all the needs of the patients.
  • Review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.
  • Review pathways between County Hospital and Royal Stoke to ensure patients transferred from the emergency department are kept safe and patients who transferred for treatments and procedures are done so efficiently and effectively.

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.