You are here

Provider: Norfolk and Norwich University Hospitals NHS Foundation Trust Requires improvement

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 April 2020

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

  • We rated safe, responsive and well led as requires improvement and caring as good. Effective went up from requires improvement to good. Ratings for four key questions, safe, caring, responsive and well led remained the same whilst effective improved. The rating for the well led question at trust level remained the same as requires improvement.
  • We rated two of the trust’s four acute core services as requires improvement (urgent and emergency care and surgery), one as good (outpatients) and one as outstanding (end of life care). Overall ratings for urgent and emergency care and surgery remained the same, and outpatients and end of life care had improved. In rating the trust, we took into account the current ratings of the four services not inspected this time.

On the basis of this inspection, the Chief Inspector of Hospitals has recommended that the trust is removed from special measures.

Inspection areas

Safe

Requires improvement

Updated 17 April 2020

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

  • There continued to be issues with mandatory training completion in the core services mainly related to medical staff training.
  • In some areas, such as the emergency department, there were vacancies. In the emergency department there was not the correct skill mix in the department, particularly amongst consultant and specialist trainee staff. In surgery, staffing did not always meet planned numbers.
  • Medicines were not stored securely or managed properly across the core services.
  • Records in surgery and outpatients were not always up to date and were not stored securely in a number of areas.
  • In outpatients we found that staff did not always report incidents.

However,

  • Infection prevention and control was managed well. We saw staff following policy and were ‘bare below the elbows’ in clinical areas.
  • There was improved understanding of and application of safeguarding within the trust.
  • Patients at risk of deterioration were generally managed well with staff clear on the steps they should take if they had concerns about patients.
  • In surgery, urgent and emergency care and end of life care, staff recognised and reported safety incidents well.
  • There had been significant improvement in mental health services in the emergency department.

Effective

Good

Updated 17 April 2020

Our rating of effective improved. We rated it as good because:

  • All the services we inspected followed national guidance and there was clear evidence based practice. Staff understood their responsibilities under the Mental Health Act 1983.
  • There had been significant improvement across the services in staffs understanding and application of the Mental Capacity Act 2005.
  • We saw excellent multidisciplinary working in most areas we inspected. Patients were the clear focus of professional discussions.
  • Patients received pain relief in a timely way.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff had access to up to date information, policies and guidance. All staff we spoke with could access this information.

Caring

Good

Updated 17 April 2020

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

  • We saw numerous examples of staffing treating patients with compassion and kindness, respecting their privacy and dignity.
  • Staff clearly took account of patient’s individual needs and actively involving patients’ families in discussions.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs.
  • In end of life care patients staff went beyond what would be expected to provide them with care. Relatives were equally empowered to support patients care.

Responsive

Requires improvement

Updated 17 April 2020

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

  • The trust had ongoing demand, flow and capacity issues which we observed across the services we inspected. Whilst there were plans in place to address this, the impact on patient care was still apparent.
  • People did not always access the service when they needed it. In the emergency department, surgery and outpatients waiting standards were not always met including referral to treatment times for a number of specialities. In the emergency department there were delays in admitting patients after a decision to admit was made. This represented ongoing issues with demand and capacity at the trust.

However,

  • Across the series we found that staff took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services and meet their need whilst they were inpatient. They coordinated care with other services and providers.

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
  • In end of life care we found that the service responded quickly, within 24 hours to almost all patients. There was a proactive approach to understanding and meeting the needs and preferences of different groups of people.

Well-led

Requires improvement

Updated 17 April 2020

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

  • There was ongoing cultural concerns in some teams in the emergency department. This was challenging and impacted on relationships, decision making and patient flow. Whilst culture was improving, there remained pockets of staff who felt undervalued with poor morale.
  • The services did not meet national performance targets for seeing and treating patients, which impacted on patient outcomes.
  • The recent changes in the emergency department leadership were not fully imbedded and required additional time to improve the department’s overall performance.

However,

  • Leadership in the divisions were stronger and clearly sighted on their challenges and risks.
  • Governance was improved within the divisions with staff aware of accountabilities. There were regular governance meetings which clearly fed into wider trust governance though governance in the divisions needed further embedding.
  • There was improved risk management and appropriate actions were taken to mitigate risks.
  • There was a clear commitment to innovation and quality improvement in the staff we spoke with who felt supported in moving the quality improvement agenda forward.
  • In end of life care we found there was compassionate, inclusive and effective leadership. Leaders had the skills and abilities to run the service. Leaders had a deep understanding of issues, challenges and priorities in their service, and beyond and managed the priorities and issues the service faced.

Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 17 April 2020

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

We rated the use of resources at this NHS foundation trust as Requires Improvement. The NHS foundation trust was last assessed in February 2019 (nine months from the date of this assessment), and although there have been some actions taken to improve workforce and service productivity, it was too early to evaluate their impact. The metrics associated with the costs of delivering activity had not yet been updated and several initiatives had either recently been implemented or were just being scoped. For areas where the assessment data had been updated, the NHS foundation trust’s performance is variable. It continues to compare well against some clinical services productivity metrics but its performance against constitutional operational standards has declined and its financial position continues to deteriorate.

Combined rating

Combined rating summary

Requires improvement

Updated 17 April 2020

Our rating of stayed the same. We rated it 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 core services at the Norfolk and Norwich Hospital not inspected at this time.
  • The overall rating for the trust's acute location stayed the same.
  • The trust was rated requires improvement for use of resources.