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Archived provider: Mid Essex Hospital Services NHS Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 March 2020

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

  • We found that there were regulatory breaches resulting in requirement notices and found that the organisation was performing at a level which led to the overall rating as requires improvement.
  • Overall, we rated safe and responsive as requires improvement, effective, caring and well-led as good. The overall rating remained the same. In rating this trust we took into account the current ratings of the service not inspected on this occasion.
  • We rated two (urgent and emergency care and surgery) of the six core services inspected as requires improvement and four services (medical care, maternity, gynaecology and outpatients) as good. The well-led part of the inspection was rated as good. We previously rated maternity alongside gynaecology, therefore we cannot compare the new ratings with previous ratings. In our current methodology gynaecology is not aggregated in the overall ratings. Rating the trust overall, we took into account the three core service not inspected this time.
  • The trust did not always have enough staff to care for patients and keep them safe. Not all staff had received training in key skills. Staff did not always fully document risk assessments of patients. Staff were not always managing medicines well.
  • 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. Key services in the trust 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 did not always meet people’s needs. Patients could not always access treatments in a timely manner in line with national standards. The trust was underperforming for a range of specialties to meet the national standards for the national 18 week referral to treatment times and 62 day cancer waits to treatment. The trust planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • 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 trust engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually. The trust was not externally reporting due to data validation issues.
Inspection areas

Safe

Requires improvement

Updated 6 March 2020

Our rating of safe stayed the same. We took into account the ratings of services not inspected this time. We rated it as requires improvement because:

  • Two of the six core services were rated as requires improvement and four as good.
  • Not all staff had completed the required mandatory training and competency assessments in key skills and had not met the trust’s compliance target for a number of modules.
  • Not all staff had received children’s safeguarding level three training in line with national guidance.
  • We found several areas where staff were not always fully completing risk assessments in line with national guidance. Record keeping varied, improvements with documentation were required in a number of core services.
  • Nursing and medical staffing was a general issue across all core services. Although this was mitigated with the use of bank and agency staff to keep patients safe. The service was actively recruiting staff from overseas.
  • The design, maintenance and use of facilities, premises and equipment did not always keep people safe. In outpatients the chemotherapy suite did not have a specific treatment room and was not designed to accommodate the number of patients receiving treatment.

However,

  • Generally core services controlled infection risk well. Staff adhered to policy for hand hygiene and staff followed infection control principles including hand hygiene and the use of personal protective equipment. However, in some areas cleaning records were not being completed.
  • Most of the core services used systems and processes to safely prescribe, administer, record and store medicines. We found that allergies and weights were not routinely documented in maternity.
  • It was evident that core services reported incidents, investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

Effective

Good

Updated 6 March 2020

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

  • All core services were rated as good.
  • The service 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.
  • Patients received food and drink to meet their needs. The trust supported patients when necessary and were able to support patients with special dietary and religious needs.
  • Services assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Most services monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • We mainly observed good multidisciplinary working and teams supporting one another.

However,

  • Not all core services had ensured staff had received an annual appraisal.
  • Some improvement was required to improve performance in national clinical audits.

Caring

Good

Updated 6 March 2020

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

  • All core services were rated as good.
  • All core services consistently treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Emotional support was provided to patients to minimise their distress.
  • Patients we spoke with felt involved in their care.

Responsive

Requires improvement

Updated 6 March 2020

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

  • Five core services were rated as requires improvement for responsive, one was rated as good.
  • Patients were not always able access the service when they needed it and waiting times for treatments in urgent and emergency care, surgery and outpatients were not in line with the England average. The trust was underperforming for a range of specialties to meet the national standards for the national 18 week referral to treatment times and 62 day cancer waits to treatment.
  • The trust did not always ensure the complaints process was completed in line with the trust policy.

However,

  • Services were inclusive and took account of patients’ individual needs and preferences. They coordinated care with other services and providers.
  • It was easy for people to give feedback and raise concerns about care received.

Well-led

Good

Updated 6 March 2020

Our rating of well-led improved. We took into account the ratings of services not inspected this time. We rated it as good because:

  • Five core service were rated as good and one was requires improvement.
  • Leaders and managers had the appropriate range of skills, knowledge and experience to perform their role.
  • Governance processes were fully effective. Staff had regular opportunities to meet, discuss and learn from the performance of the service. Risks and issues were escalated promptly, and mitigating actions were taken quickly to reduce the impact of risks identified.
  • The executive team and managers visible and approachable throughout all core services.
  • Staff felt respected, supported and valued by the senior leadership team. Culture had improved since our last inspection.
  • All staff were committed and supported by managers to continually learn and improve their service. They had a good understanding of quality improvement methods and the skills to use them.

However,

  • We could not gain accurate assurances that people could access the service when they needed it and receive the right care promptly. Waiting times from referral to treatment (RTT) were not externally reported at the time of our inspection. From 2018 to 2019, the trust implemented an electronic patient record system which caused data validity issues and poor quality data. With agreement from NHS England the trust were excluded from reporting data until they had completed a review and data cleansing exercise.
  • Locally, managers told us waiting times were being monitored. However, at the time of our inspection local leaders were unable to provide us with data to evidence the percentages of harm reviews or whether the service were meeting the national targets.
  • Following our inspection we requested data from the senior leadership team. We reviewed the data that was provided, we were not able to analyse trends on the unvalidated data. Senior leaders told us patients that were not able to access services within national targets, received a harm review and were reported to board in common meetings. They also told us that until they returned to reporting (scheduled April 2020) ‘shadow reporting’ was in place, which included monthly review meetings with NHS Improvement/England and commissioners.

Assessment of the use of resources

Use of resources summary

Inadequate

Updated 30 January 2019

Combined rating

Combined rating summary

Requires improvement