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Provider: Oxford University Hospitals NHS Foundation Trust Requires improvement

CQC has taken urgent enforcement action for a failure to provide safe care and treatment. We have issued conditions on the providers registration and these will remain until CQC are satisfied that improvements have been made. See our press release.

On 07 June 2019, we published a report on how well Oxford University Hospitals NHS Foundation 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

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 7 June 2019

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

  • We rated, effective, caring and responsive as good, and safe and well led as requires improvement.

  • At the John Radcliffe Hospital, we rated two of the trust’s services as good and three as requires improvement. In rating the trust, we took into account the current ratings of the four services not inspected this time.

  • At the Churchill Hospital we rated one of the trust’s services as good and one as requires improvement. In rating the trust, we took into account the current ratings of the four services not inspected this time.

  • At the Horton General Hospital, we rated one of the trust’s service as good and one as requires improvement. In rating the trust, we took into account the current ratings of the six services not inspected this time.

  • At the Nuffield Orthopaedic Centre, we rated one of the trust’s services as good. In rating the trust, we took into account the current ratings of the two services not inspected this time.

  • We rated well-led for the trust overall as requires improvement.

Inspection areas

Safe

Requires improvement

Updated 7 June 2019

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

  • The services provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. However, medical staff’s compliance with safeguarding training on how to recognise and report abuse was significantly below the trust target for adults and children modules. There was a risk patients may not be safeguarded from harm.

  • Staff kept records of patients’ care and treatment and they were easily available to all staff providing care. However, patient notes were not always fully completed and in some areas, they were not securely stored.

  • In general, services followed best practice when prescribing, giving and recording medicines, but in some areas medicine storage was not in line with best practice.

  • Services mainly had suitable premises and equipment and mostly looked after them well. There was a mix of old and new estate which did present the trust with challenges which they were monitoring and addressing. However, in some areas the environment had not been maintained to a satisfactory standard and the entrance to the children’s emergency department was not always secure.

  • Services had processes in place to manage the risk of infection and in most areas staff kept themselves, equipment, and the premises clean. However, within surgery, gynaecology, emergency department and maternity service there were areas where these processes were not being constantly applied.

  • In some areas within surgery the incident reporting system was not being effectively used to report events which had resulted in harm or where there was risk as a result of damage to the fabric of the building.

  • Not all services always had enough nursing staff, with the right mix of qualification and skills, although they were working hard to remedy this. The Midwifery service did not have the planned numbers of midwifery and nursing staff which impacted on the women’s choice. Staff worked flexibly to provide a safe service although there was not enough midwifery staffing to reach the Royal College of Obstetricians and Gynaecology (RCOG) recommended midwife ratio of 1:28.

  • As a major trauma centre the service did not met the national requirements regarding consultant cover. However, the service had enough medical staff with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.

However

  • Staff completed and updated risk assessments for each patient. They kept records and asked for support where necessary.

  • Services took a flexible approach to ensuring they had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • Services had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • Services managed patient safety incidents well. Most staff recognised incidents and reported them appropriately. Managers 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.

Effective

Good

Updated 7 June 2019

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

  • Services provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service could cater for patients’ religious, cultural and other preferences.

  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • Staff worked well together for the benefit of patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • Services collected performance data against clinical standards for seven days working. The Trust had produced a seven-day service guide, which all staff we spoke with were very positive about.

  • People who use services were empowered and supported to manage their own health, care and wellbeing to maximise their independence.

  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.

However

  • Services were supportive of staff development with a strong desire to ensure they were competent for their role. However, managers did not always appraise staff work and performance.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. However, the emergency department (ED) at John Radcliffe hospital failed to meet any of the national standards for the three Royal College of Emergency Medicine audits in which it participated.

Caring

Good

Updated 7 June 2019

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

  • Staff cared for patients with compassion and kindness. Feedback from patients was consistently positive about the way staff treated them.
  • Staff provided emotional support to patients to minimise their distress
  • Staff involved patients and those close to them in decisions about their care and treatment.

However

  • We observed some instances where a patents’ privacy and dignity was not respected.

Responsive

Good

Updated 7 June 2019

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

  • Services planned and provided services in a way that met the needs of local people.

  • Service took account of patients’ individual needs. This included refurbishment of the complex medical wards to make them more dementia friendly and the development of treatment pathways such as direct admission and ambulatory care.

  • In general people could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit and treat patients were being monitored and action had been taken by the trust to assess the risk to patients and improve performance in areas where this had been poor.

  • Services investigated concerns and complaints and learned lessons from the results, and shared these with staff.

However

  • A proportion of patients experienced a delayed discharge.

  • Services responses to complaints were not always completed in a timely manner.

  • Due to staffing challenges the endoscopy procedure rooms sometimes at the Horton General Hospital, which had extended the waiting list for non-cancer patients.

  • In the emergency department at the John Radcliffe hospital found demand for services frequently outstripped the availability of appropriate clinical spaces to assess, treat and care for patients.

  • Generally, people could access the services when they needed it. However, in the emergency department waiting times from referral to treatment and arrangements to admit, treat and discharge patients did not always meet national standards. In the gynaecology service patients could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with good practice.

Well-led

Requires improvement

Updated 7 June 2019

Our rating of well-led went down. We rated it as requires improvement because: