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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

Reports


Inspection carried out on 19 - 21 November 2018

During a routine inspection

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.


CQC inspections of services

Inspection carried out on 20 to 21 November 2017

During an inspection to make sure that the improvements required had been made

Oxford University Hospitals (OUH) became a Foundation Trust on 1 October 2015

The Trust is made up of four hospitals - the John Radcliffe Hospital (which includes the Children's Hospital, West Wing, Eye Hospital, Heart Centre and Women's Centre), the Churchill Hospital and the Nuffield Orthopaedic Centre, all located in Oxford, and the Horton General Hospital in Banbury, north Oxfordshire.

The trust provides a wide range of clinical services, specialist services (including cardiac, cancer, musculoskeletal and neurological rehabilitation) medical education, training and research.

This was a focused inspection looking at the trust level leadership. We have not rated well-led on this occasion as we did not conduct a complete inspection of all areas of the well led domain.

Our findings were:

  • Risks, issues and poor performance were not always escalated in a timely way, and therefore not dealt with appropriately or quickly enough. The risk management approach was applied inconsistently with some people not recognising and escalating risk.

  • Leaders, managers and staff did not always receive information to enable them to challenge and improve performance. Information was used mainly for assurance and rarely for improvement.

  • The governance arrangements at divisional and directorate levels were not always clear and did not always operate effectively. In order to address some of these issues and to hold the divisions and directorates to account formalised quality and performance review meetings had recommenced with executive level leadership. These meetings had only recently been implemented, with only one round of meetings having been completed. Therefore it was not possible to assess their impact.

  • Equality and diversity was not consistently promoted and the causes of workforce inequality were not always adequately addressed. Staff, including those with particular protected characteristics under the Equality Act, did not always feel they were treated equitably.

  • Staff appraisals took place but staff reported these were not always of a high quality.

However:

  • The trust had an experienced and credible leadership team with the skills, abilities, and commitment to provide high-quality services. They were approachable, visible and supportive to their staff and to people who used or supported the work of the trust.

  • The trust board presented as a cohesive and supportive leadership team and we saw evidence of sufficient challenge where appropriate from the non-executive directors.

  • The trust had a clear vision and set of values informed by quality and sustainability. This had been translated into realistic strategy with defined objectives which were achievable and relevant. A structured process in engaging with people who use the service, staff and external partners had taken place to ensure they had the opportunity to contribute, inform and comment on the strategy.

  • The trust had appointed a Freedom To Speak Up Guardian and provided them with sufficient resources and support to help staff to raise concerns. This was a new role and while staff were aware of the support available it was too early to judge the impact of this role.

  • Candour, openness, honesty, transparency in general were the norm and the trust applied duty of candour appropriately.

  • The leadership team actively promoted staff empowerment to drive improvement.

  • The board level of governance functioned effectively and interacted with each other appropriately. Structures, processes and systems of accountability, were clearly set out, understood and effective.

  • The trust had implemented a process for case record reviews of all selected deaths to identify any concerns or lapses in care which may have contributed to, or caused, a death. The process also identified possible areas for improvement. The outcomes of these reviews were documented.

  • The trust board had sight of the most significant trust wide risks and mitigating actions were clearly documented. All staff we spoke with were clear about the overarching trust wide risk.

  • The serious incident (SIRI) forum was seen as an effective multi-disciplinary meeting. The group operated in line with the trust’s value of respect and was a forum where learning took place.

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

Importantly, the trust must:

  • Review the process for the identification and escalation of risk, to ensure staff appropriately identify and escalate risk in a timely way.

  • Ensure staff have timely access to information so they understand their performance and are able provide challenge and identify areas for improvement.

  • Ensure governance arrangements at divisional and directorate level are clear and their effectiveness monitored and evaluated.

  • Ensure they hold the divisions and directorates to account through an effective system.

 The trust should :

  • Ensure equality and diversity are consistently promoted and any workforce inequality identified and appropriate action taken in a timely manner.

Professor  Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 25-26 Feb and 2-3 March 2014

During a routine inspection

Oxford University Hospitals NHS Trust is one of the largest acute teaching trusts in the UK and has four hospitals. The John Radcliffe Hospital, the Churchill Hospital, and the Nuffield Orthopaedic Centre are situated in Oxford and serve a population of around 655,000. The Horton General Hospital in Banbury serves a population of around 150,000 people in north Oxfordshire, south Northamptonshire and south east Warwickshire. The trust has around 1465 beds, 832 of which are at the John Radcliffe. The trust has around 186,000 patients who stay in hospital and it arranges around 878,000 outpatient appointments every year. The hospitals in the trust are busy with the John Radcliffe being the busiest. The trust’s bed occupancy from July to September 2013 has been 92%, higher than the England average of 85.2%. The recommended occupancy rate is 85%, beyond that the pressure that a hospital is under can start to affect the quality of care given and the orderly running of the hospital.

The trust is registered to provide services under the regulated activities:

  • Assessment or medical treatment for persons detained under the Mental Health Act 1983
  • Diagnostic and screening procedures
  • Family planning
  • Maternity and midwifery services
  • Nursing care
  • Personal care
  • Surgical procedures
  • Termination of pregnancies
  • Treatment of disease, disorder or injury

Staffing

The trust employs around 11,000 staff. It has difficulties in recruiting and retaining sufficient staff, particularly nursing staff and healthcare assistants, in all four hospitals. The high cost of living in Oxford coupled with the difficulty and cost of parking is felt to be an issue. The trust has an ongoing recruitment campaign and is exploring options to help ease the parking problems. The trust employs agency and bank staff to make up the shortfalls and permanent staff spoke positively about the skills of their temporary colleagues. At the John Radcliffe hospital the vacancy rates were particularly high in the surgical wards and theatres, 19% in nursing and medical grades in January 2014. Staff described working long days and overtime to help address the shortfalls. However staff shortages have led to the cancellation of operations. At the Horton hospital staff felt that people were deterred from applying for posts because of perceived uncertainties about the future of services there however the low turnover of staff made it the most stable of the four hospitals for staffing. Staff turnover at the trust has run at or slightly above 11% over the last two years. The trust has a clear workforce plan and has set a target to reach 10% turnover. Targeted actions at problem areas for turnover have delivered significant improvements. Staffing levels have been increased on medical wards following an audit and assessment of patients’ needs.

Cleanliness and infection control

All four hospitals were clean and we observed good infection control practices among staff. Staff were wearing appropriate personal protective equipment when delivering care to patients and they cleaned their hands between patients. There were suitable hand-washing facilities in the hospitals and a good provision of hand gels. We saw staff using the gels and asking patients to do the same. Staff observed the hospital’s policy on being bare below the elbow. The number of methicillin resistant Staphylococcus Aureus (MSRA) bacteraemia infections and Clostridium difficile infections were within an acceptable range for a trust of this size. Each reported case had been reviewed in detail. The trust takes action to access its own performance with its policies and practices both for cleaning and infection control.

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.