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Provider: East and North Hertfordshire NHS Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 December 2019

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, effective and caring were rated as good.
  • We rated eight of the trust’s services as requires improvement and two as good. In rating the trust, we took into account the current ratings of the five services not inspected this time.
  • Not all services controlled infection risks well and medicines were not consistently managed well across the trust. These were similar to concerns we found at our previous inspection. Whilst the trust had taken some actions to make improvements, these were yet to be embedded.
  • The trust had made improvements to their governance systems and structures which were yet to be embedded across all areas
  • Significant changes in leadership at various levels meant that there was a lack of pace in embedding new processes and practices.

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/RWH/reports.

Inspection areas

Safe

Requires improvement

Updated 18 December 2019

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

  • Surgery was rated as inadequate for safe. The service still did not control infection risk well and staff did not consistently follow infection prevention and control policies.
  • We rated five of the core services we inspected as requires improvement for safe. Records were not always stored consistently and the design, maintenance and use of facilities did not always keep people safe. There were high medical and nursing staff vacancies in some services.
  • The trust did not ensure that all services consistently used systems and processes to safely prescribe, administer and record medicines.

Effective

Good

Updated 18 December 2019

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

  • We found improvements in surgery and the urgent care centre.
  • Services were now using evidence-based guidance to deliver care and treatment.
  • Pain relief was monitored and managed in line with national guidance and teams mostly used results from internal; and external audits to improve patient outcomes.
  • Outpatients was not rated in line with our methodology.

Caring

Good

Updated 18 December 2019

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

  • All core services we inspected were rated as good.
  • Staff continued to deliver compassionate care and treated patients and their loved ones with respect and dignity.
  • Patients that we spoke with told us that staff had been caring and treated them with kindness.

Responsive

Requires improvement

Updated 18 December 2019

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

  • Outpatient services at Queen Elizabeth II Hospital and Mount Vernon Cancer Centre were rated as requires improvement. Although the trust had implemented a number of actions to improve performance in specific areas; patients could not always access initial treatment and assessment in a timely manner. This was a particular concern for patients awaiting initial treatment for cancers.
  • In end of life care the trust had not ensured that patients individual needs were being met and patients were being given the opportunity to choose their preferred place of death or care.

Well-led

Requires improvement

Updated 18 December 2019

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

  • We rated eight of the trust’s core services we inspected as requires improvements for being well-led.
  • Leaders had developed effective governance processes; however these were still being embedded.
  • Leaders had the skills and abilities to run the trust and services. However, there had been significant change in the leadership teams in the 12 months prior to our inspection. Whilst they understood the priorities and issues the trust and services faced, plans were still being developed to manage them effectively and consistently across the organisation.
  • Leaders at all levels worked hard to be visible and approachable; however, staff at some locations felt that leaders were not always visible and accessible.
  • Surgery rating for well-led improved from inadequate to requires improvement. This was because leaders were working hard to drive necessary improvements that were sustainable.

However,

  • The trust had made some improvements since our last inspection. This included supporting teams to make changes using quality improvement methodology. It was evident that the trust was committed to making improvements that were sustainable and ensured quality care.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 18 December 2019

We rated Use of Resources as requires improvement because whilst the NHS trust is performing well in some areas, there are other areas where further work is needed to enable it to provide high quality, efficient and sustainable care for patients.

​Please see the separate use of resources report for details of the assessment. The report is published on our website at www.cqc.org.uk/provider/RWH/Reports.

Combined rating

Combined rating summary

Requires improvement

Updated 18 December 2019

This is the first time we have given a combined quality and resources rating for this trust. We rated it as requires improvement because:

  • We rated safe, responsive and well-led as requires improvement, effective and caring were rated as good.
  • We rated eight of the trust’s services as requires improvement and two as good. In rating the trust, we took into account the current ratings of the five services not inspected this time.
  • Not all services controlled infection risks well and medicines were not consistently managed well across the trust. These were similar to concerns we found at our previous inspection. Whilst the trust had taken some actions to make improvements, these were yet to be embedded.
  • The trust had made improvements to their governance systems and structures which were yet to be embedded across all areas
  • Significant changes in leadership at various levels meant that there was a lack of pace in embedding new processes and practices.
  • The trust was rated Requires Improvement for use of resources. Full details of the assessment can be found on the following pages.

Checks on specific services

Community health services for children, young people and families

Good

Updated 5 April 2016

Overall we rated the service as good with the service being outstanding for caring and good in all other areas.

We found Children’s Community Services (CCS) provided a caring and effective multidisciplinary and multiagency service for children and young people (CYP) who required assessment, support and intervention to ensure their wellbeing and development.

Services were provided in a child friendly environment by a highly skilled and empathetic workforce across all children’s community settings. Services provided at the Child Development Centre (Danestrete) and the Children’s Zone (QEII) included visit’s to a child’s home, nursery, school or other locality setting. This enabled the development of holistic packages of care for each child and minimised the need for multiple appointments and duplication of history taking and documentation.

Children were truly respected and valued as individuals and encouraged to self-care and were supported to achieve their full potential within the limitations of their clinical condition. Feedback from children who used the service, parents and stakeholders were continually positive about the way staff treated people. Parents said staff went the extra mile and the care they received exceeded their expectations.

Services were well-led and staff were aware of the wider vision of the trust and felt supported in their roles.

We spoke to 43 staff which included nurses, doctors, therapist’s teachers, care support staff and administrative staff.  We also spoke to five children and eight parents.