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Provider: Worcestershire Acute Hospitals NHS Trust Inadequate

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

Inadequate

Updated 5 June 2018

We rated safe and responsive as inadequate, and effective and well-led as requires improvement. We rated caring as good. We rated eight of the trust’s 16 services we inspected as inadequate, seven as requires improvement and one as good. In rating the trust, we took into account the current ratings of the core services not inspected this time.

Inspection areas

Safe

Inadequate

Updated 5 June 2018

  • The trust was performing worse than the England average for patients waiting over 60 minutes before being handed over to emergency department staff. Not all patients were recorded as being seen by a specialist doctor despite being referred.
  • Not all systems in place were effective in recognising and responding to deteriorating patients’ needs. This included harm reviews of patients waiting for a procedure.
  • There were inconsistencies in staff being able to recognise and report incidents. Mixed sex breaches were not always reported.
  • Some areas did not have enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • There were inconsistencies with infection control and prevention techniques, particularly hand hygiene.
  • The trust did not ensure everyone completed mandatory training.

However:

  • Managers investigated reported incidents and shared lessons learned with the whole team. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The hospital had suitable premises in most areas and systems were in place to ensure most equipment was well looked after.
  • The hospital prescribed, gave, and recorded medicines well. Patients generally received the right medication of the right dose at the right time.

Effective

Requires improvement

Updated 5 June 2018

  • Not all staff had received an appraisal.
  • Not all staff received supervision to provide support and monitor the effectiveness of the service.
  • The hospital managed most patients’ pain effectively and provided or offered pain relief regularly. However, children’s and young peoples’ pain was not always managed effectively.
  • There was limited use of national and local audit to monitor performance and drive improvement in some areas.

However:

  • Generally, the hospital provided care and treatment based on national guidance and evidence of its effectiveness.
  • The hospital managed patients’ pain effectively and provided or offered pain relief regularly.
  • Staff generally gave patients enough food and drink to meet their needs and improve their health.
  • Multidisciplinary staff worked together as a team to benefit patients.

Caring

Good

Updated 5 June 2018

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • 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:

  • There was no privacy and very little confidentiality for patients waiting on trolleys in the emergency department corridor. Staff did not use privacy screens.

Responsive

Inadequate

Updated 5 June 2018

  • Patients could not access services when they needed them. Waiting times for treatment were not in line with good practice. The number of cancelled operations for non-clinical reasons was worse than the England average.
  • The trust planned but did not provide services in a way that met the needs of local people.
  • The outpatients department planned but did not always provide services in a way that met the needs of the local people.
  • People could not always access the outpatient services when they needed them. Waiting times from treatment and arrangements to admit, treat and discharge patients were not in line with good practice. There was no improvement in most areas since our inspection in November 2016. There were long waiting lists with many patients waiting up to 52 weeks for outpatient services.
  • In July 2017, the trust reported that 8,376 patients had not received a follow up ophthalmology appointment due to a change in the way outpatient follow up appointment data was collected. As at January 2018, the backlog had not significantly reduced and 7,655 patients waited for a follow up appointment.
  • From October 2016 to September 2017 the trust’s referral to treatment time (RTT) for non-admitted pathways was significantly worse than the England overall performance. From quarter 3 of 2016/17 to quarter 2 of 2017/18, the trust consistently failed to meet the 85% operational standard for patients receiving their first treatment within 62 days of an urgent GP referral. The trust’s performance was also consistently worse than the England average.
  • From quarter 3 of 2016/17 to quarter 2 of 2017/18, the trust consistently failed to meet the 93% operational standard for people being seen by a specialist within two weeks of an urgent GP referral. The trust’s performance was also consistently worse than the England average. In quarter 2 of 2017/18, 81.5% of patients referred urgently by their GP were seen by a specialist at the trust within two weeks. This compared to the England average of 93.9%.

However:

  • Services took account of patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with staff.
  • The Meadow Birth Centre won the MaMa 2017 national birth centre of the year award, in recognition of its outstanding health care environment. Feedback from women who had had their baby in the birth centre was overwhelmingly positive, and staff were often described as having gone “the extra mile”.

Well-led

Requires improvement

Updated 5 June 2018

  • Services did not always have a documented vision or strategy.
  • The trust did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Not all risks identified during the inspection were documented on risk registers.
  • Information was not always collected, analysed, managed and used well to support activity.
  • Some of the performance data was only available trust wide and related to all hospital sites covered by the Worcestershire Acute Hospitals NHS Trust. As the data was not always available at site level, the trust was unable to identify if any of the sites were a particular outlier. Therefore, risk management and oversight remained limited.
  • Continuous improvement, and learning from when things go wrong was not evident across all areas.

However:

  • Most managers, but not all, across the hospital promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • Staff spoke positively about the senior management team. They told us they were visible and they felt well supported by managers. Staff were confident to raise any concerns they had.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.