You are here

Provider: East Sussex Healthcare NHS Trust Good

Reports


Inspection carried out on 05 November to 12 December 2019

During a routine inspection

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

We rated safe, responsive and well-led as good, caring and effective as outstanding. We rated three of the trust’s five services as outstanding and two as good. In rating the trust, we took into account the current ratings of the 13 services not inspected this time.


CQC inspections of services

Service reports published 27 February 2020
Inspection carried out on 05 November to 12 December 2019 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report UK (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 November to 12 December 2019 During an inspection of Community end of life care Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 6 March 2018

During a routine inspection

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

  • The ratings from previous inspections impacted on the aggregated overall rating for the trust. The requires improvement rating remains in children and young people and end of life care as we did not re-inspect these on this inspection.
  • The emergency department at Eastbourne District General Hospital needed to improve further. We saw progress and improvements but there were still some gaps in the service that required further attention.

However

  • The leadership team had the capacity and capability to deliver high quality, sustainable care. The board and senior leaders were able to demonstrate a sound understanding of the requirements of their roles and their responsibilities. Leaders at all levels had followed the board lead in modelling good leadership practice. Two core services on the Conquest site were rated outstanding for leadership with other leadership teams not far behind.
  • There was much improved cross site working and relations. Most staff felt they worked for the trust rather than at individual hospitals. There were pockets of staff where this didn’t hold true but this was a very small minority.
  • There was a clear and known Vision and strategy for achieving the trust objectives. All staff that we spoke with knew the statement “Outstanding by 2020” and were committed to achieving this. The staff now believed it was possible and showed great pride in the work they were doing.
  • The clinical strategy had been created in consultation with staff and local stakeholders. It reflected the needs of the local community and aimed to deliver. “The right care at the right time in the right place”. Key priorities were identified and service redesigned was well underway to streamline care between community, acute hospitals and primary care.
  • There were acknowledged serious financial challenges and the trust was in Financial Special Measures but the focus for the entire board was on maintaining and improving the quality and safety of the services provided. No financial decisions were made without undertaking a quality impact assessment.
  • The updated Risk and Quality Delivery Strategy provided a very clear and comprehensive account of the risk management tools and processes across the trust. There were effective structures, processes and systems of accountability to support the delivery of the strategy and good quality, sustainable services.
  • The Integrated Performance Report provided a holistic understanding of performance, which integrated people’s views with information on quality, operations and finances. The IPR was used by the board for assurance and by the divisions to benchmark and drive improvements.
  • Engagement was a real strength of the organisation. Innovative and effective work with East Sussex Healthwatch had led to changes in care practice and provision. The trust had built positive relationships with other local agencies and was well represented at external meetings and groups. Internally, the staff reported feeling much more engaged and motivated by a visible executive team who recognised the challenges and valued them.
  • The needs of patients attending with mental illness were given due consideration. The board was well engaged with ensuring the needs of patients with mental illness were met. The East Sussex Better Together initiative members had redesigned the end to end pathway around the interface of Mental Health with Acute Medicine. In the ED at Conquest Hospital, the care of patients with mental illness was given parity with those attending with physical illness.
  • Community services were not inspected at this inspection but the overall rating of good remained from the last time these services were inspected and was used to aggregate the overall trust rating.

Inspection carried out on 4th-6th October 2016

During an inspection looking at part of the service

East Sussex Healthcare NHS Trust is a provider of acute and specialist services that serves a population of 525,000 people across East Sussex. It provides a total of 833 beds with 661 beds provided in general and acute services at the two district general hospital (Eastbourne District General Hospital and Conquest Hospital, Hastings) and community hospitals. In addition there are 45 Maternity beds at Conquest Hospital, and the midwifery led unit at Eastbourne District General Hospital and 19 Critical care beds (11 at Conquest Hospital, 8 at Eastbourne District General Hospital).

We carried out an announced inspection between the 4th and 6th of October.

This is the third inspection of this trust. Following the inspections of  September 2014 and March 2015 the trust was rated as inadequate and placed in special measures in September 2015.

This inspection was specifically designed to test the requirement for the continued application of special measures at the trust. Prior to inspection we risk assessed all services provided by the trust using national and local data and intelligence we received from a number of sources. That assessment led us to include six acute hospital services (emergency care, surgery, maternity and gynaecology, children and young people, end of life care and outpatients) in our inspection. The two other acute hospital  services (medicine and critical care) and community services were not inspected as they had indicated good performance at previous inspections and our information review suggested that this had been sustained.

Following this inspection we have re-rated the services inspected. For other services we have maintained ratings from previous inspections. We have aggregated the ratings to provide an overall rating for the trust of requires improvement.

Caring was rated as good, whilst safe, effective, responsive and well-led are all rated as 'requires improvement'. This constitutes a significant improvement from the previous rating of inadequate.

Both Eastbourne District General Hospital and Conquest Hospital Hastings were rated as 'requires improvement', again a significant improvement from the previous rating of inadequate. 

Our key findings were as follows:-

SAFE

  • The incident reporting culture had been significantly improved.
  • Staff understanding of duty of candour had improved.
  • Infection control oversight had been significantly strengthened and hand hygiene practice was largely compliant.
  • Medicines management processes had been significantly improved.
  • The transfer of patients from ambulance to the emergency department was subject to delay and not being monitored.
  • There was a significant backlog in the reporting of x-ray examinations.
  • Record keeping was not consistent across the trust notably in the documentation of risk assessments within the emergency department.
  • Deficiencies in staffing levels in the emergency department and maternity services were impacting on patient care and experience.

EFFECTIVE

  • End of life care and emergency departments were not meeting national audit standards in some areas.
  • Nursing appraisal rates were variable across the trust.
  • The assessment of mental capacity by staff remained inconsistent across the trust.

  • Maternity and gynaecology services were no longer rated as inadequate
  • Policies are now largely up to date and referenced by best practice, with the exception of maternity services.
  • Surgery services are no longer an outlier for clinical outcomes.

CARING

  • All services inspected were rated as good for caring.
  • Data and our observations confirmed the very positive feedback received from patients with respect to the caring nature of staff.

RESPONSIVE

  • The emergency department indicated a deteriorating performance against access standards.
  • The trust was not maintaining the delivery of treatment to patients within 18 weeks of referral from GP's or within 62 days for patients referred onto a cancer pathway.
  • Patient flow through the trust was challenged leading to patients being cared for in suboptimal clinical areas.
  • Patients on an end of life care pathway did not have access to a rapid discharge service.
  • The outpatients service was no longer rated as inadequate with significant improvements to the call centre.
  • The trust was very responsive to meeting the complex needs of patients notably those living with dementia or learning disabilities.

WELL LED

  • No services were rated as inadequate for leadership.
  • The senior leadership was now sighted on operational and strategic issues and had clear and well considered plans for service improvement.
  • The organisational culture had transformed since our last inspection. Staff are now largely positive, well engaged and felt valued by the organisation.
  • Governance had been significantly strengthened in terms of structure and the quality of board papers and data. This had led to a strong sense of accountability within the trust.
  • The senior team remains relatively new in constitution and some elements of governance and performance management had only recently been introduced
  • The trust is yet to complete the transition to a new operational structure.
  • At service levels our inspection identified some weaknesses in the management of risk and mortality.

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

Importantly, the trust must :

  • Ensure that consultant cover meets the minimum requirements of 16 hours per day, as established by the Royal College of Emergency Medicine.

  • Must develop play services in line with national best practice guidance.

In addition the trust should:

  • The surgery directorate should ensure completion of anaesthetic machine logbooks

  • The surgery directorate should ensure compliance with: inadvertent perioperative hypothermia, NICE guidance clinical guideline CG 65.

  • The surgery directorate should ensure accurate record keeping of controlled drugs in theatres.

  • The surgery directorate should improve the quality, content and outcomes of mortality and morbidity meetings.

  • The surgery directorate should ensure compliance with National Patient Safety Alerts regarding safer spinal and epidural needles.

  • The surgery directorate should ensure a consistent governance structure across the two surgical directorates.

  • Review all maternity policies and procedures that are outside their review date and take action to ensure all policies reflect current national and evidence-based guidance.

  • The hospital should discuss and record ceilings of care for patients who have a DNACPR.

  • The trust should have a defined regular audit programme for the end of life care service.

  • The trust should record evidence of discussion of an end of life care patient’s spiritual needs.

  • The trust should implement a formal feedback process to capture bereaved relatives views of delivery of care.

  • The trust should ensure that all staff received regular mandatory training for end of life care.

  • The trust should provide a formal referral criterion for the specialist care team for staff to follow.

  • The trust should define and streamline their end of life care service to ensure staff are clear of their roles and who to contact.

  • Develop a rapid discharge process for end of life care patients to be discharged to their preferred place of death.

  • Extend the Palliative care team service to provide support and advice over the full seven days. As the hospital did not currently have this provision, some patients did not have access to specialist palliative support, for care in the last days of life in all cases.

  • Work towards meeting the requirements of the key performance indicators of the National Care of the Dying Audit (NCDAH) 2016.

  • Continue to consider ways to improve staff recruitment and retention such that it meets the national recommended levels.

  • The trust should ensure incidents occurring in the ED are investigated thoroughly and all staff are included in the dissemination of the outcomes.

  • The trust should ensure nurse to patient ratios in the ED are managed in relation to the individual needs of patients based on acuity.

  • The trust should ensure that RTT is met in accordance with national standards.

  • The trust should ensure that standard for patients receiving their first treatment within 62 days of an urgent GP referral is met.

  • The diagnostic department should ensure all policies and procedures are up to date.

  • The diagnostic imaging department should ensure they have a recent audit from their Radiation Protection Advisor.

  • The diagnostic imaging department should monitor their waiting times and reporting times.

  • The diagnostic imaging department should ensure staff attend mandatory training in line with the trusts target.

  • The maternity services should ensure medication locks are suitable and do not allow unauthorised patient access.

  • The maternity services should ensure there is a clear procedure documented for pool evacuation.

  • The trust should consider improving the environment in the Day Assessment Unit waiting area as flooring could be a trip hazard and the room is unwelcoming.

  • The maternity services should ensure a robust mechanism is in place to monitor and audit abortion HSA4 notification completion.

  • The maternity services should ensure resuscitation trollies are fully stocked with items that are in date, at all times.

  • The maternity services should ensure cleaning schedules are adhered to and audit is appropriately used to monitor this in the obstetric theatres.

  • The children's service should address the lack of storage space and cramped conditions on the Kipling ward.

  • The children's service should develop transition planning for children with long term conditions approaching adulthood.

  • The children's service should improve efficiency of appointment and clinic booking systems to avoid long delays in accessing paediatric review and to improve efficiency.

There is no doubt that substantial improvements have been made since our last inspection. The new leadership has had a significant impact on all areas of the trust and it is clear that morale and engagement of the workforce is now much higher.

However, I recommend that East Sussex Hospitals NHS Trust remains in special measures to provide time for the leadership to fully stabilise, governance to become embedded and the safety issues in the emergency department addressed.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 24, 25, 26 March and 10 April 2015

During an inspection looking at part of the service

East Sussex Healthcare NHS Trust (ESHT) provides acute hospital and community health services for people living in East Sussex and the surrounding areas. The trust serves a population of 525,000 people and is one of the largest organisations in the county. Acute hospital services are provided from Conquest Hospital in Hastings and Eastbourne District General Hospital, both of which have Emergency Departments. Acute children’s services and maternity services are provided at the Conquest Hospital and a midwifery-led birthing service and short-stay children’s assessment units are also provided at Eastbourne District General Hospital.

The trust also provides a minor injury unit service from Crowborough War Memorial Hospital, Lewes Victoria Hospital and Uckfield Community Hospital. A midwifery-led birthing service along with outpatient, rehabilitation and intermediate care services are provided at Crowborough War Memorial Hospital. At both Bexhill Hospital and Uckfield Community Hospital the trust provides outpatients, day surgery, rehabilitation and intermediate care services. Outpatient services and inpatient intermediate care services are provided at Lewes Victoria Hospital and Rye, Winchelsea and District Memorial Hospital. At Firwood House the trust jointly provides, with adult social care, inpatient intermediate care services.

Trust community staff also provide care in patients’ own homes and from a number of clinics and health centres, GP surgeries and schools.

The trust employs almost 7,000 staff and has 706 inpatient beds across its acute and community sites. The trust serves the population of East Sussex which numbers 525,000.

We carried out this unannounced focussed inspection in March 2015. We analysed data we already held about the trust to inform our inspection planning. Teams, which included CQC inspectors and clinical experts, visited the two acute hospitals along with the Crowborough Birthing Centre and reviewed four of the eight core services that we usually inspect as part of our comprehensive inspection methodology. Services reviewed were maternity services, outpatient services, surgery and accident and emergency care; we reviewed these particular core services as in our comprehensive inspection in September 2014, we had identified serious concerns about the care and treatment provided. We spoke with staff of all grades, individually and in groups, who worked in these services. Staff from across the trust attended our drop in sessions on both sites.

In September 2014 we identified concerns about the provision of pharmacy services. We looked at this in our unannounced visits by a CQC pharmacist. A large number of people from the local community and staff had contacted CQC after the previous inspection report was published to tell us it was an accurate reflection of the way the trust provided services.

It is important to note that in the past two years the trust had been through a period of significant change with reconfiguration of some key services across both acute sites. The trust had followed guidance on both consultation and reconfiguration set out by the Secretary of State for Health. The consultation process was led by the local Clinical Commission Groups and has been assessed by an audit of its corporate governance. The assessment of this process by an internal audit company provided assurance to the board and stakeholders that “Corporate governance, in relation to the maternity project specifically, considered to be executed to a high standard and in compliance with the selection of Good Governance Institute outcomes examined”. It also set out that “Structures and decision-making processes clearly set out and followed”. We were aware that the reconfiguration was not universally accepted as a positive change by some members of the public and some staff. Despite the process, many people we spoke to said that they felt their concerns had not been listed to, and they had not been well engaged.

We met with the trust and Trust Development Authority (TDA) representatives on  23 March 2015 to hear about the action they had taken since the comprehensive inspection in September 2014. Details of the action plan were shared with us, with a copy of the draft plan being provided to us on 26 March 2015. Since then the trust has amended and finalised the action plan, making it more robust and focussed.

During this unannounced follow up inspection and in the preceding comprehensive inspection we reviewed clinical services as they are currently configured. Our remit does not include commenting on local decisions about the configuration of services. We have, where pertinent, considered the safety and effectiveness of the services post reconfiguration and whether the trust is responsive to individual and local needs.

Our key findings from the unannounced follow up inspection were as follows:

  • The trust board continues to state they recognise that staff engagement is an area of concern but the evidence we found suggests there is a void between the Board perception and the reality of working at the trust. At senior management and executive level the trust managers spoke entirely positively and said the majority of staff were ‘on board’, blaming just a few dissenters for the negative comments that we received.

  • We found the widespread disconnect between the trust board and its staff persisted. This is reflected in the national NHS Staff survey.

  • The most recent NHS staff survey showed the trust performing badly in most areas. It was below average for 23 of the 29 measures, and in the bottom 20% (worst) for 18 measures.

  • Overall the trust was amongst the bottom 20% of all trusts in England for staff engagement. Only 18% of staff reported good communications between managers and staff against a national average of 30%.

  • The trust was also in the bottom quintile for staff reporting that they had the ability to contribute towards improvement at work.

  • The trust told us they were disappointed by the results; but we saw no direct programme to address this or to change the position.There remained a poor relationship between the board and some key community stakeholders. We found the board lacked a credible strategy for effective engagement to improve relationships.

  • We saw a culture where staff remained afraid to speak out or to share their concerns openly. We heard from several sources about detriment staff had suffered when they raised concerns about patient safety.

  • Staff remained concerned when they contacted us of the risk of doing so.

  • We saw that there remained little public engagement in the wider benefits of the reconfiguration. The trust had followed its original strategy. We saw this had failed to engage significant elements of the community. We saw no new plan to address this issue.

  • We saw that local managers had taken some steps that had resulted in an improved patient experience in the outpatient areas but there remained long delays in the referral to treatment time. The trust had taken steps towards improvement but these were yet to demonstrate a sustainable improvement.

  • Patients were not being seen for follow-up appointments within the timescale requested by their clinician.

  • The call centre for outpatient appointments was not effective. Patients were often unable to make contact with the staff.

  • Clinics were sometimes cancelled, and patients had not been informed, or informed at very short notice. There was a lack of appropriate staff to ring patients; who arrived for their appointment and found the clinic was not being held.

  • Within the trust, we did not see a cycle of improvement and learning based on the outcome of either risk or incidents.

  • Staff remained unconvinced of the benefit of incident reporting, and were therefore not reporting incidents or near misses to the trust. the trust was not able to benefit from any learning from these. this position had not improved.

  • The risk register was not capturing risks in a robust way.

  • We saw a redesign of the governance structure, but were unable to yet see any significant benefits or improvements from this.

  • We saw low staffing levels that impacted on the trusts ability to deliver efficient and effective care.

  • In maternity we saw some small improvements had been made to the governance systems but the major improvements needed to bring about sustainable improvements, such as staffing as yet remained unchanged.

  • We saw that surgical services and outpatients’ services did not report incidents in a way that would lead to the trust improving services from that learning. We saw that in maternity and surgery there had been improvements in incident reporting but learning was still limited and lessons learned were not embedded.

  • We had concerns about the accuracy and robustness of data provided to external stakeholders and the board.

  • Training for safeguarding for medical and nursing staff fell well below acceptable levels.

  • In a number of areas we remained concerned about medicines management and pharmacy services.

  • Checks on controlled drugs were inconsistent in ED, and remained sporadic in surgery, despite a drug register in one area noting an incidence of drugs missing.

  • The trust was breaching the provision of single sex accommodation requirements frequently and regularly but not identifying or reporting these. Women and men were both accommodated overnight in the clinical decisions unit and had to walk past people of the opposite sex to use the lavatories and washing facilities.

  • There was little consideration for affording privacy to people attending the OPD and radiology where patients changing and waiting facilities were unsuitable and where weighing and other procedures were carried out in corridors.

  • The trust healthcare records and records tracking systems remained inadequate.

  • The trust was failing to meet the requirements of the National Schedule for Cleanliness in the NHS. Scores from cleanliness audits provided by the trust did not match the aggregated scored from the cleanliness audits we were provided with.

  • Staff we spoke with were unaware of their responsibilities regarding the Duty of Candour. Staff we spoke to had not received training on the statutory Duty of Candour (a legal duty to be open and honest with patients or their families when things go wrong that can cause harm) and were therefore unable to describe the processes the trust had in place.

  • The trust does receive a higher than average number of complaints for its size although numbers of complaints have fallen over the last two years.  We found a complaints system that gave both poor support for people who wished to raise a concern, and concerns on how the trust handled complaints.

We identified some good practice including

  • The telephone triage system provided a high standard of information, guidance and support to women, without them necessarily needing to come into hospital.

There were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Give full consideration to whether there have been any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 5 (3)(d) Fit and proper persons: directors
  • The board needs to give serious consideration to how it is going to rebuild effective relationships with its staff, the public and other key stakeholders. This was a requirement following our inspection in September 2014 but we are not yet assured from the action plan and speaking with the lead executive officer that this had begun to be addressed.

  • The board needs to create an organisational culture which is grounded in openness, where people feel able to speak out without fear of reprisal. This was a requirement following our inspection in September 2014 but we are not yet assured that this work was underway.

  • Undertake a root and branch review across the organisation to address the perceptions of a bullying culture, as required in our previous inspection report.

  • Review and improve the trust’s pharmacy service and management of medicines.

  • Review the reconfiguration of outpatients’ services to ensure that it meets the needs of those patients using the service.

  • Review the waiting time for outpatients’ appointments such that they meet the governments RTT waiting times, and that this is sustainable. 

  • Ensure that health records are available and that patient data is confidentially managed.

  • Review staff deployment in maternity services to ensure that they are sufficient for service provision such that the organisation meets the recommendations made by the Royal Colleges. This was a requirement following our inspection on September 2014 but we are not yet assured from the action plan and data provided by the trust that this has been fully addressed.

  • Reduce the proportion of OPD clinics that are cancelled at short notice and develop systems to ensure that where this is unavoidable, that patients are informed in a timely manner.

  • Develop achievable succession planning to minimise the impact of staff movements.

  • Improve the governance of incident reporting systems to ensure that the number of incidents reported via the electronic system reflects all the incidents that happen.

  • Ensure sustained compliance with the National Schedule for Cleanliness.

Additionally the trust should

  • Ensure that fridges used for the storage of medicines are kept locked and are not accessible to people and that medicines are secured in lockable units.

  • Develop sustainable systems to ensure equipment checks are carried out as required by trust policy and national guidance.

  • Develop sustainable systems to ensure that VTE assessments and management are conducted in accordance with the guidance from the Royal Colleges.

Subsequent to this inspection visit a warning notice served under Section 29a of the Health and Social Care Act 2008. This warning notice informed the trust that the Care Quality Commission had formed the view that the quality of health care provided by East Sussex Healthcare NHS Trust requires significant improvement:

On the basis of this inspection, I have recommended that the trust be

placed into special measures.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 9–12 September 2014

During a routine inspection

East Sussex Healthcare NHS Trust (ESHT) provides acute hospital and community health services for people living in East Sussex and the surrounding areas. The trust serves a population of 525,000 people and is one of the largest organisations in the county. Acute hospital services are provided from Conquest Hospital in Hastings and Eastbourne District General Hospital, both of which have Emergency Departments. Acute children’s services and maternity services are provided at the Conquest Hospital and a midwifery-led birthing service and short-stay children’s assessment units are also provided at Eastbourne District General Hospital.

The trust provides a minor injury unit service from Crowborough War Memorial Hospital, Lewes Victoria Hospital and Uckfield Community Hospital. A midwifery-led birthing service along with outpatient, rehabilitation and intermediate care services are provided at Crowborough War Memorial Hospital. At both Bexhill Hospital and Uckfield Community Hospital the trust provides outpatients, day surgery, rehabilitation and intermediate care services. Outpatient services and inpatient intermediate care services are provided at Lewes Victoria Hospital and Rye, Winchelsea and District Memorial Hospital. At Firwood House the trust jointly provides, with Adult Social Care, inpatient intermediate care services.

Trust community staff also provide care in patients’ own homes and from a number of clinics and health centres, GP surgeries and schools.

The trust employs almost 7,000 staff and has 820 inpatient beds across its acute and community sites. The trust serves the population of East Sussex which numbers 525,000.

We carried out this comprehensive inspection in September 2014. We held two public listening events in the week preceding the inspection visit, met with individuals and groups of local people and analysed data we already held about the trust to inform our inspection planning. Teams, which included CQC inspectors and clinical experts, visited the two acute hospitals, community hospitals and midwifery led centres and teams working in the community. We spoke with staff of all grades, individually and in groups, who worked in acute and community settings. We also carried out two unannounced inspection visits after the announced visit.

We received concerns about the provision of pharmacy services. We looked at this in our unannounced visits using a team of CQC pharmacists. As the issues identified are across the whole hospital (rather than within one core service), we have included our findings on pharmacy as a trust wide service in the provider report.

In consultation and with the support of the Clinical Commissioning Groups who commission their services and the Health Overview and Scrutiny Committee of East Sussex County Council, the trust had recently made permanent what had previously been a temporary reconfiguration of services. The temporary reconfiguration had been in response to safety concerns. In July 2013 a group of consultant obstetricians working in both hospitals had raised concerns about the safety of maternity services. The reconfiguration moved consultant led maternity services from the Eastbourne District General Hospital site to a single consultant-led unit at the Conquest Hospital. Eastbourne District General Hospital retained a small midwifery-led unit. As a consequence of moving maternity services, gynaecology and children’s services also had to be moved to the single site provision. There is much local opposition to the changes and concern about maternal and child safety within the Eastbourne population. Additionally, some surgical services (including trauma and orthopaedic services) are now also centralised at the Conquest Hospital. The additional travel costs and times between the two hospitals has also been a concern for local people. There was some reconfiguration of other services but we heard less about these from local people.

The trust had followed guidance on both consultation and reconfiguration set out by the Secretary of State for Health. The consultation process was led by the local Clinical Commission Groups and has been assessed by an audit of its corporate governance. The assessment of this process by internal audit company provided assurance to the board and stakeholders that “Corporate governance, in relation to the maternity project specifically, considered to be executed to a high standard and in compliance with the selection of Good Governance Institute outcomes examined”. It also set out that “Structures and decision-making processes clearly set out and followed”.

We inspected the clinical services as they are currently configured our remit does not include commenting on local decisions about the configuration of services. We have, where pertinent, considered the safety and effectiveness of the services post reconfiguration and whether the trust is responsive to individual and local needs.

Our key findings were as follows:

  • The trust board recognises that staff engagement is an area of concern. Despite this we found a disconnect between the trust board and its staff.
  • We saw a culture where staff were afraid to speak out or to share their concerns openly.
  • We found that management of outpatients’ reconfiguration has led to service deterioration and a failure to respond to the needs of people using the service.
  • We saw that waiting times in outpatients were excessive and did not meet government targets.
  • We saw that surgical services and outpatients’ services did not report incidents in a way that would lead to the trust improving services from that learning.
  • In a number of areas; we were concerned about medicines management and pharmacy services.
  • The trust board had taken steps to secure stakeholder engagement in the development of its plans and has worked in partnership with commissioners to ensure stakeholders have been engaged in the consultations on service reconfiguration.
  • Despite this work there remained a poor relationship between the board and some key stakeholders. This has led some of the public to lose confidence that the service configuration meets their needs. A much higher than expected number of people attended the listening event and contacted us with their concerns.

We saw several areas of outstanding practice including:

  • Clinical leadership and consultant presence in critical care.
  • Introduction of a handheld electronic system for recording patients’ observations
  • Nurse-led discharge.

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

Importantly, the trust must:

  • Rebuild the relationship with its staff grounded in openness, developing a culture of the organisation with regard to people feeling able to speak out.
  • Undertake a root and branch review across the organisation to address the perceptions of a bullying culture.
  • Improve relationships with stakeholders and the population it serves; specifically relating to their concerns about service configuration.
  • Review and improve the trust’s pharmacy service and management of medicines.
  • Review the reconfiguration of outpatients’ services to ensure that it meets the needs of those patients using the service.
  • Review the length of waiting time for outpatients’ appointments such that they meet the governments RTT waiting times.
  • Ensure that health records are available and that patient data is confidentially managed.
  • Review staffing levels to ensure that they are sufficient for service provision.

Professor Sir Mike Richards

Chief Inspector of Hospitals

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.