January 20, 2018

"The people of Cornwall are entitled to a better service" – Damning CQC report at RCHT that STILL 'requires improvement'

Royal Cornwall Hospital Trust still ‘requires improvement’ according to a CQC inspection report released today.


Overall summary & rating

Requires improvement

Inspection areas

Safe

Requires improvement

Effective

Requires improvement

Caring

Good

Responsive

Requires improvement

Well-led

Requires improvement

This is no improvement on the same rating given to the hospital trust back in 2014 with the Chief Inspector reporting that there has been ‘little sign of improvement’. He raised doubts as to to whether the managers had the capacity and wherewithal  to turn things round.

Chief inspector Sir Mike Richards, said: “The people of Cornwall are entitled to a better service. Such are my concerns that we will be returning to the trust in July to carry out a full inspection of all core services. We will decide then what further action we must take to ensure that services improve.”

He said the lack of progress “raised questions about the capacity of the trust leadership team” and there was evidence that a “prolonged period of instability at board level” had affected patient care and staff morale.

The Trust serves a population of around 450,000 people, a figure that can be doubled by holidaymakers during the busiest times of the year.

The CQC held an unannounced inspection in January and checked services at Treliske, St Micheal’s (Hayle) and West Cornwall Hospitals (PZ).

“This is the second comprehensive inspection we have carried out at Royal Cornwall Hospital NHS Trust” says the report . “The first being in January 2014 when the Trust was rated as requires improvement. In June 2015 we carried out a follow up to the first inspection and found the trust had not made sufficient progress in urgent and emergency services, medical care and surgery. At this time we issued the trust with a section 29A warning notice in regard to concerns around staffing in the emergency department and the high care bay on Wellington ward. . Due to the lack of sufficient progress in all areas since January 2014, we decided that a second comprehensive inspection was required”

Kathy Byrne, Chief Executive of the RCHT responded to report by saying the inspectors had come on particularly busy days..

“We have an opportunity with the full CQC inspection in July to demonstrate the action we have taken to improve and to provide the evidence that our care is safe and effective” she said in a statement

“The unannounced inspection in January took place on two of the most difficult days for our services with demand throughout the Trust at the most extreme levels but it is right that we confront the issues raised in this report.

“I am pleased that our urgent and emergency care service has improved their CQC ratings and shown their professionalism under pressure. Other parts of the report are disappointing reading and does not reflect well on our general medical service who I know to be dedicated and caring.
“Since the January CQC inspection, we have made measurable improvement in areas such as emergency care, sepsis, mortality and stroke and we are committed to sustaining that progress.”

Overall the trust was rated as requires improvement, with Royal Cornwall Hospital rated as requires improvement, West Cornwall Hospital as good and St Michael’s Hospital as good.

The CQC wrote to the trust shortly after the inspection asking them to send action plans for some of the concerns found.

Chief Inspector Sir Mike Richards said: “The people of Cornwall are entitled to a better service. Such are my concerns that we will be returning to the trust in July to carry out a full inspection of all core services. We will decide then what further action we must take to ensure that services improve.”

He said the lack of progress in addressing the issues in their previous report “raised questions about the capacity of the trust leadership team” and there was evidence that a “prolonged period of instability at board level” had affected patient care and staff morale.

Some areas of concern were:

  • Instability in board level management – (eg Former chairman Jon Andrewes was jailed in March for lying about his qualifications!)
  • Nursing staff levels remained a challenge for the trust in particular areas of medicine, surgery, theatres, and the trust continued to use a high level of bank and agency staff to maintain planned staffing levels
  • Bed capacity and patient flow were constant challenges within the trust and the impact was often felt in the emergency department who were unable to meet the standards for seeing and admitting patients due to a lack of bed availability.
  • Patients did not always receive care and treatment in the most appropriate clinical setting. This meant inequitable standards of care were provided, with some patients having to wait longer for specialist support.
  • Ongoing delays for cardiology patients,
  • Lack of robust recording of patient early waring scores leading to delays in escalating concerns to a doctor
  • The continued situation of only 51% of stroke patients spending 90% of their time on the stroke unit (the contracted target was 92%).

     

They did point out some examples of ‘outstanding’ practice by staff including

  • Kerensa ward had been appropriately designed to provide a safe and suitable environment for patients living with dementia.
  • Surgical services had a compassionate and caring approach to people with a learning disability. There was a team of experienced staff to support people with different needs, and an innovative approach to meeting their needs, which included carrying out procedures at home if this was safe.
  • At West Cornwall Hospital staff went the extra mile by providing a ‘memory café’ in the day room on a weekly basis.
  • The interventional radiology team had won an innovation award for their success with the vascular access service.
  • The medical simulation training program training provided to obstetrics and gynaecology services (and other specialties) was outstanding
  • There was an outstanding example of individualised and multi-professional care for a patient who had been in the unit for 10 months. The critical care team, the ambulance crew, the family and community teams were all instrumental in enabling the patient to go home safely. A member of the team arranged what was described as a “huge meeting with all the people who needed to be there to formalise [the patient’s] discharge.”
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