The Chief Inspector of Hospitals has recommended that Royal Cornwall Hospitals NHS Trust should be placed into special measures after its latest inspection by the Care Quality Commission.
The Royal Cornwall Hospital at Treliske has been rated Inadequate overall – with surgery, maternity and gynaecology, end of life and outpatient services also rated as Inadequate. Critical care and children and young people’s services have been rated as Good.
Services provided at St Michaels Hospital, Hayle, and West Cornwall Hospital, Penzance were rated Good. The Penrice Birthing Centre at St Austell has been rated Requires Improvement. Overall the trust has been rated Inadequate for being safe, responsive and well led, although Good for caring. Full ratings for all core services have been published on CQC website.
At the time of the inspection in July the trust was asked to make a number of immediate improvements to manage the risks to patients in maternity and the paediatric emergency department, and outpatients awaiting treatment for cardiology and ophthalmology. CQC also issued a Warning Notice requiring the trust to make significant improvements to the quality and safety of care by 30 November 2017.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“The people of Cornwall are entitled to services which provide safe, effective, compassionate and high quality care.”
“During this inspection and in our previous visits to the Royal Cornwall Hospital we have found persistent evidence of care that falls below those standards. As a result patients have been let down – and some have been placed at risk.”
“It is clear that these are not isolated lapses. I am concerned that the management systems to assess, monitor, and deal with risks to patients have not been operating effectively and the Board has not had the oversight that is required.”
“Throughout our inspections, we have invariably found the staff to be caring and compassionate. Despite their best efforts Royal Cornwall Hospitals has a history of poor performance, with a failure to make improvements over a number of years. The time has now come to bring in external support – which is why I am recommending that the trust goes into special measures.”
“I recognise that there over the last few years there have been periods of instability at Board and executive level; it is only now that the trust has a full complement of board directors in post. I note that they have the support of the staff. There is a lot of work ahead of them to address the issues that have not always been dealt with in the past.”
“I am determined that we will continue to monitor the trust’s progress, in partnership with NHS Improvement and NHS England and in due course we will return to check that the improvements have been made.“
Inspectors found that the hospital was struggling to deal with the flow of patients. Some medical patients were accommodated on unsuitable wards, and too many operations were cancelled or delayed because theatres were not managed effectively.
In surgery, safety was not a sufficient priority. There was limited measurement and monitoring of safety performance. There were significant numbers of serious incidents and never events.
At the time of the inspection, CQC required the trust to take immediate action to protect the safety of women in maternity whose condition was at risk of deteriorating. There were not enough midwives deployed to provide a safe service in all areas at all times. There was no dedicated high dependency area for deteriorating women and no process to ensure that there was always a trained nurse or midwife on duty to manage women in need of high dependency care.
In end of life care, the specialist palliative care team was too small to meet national guidance. It was only able to provide a five day a week service, and even this stretched the capacity of the team.
In outpatients and diagnostic imaging, appointment waiting lists were too long and patients were coming to harm through delays in treatment. The impact of waiting longer on individual patients was not being assessed well enough and there were no clear plans to manage and reduce the backlogs. At the time of the inspection, the trust was asked to put in place steps to monitor cardiology and ophthalmology patients who were waiting for treatment.
The hospital’s critical care and children and young people’s services were rated as Good. Inspectors found that children and young people were at the centre of the service and the priority for staff. Innovation, high performance and the high quality of care were encouraged and acknowledged. Children, young people and their families were respected and valued as individuals. Feedback from those who used the service had been consistently positive.
The critical care service had a good track record on safety. Staff were aware of their responsibility to report incidents and the electronic reporting system had been improved. Staffing levels had been increased since the last inspection with less reliance on agency staff, although more doctors were needed to improve consultant presence.
A team of inspectors including specialist advisors from other healthcare organisations visited the Royal Cornwall Hospital at Treliske, St Michaels Hospital, Hayle, West Cornwall hospital, Penzance and the Penrice birthing unit, St Austell.
Kathy Byrne, RCHT Chief Executive, responded to the Care Quality Commission’s reports on Royal Cornwall Hospitals NHS Trust by saying:
“Good, safe care is the number one priority for Royal Cornwall Hospitals NHS Trust and we are responding swiftly and effectively to every one of the CQC recommendations.
“We take the CQC report very seriously and I want to apologise to any patient who has waited too long for treatment or not received the very best care.
“We have now established a stable senior leadership team and we want good clinical leadership to be at the heart of our quality improvement programme.
“Everyone who works in our hospitals is committed to making the changes our local community and regulators want to see.
“We thank patients for their continued support for our caring and dedicated staff, which has been rightly recognised by the CQC.”
• In a separate report that is published today, the Care Quality Commission has called on leaders of the organisations that oversee the provision of health and social care in Cornwall to join forces and work together to ensure that people get the services they need as they move through the system.
The review focused on how different parts of the health and social care system work together. It found poorly coordinated processes that meant the experiences of people moving between hospitals, social care and their own homes was not good enough and that the services need to make urgent and significant change to improve.
Professor Baker said:
“Our report has identified that the health and social care system in Cornwall is not working well together. The experience for patients who need to leave hospital but require ongoing care is poor.
“It is more important than ever that local authorities, acute, community and primary medical services NHS colleagues work together in mature, purposeful and trusting relationships.
“If they can achieve that – there is every chance that the communities those organisations serve will be provided with good quality care. And that’s vital for all those people living with long term conditions who may need to move between health and care services as their needs change.”
Kathy Byrne, RCHT Chief Executive, reacted:
“The Care Quality Commission review of the wider health and social care system in Cornwall echoes the message that our local leaders have been giving through the Shaping Our Future programme.
“We fully recognise that the current health and social care system needs reform and we have been working hard to find ways to provide a more integrated service between health and social care, between providers and with the voluntary sector. We must find the way to put more resources into preventing ill health and caring for people in their homes or communities, avoiding the need for admission to hospital wherever possible.
“Preparing for this winter, we are working together more closely than ever before, making changes and investment to improve the care we provide. We are united in our view that we need to go further and faster to bring our health and care system closer together with the citizen at the centre. By April 2018, we plan to jointly establish an Accountable Care System that brings services together in a way that can make a real difference to people’s care and more reliably meets the changing needs of our community over the years to come.”