In June 2014, the Care Quality Commission (the “CQC”) rated the Isle of Wight NHS Trust, the Trust responsible for St Mary’s Hospital along with other services, as “requires improvement”.
A further inspection in November 2016 rated the Trust as “inadequate” following which, the CQC urgently imposed conditions on the Trust’s registration in relation to mental health services.
In April 2017, the Trust was placed in special measures by the CQC.
The CQC recently carried out a further inspection and although some improvements were noted, the Trust was again rated inadequate. The CQC has said the Trust must make further “significant improvements” as there were still “significant concerns” about patient safety.
Some of the key criticisms the CQC listed in relation to patient safety at St Mary’s Hospital include:
- Safety systems were not fit for purpose, or were not implemented sufficiently, across many services. In surgical services, medical staff were not sufficiently engaged in the safety checks in surgery. Staff did not always assess and manage risks to patients appropriately, to keep them safe from avoidable harm.
- There was an overall low rate of compliance with mandatory training. Not all staff had completed appropriate safeguarding training. Staff did not always recognise or report serious incidents.
- There were insufficient provision for infection prevention and control trust wide, and staff did not always follow best practice to keep patients safe.
- There were substantial staff shortages across services and gaps in rotas could not always be filled. There was a reliance on locum doctors and agency nurses, who were often poorly managed and disengaged.
- There were a range of different patient records systems, which did not communicate, and in some services these were not fit for purpose. Patient records were not always completed fully or correctly.
- There was limited measuring and monitoring of safety performance. Safety information was not shared with staff and patients.
- Medicines were not always managed and stored safely across services.
- Some services did not have consistently suitable premises and equipment.
- Care assessments did not fully consider the range of patient needs.
- There were gaps in competency assessment, appraisal, training and supervision of staff.
- Patients could not always access services when they needed and this was of particular concern for patients in mental health crisis.
- Patients were not discharged from services in a timely and responsive way to meet their needs. It was found that delayed discharges led to waits and crowding in the emergency department and wards.
- Community services were rated as “inadequate”.
- Ambulance services required improvement.
- Response times to complaints continued to be slow and complaints/concerns were rarely used to improve the quality of care.
The CQC found that there were signs of recovery since the inspection in November 2016 in the leadership of the Trust. However, this recovery was starting from a very low base and, despite some elements of outstanding leadership from the senior team, this was not yet enough to change the overall rating for leadership from “inadequate”.
The CQC has told the Trust that they must take certain action and also made various recommendations that the Trust should implement.
The CQC has told the Trust that it must take action to bring services into line with legal requirements and their detailed and lengthy report contains an extensive number of action points to be completed.
Some of the action points that must be followed by the Trust are:
- Ensure there is competency-based recruitment to leadership posts and that a leadership development programme is implemented.
- Ensure urgent improvements are made to their Human Resources process, including recruitment and management of performance.
- Ensure the Code of Practice for prevention and control of infection is followed at all levels and services of the Trust.
- Ensure there is improved clinical engagement and leadership across all services.
- Ensure Mental Health Act administration and governance is improved, that all staff are trained and compliance is monitored by the Board.
- Ensure that there are arrangements in place for identifying, assessing, managing and effectively escalating risk at all levels.
- Ensure that records systems are fit for purpose.
- Ensure there are sufficient numbers of suitably qualified, competent, skilled and experienced nurses to meet the needs of the patients in the Emergency Department.
- Ensure there are complete, accurate and contemporaneous records for each patient in the Emergency Department.
- Ensure that crowding is reduced so that patients do not have to wait on trolleys in the corridor in the major treatment area.
- Arrangements must be in place for the safe management of the birthing pool on the maternity suite, to include risk assessments and all necessary equipment for the safe removal of women and babies in an emergency.
- Must ensure there is improved partnership working which leads to improvements in end of life care across the hospital and community.
- Ensure that complaints are investigated and staff receive information on lessons learned.
The CQC has said they will check that the Trust takes the necessary action to improve its services. They will continue to monitor the safety and quality of services through regular inspections.
Professor Ted Baker, the Chief Inspector of Hospitals, said:
“While we have seen sufficient progress to remove restrictions on some mental health services – we still need to see further improvement in community mental health services. There are some areas where we still have significant concerns about patient safety. The Trust will remain in special measures until we see signs of sustainable improvement across the services provided by the Trust.”
Maggie Oldham, the recently appointed Chief Executive of Isle of Wight NHS Trust, commented:
“Although the Trust remains rated as ‘inadequate’ overall, the CQC identified a number of areas of progress, including several examples of outstanding practice.…However, the fact remains we have not improved our overall rating from ‘inadequate’ and we are under no illusions we still have a lot of hard work ahead of us to turn things around.”
It appears that the Trust has taken steps in the right direction, although major improvements are still required. It is worrying that until improvements are made, patient safety remains at risk. It is hoped that the Trust will take the required steps as soon as possible.
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