Inspectors lift hospital rating to ‘good’ overall
A HOSPITAL trust has moved from ‘requires improvement’ to being rated ‘good’ overall following inspections that revealed a turnaround in its performance.
The South Tees Hospitals NHS Foundation Trust had been handed a warning notice by the Care Quality Commission (CQC) last year and ordered to make immediate improvements amid concerns that included patients not always being safely discharged and having enough to eat and drink, something since addressed.
A detailed action plan had been put in place by trust bosses to address a number of regulatory breaches dating back to July 2019 since when the majority of the executive team has changed.
The CQC returned in November last year and also in January to examine critical care services and urgent and emergency care at Middlesbrough’s James Cook University Hospital, along with medical wards at James Cook and Northallerton’s the Friarage Hospital, and how well the trust was being managed overall.
The CQC said the trust, which employs about 9,000 staff and provides services for more than 1.5 million people, could now be rated good in each of five categories covering how safe, effective, caring, responsive and well-led it was, whereas each of these previously required improvement.
However, in terms of individual services inspected, urgent and emergency services at James Cook were moved down from good to requires improvement when it came to their responsiveness. Medical care at both hospitals was again rated as requiring improvement.
The CQC said overall there had been enough improvement to meet the requirements of the warning
notice issued in February last year and for this to be removed.
It said: “In the core services inspected, we found that morale was not perfect, but significantly improved. In every observed interaction, staff were kind to each other, and their patients.”
Inspectors found that bosses ran services well, understood the issues faced and made plans to tackle them, and were visible and approachable. Leaders and teams identified and escalated relevant risks and issues and took actions to reduce their impact, and had plans to cope with unexpected events.
Staff felt respected, supported and valued, and were focused on the needs of people using services and there was an “open culture” where patients, their families and staff could raise concerns without fear.
Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the organisation.
But in terms of medical care there was not always enough nursing staff to care for people and keep them safe, which was deemed to be an issue in terms of surgery at the Friarage and general medical, including older people’s care, and surgery at James Cook.
There was also no clear flagging system for risks associated with people experiencing mental health crises and people couldn’t always access services when they needed it.
Meanwhile, “ongoing challenges with access and flow” in the accident and emergency department at James Cook meant people did not always access the right care promptly. In December last year only 60.2% of patients were seen within the Government’s four hour wait A&E standard with the number of people attending that month – 10,981 – a new record. Timely discharges into social care have added to the problem, although various A&E statistics have shown improvements since the end of last year.
The CQC said despite the pressures, staff worked hard to keep people safe and highlighted the success of a pilot scheme introduced in January last year working with frail patients in a bid to avoid them being admitted to hospital altogether. The department had also been proactive in trying to address extended waiting times for patients and had introduced new roles to try to optimise access and flow.
The CQC noted how while the trust provided mandatory training in key skills, compliance was below the trust’s own target. A separate concern was aired regarding substances hazardous to health, which were not always stored securely in areas where there were vulnerable people. Both these elements were expressed in a list of ‘must do’ actions for the trust.
Other must-dos included considering ways to ensure optimal nurse staffing levels, making sure staff used systems and processes to safely prescribe, administer and record medicines in line with trust policy and, in terms of surgery, ensuring pain relief is given to patients when they need it with no delays.
Sarah Dronsfield, CQC deputy director of operations in the North, said: “When we returned to South Tees, we found an effective leadership team who had made significant and widespread improvements since our last inspection.”
She added: “However, there are pockets of improvements that still need to be made, particularly around making sure all staff are completing mandatory training to have the skills to keep people safe and provide effective care.
“The trust has worked hard to improve the quality and safety of services they are providing to people and other organisations should look at this report as an example of how to deliver high standards of care.”
The trust said it had become one of the first acute hospital trusts in England since the start of the pandemic to achieve a rating increase from the CQC.
The trust recently confirmed a formal group partnership with its counterparts at the North Tees and Hartlepool NHS Foundation Trust, which aims to further improve health services and aid with the recruitment and retention of special doctors and nurses, although it has been at pains to stress it will not amount to a full-blown merger.
Chief executive Sue Page said the organisation would not rest on its laurels and recognised there was more work to do. She said: “I am incredibly proud of all our staff.
“This achievement is a testament to their dedication and hard work. It has been a team effort and I am honoured to lead such a fantastic group of teams and individuals.”
The trust has worked hard to improve the quality and safety of services they provide.
Sarah Dronsfield