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Hinchingbrooke Health Care NHS TrustCQC report

October 2015

Inspection Chair: Helen CoeTeam Leader: Fiona Allinson

Quality Summit2 February 2016

CQC Inspection: 20-21October 2015

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• The trust is a medium sized acute trust with 304 beds, 38,831 A&E attendances and 93,000 outpatient attendances pa

• The trust offers a range of hospital-based medical, surgical, obstetric and gynaecological services to the people of North Peterborough, Cambridge and surrounding areas.

• The trust was the only privately managed NHS trust in the country, being managed by Circle since 2012. However the trust returned to a traditional management model in April 2015.

• The trust has one main site - Hinchingbrooke Hospital.

CQC Inspection: 20-21October 2015

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• The inspection covered

• Hinchingbrooke Hospital

• The inspection covered: Urgent and Emergency Care, Medical Care, Surgical Care and End of life Care.

• The trust had been inspected in 2014 and was subsequently placed in special measures following this inspection.

The CQC’s new approach (1)

• 3 Phases: Pre-inspectionInspectionReport and Quality Summit

• Pre-inspection: Planning inspectionDevelopment of a data packsRecruitment of inspection team

• Inspection: Covered Hinchingbrooke Hospital2 days and three unannounced visits

20 team membersListening event, interviewsand visits to clinical areas

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Inspection Process

CQC’s 5 key questions

Safe? Are people protected from abuse and avoidable harm?

Effective? Does people’s care and treatment achieve good outcomes and promote a good quality of life, and is it evidence-based where possible?

Caring? Do staff involve and treat people with compassion, kindness, dignity and respect?

Responsive? Are services organised so that they meet people’s needs?

Well-led? Does the leadership, management and governance of the organisation assure the delivery of high-quality patient-centred care, support learning and innovation and promote an open and fair culture?

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Ratings

• CQC has been tasked with rating all acute trusts by March 2016 as

Outstanding

Good

Requires Improvement

Inadequate

• We are taking a ‘bottom up’ approach – rating each domain (e.g. safe, effective, caring …) for each service (A&E, medicine etc.) at each location

• We believe this will be of greatest assistance both to patients/public and to providers and other stakeholders

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Inspection Findings• Due to the structural management changes that had

occurred over the past six months we found a service in transition. New systems and process were in place but these had yet to be embedded.

• Staff were caring and compassionate in their care of patients.

• The emergency services required significant improvement to ensure patients were protected from avoidable harm.

• Services for patients at the end of their lives required improvement to ensure that patients received a safe, effective and responsive service that was well led.

Hinchingbrooke Hospital: Ratings Grid 2015 v 2014

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Safe Effective Caring Responsive Well-led Overall

Urgent & emergency services Inadequate Requires

improvement Good Requires

improvement Inadequate

Inadequate

Medical care Requires improvement

Requires improvement Good

Good Requires improvement

Requires improvement

Surgery Requires improvement Good Good

Good Requires improvement

Requires improvement

Critical care Good Good Good Good Good

Good

Maternity & Gynaecology Good Good Good

Good Good

Good

End of life care Requires improvement

Requires improvement Good

Requires improvement

Requires improvement

Requires improvement

Outpatients &Diagnostic Imaging

Good Inspected but not rated1 Good

Good Good

Good

Overall Requires improvement

Requires improvement Good

Requires improvement

Requires improvement Requires

improvement

A&EGood practice

• Good multidisciplinary working

• There was evidenced learning from incidents with detail shared amongst staff through meetings.

• Staff were knowledgeable about what constitutes a safeguarding concern, how to recognise abuse and how they would escalate such concerns appropriately.

• Medicines management was much improved since the last inspection.

• Children's services had improved.

• Positive interactions between staff and patients.

Recommendations

•There were concerns regarding cleanliness of the department, cubicles, isolation of infectious patients and hand hygiene techniques.

• Monitoring of equipment.

• The care and risk assessment of patients with mental health concerns.

•Formal risk assessments not always undertaken.

•Adherence to national guidance required improvement.

MedicineGood practice

• Caring and compassionate staff.

•Pain relief administered in a timely manner.

•Positive NHS Friends and Family test responses.

•Generally positive RTT.

•Individual needs of patients met especially in dementia care.

•Staff positive about recent changes.

Recommendations

• Learning from incidents not consistently shared across wards.

•No formal morbidity and mortality meetings.

•Some poor infection control practices.

•Risk assessments were not always updated to reflect changing needs of patients.

•Local audits and learning from national audits not always undertaken.

•Staff knowledge of MCA inconsistent.

SurgeryGood practice

•Staff treated patients with dignity and respect and displayed compassion and kindness towards patients and relatives.

•There were up to date policies and procedures in place to ensure adherence to national guidance and participated in national audits to monitor performance.

•Use of a safety huddle to ensure patient safety.

•Records reflected the patients needs and care given.

Recommendations

•Governance framework requires embedding.

•Staffing levels in both nursing and medicine were not always sufficient to meet the needs of patients.

•Consistency of Consultant attendance at ward rounds.

•Inconsistent formal morbidity and mortality meetings.

•Medicines management issues.

End of Life CareGood practice

•Focus on patient care

•Excellent multidisciplinary working

•Patients were treated with compassion, dignity and respect

•Patients and relatives felt involved in their care

•Excellent chaplaincy service for patients relatives and staff.

•Improved training for general staff in having difficult discussions.

•Increase in availability over seven days.

Recommendations

•Lack of resources to provide training to staff

•DNACPR form completion required improvement to ensure consultant sign off and rationale for not discussing issue with patients.

•Risks not on the risk register.

•Some delays in responding to patient need.

•Incident reporting not consistent and lessons were not always identified.

•Pace of progress slow.

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Hinchingbrooke Health Care NHS Trust Ratings Grid 2015 v 2014

Safe Effective Caring Responsive Well-led Overall

Overall trust Inadequate Requires improvement Inadequate

Requires improvement

Inadequate

Inadequate

• We found a trust that was in the process of undergoing significant transformation. A number of new initiatives, governance structure and management processes had been undertaken. However these were yet to be embedded.

• A senior management team who were cohesive and were aware of the challenges they face.

• A senior team who were open and receptive to the inspection findings.

Overall Requires improvement

Requires improvement Good

Requires improvement

Requires improvement

Requires improvement

Any Questions?

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