Hereford County Hospital was rated as ‘Inadequate’ whereas Wye Valley Community Health Services were rated as ‘Requires Improvement’ under the new inspection regime, introduced by the Care Quality Commission, to provide a much more detailed picture of care in hospitals than ever before.
Inspectors found a number of improvements were needed in the trust’s services.
The trust was judged as ‘Inadequate’ with regard to whether services were safe, well-led and responsive. It was rated as ‘Requires Improvement’ for whether services were effective and ‘Good’ with regard to whether services were caring.
Full copies of the reports relating to the trust can be found on the CQC website here.
An inspection team, including doctors, nurses, midwives, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent four days at the hospitals in June.
This included an unannounced inspection on 19 June which followed three consecutive days of inspection from 3 June, which had been announced.
Wye Valley NHS Trust was selected for inspection, under CQC’s new inspection approach, because it was a high priority trust based on CQCs intelligent monitoring and local concerns.
The inspection highlighted a number of concerns and CQC has told the trust it must improve. Areas for improvement include:
- That the trust continues to improve mortality rates.
- That action is taken to improve the flow of patients into, through and from the trust and that patient reviews are undertaken in a timely manner.
- The trust was failing to meet the four-hour target for patients attending A&E. There were instances when patients remained on a trolley for 12 hours.
- All environments needed to support the privacy and dignity of patients.
- Patients must have access and support, if required, to appropriate foods and fluids.
- Staff must be able to report incidents, feel confident to do so and, where appropriate, any lessons learned, needed to be disseminated across the trust. Any risks also needed to be recorded, escalated and acted on.
- Improvements were needed with regard to discharge planning and arrangements, so that people were able to leave hospital when ready.
- Medicines must be managed in line with the trust’s medication policy.
- Forms for recording ‘do not attempt cardiopulmonary resuscitation’ (DNAR) must be completed in line with trust policy.
- Improvements were needed in end of life care at both the hospital and in the community.
- Systems for mandatory training and training of staff need to be improved so the trust can assure itself staff have the necessary skills to effectively care for patients.
Inspectors found examples of outstanding practice at the trust, including:
- Dedicated and committed staff who would go above and beyond the call of duty for patients.
- Established schemes – such as ‘virtual wards’ and ‘hospital at home’ – which prevent patients having to come into hospital and promote timely and effective discharges.
- Excellent preoperative assessments, which included public health initiatives.
- A midwifery academy, which had been developed to aid recruitment and promote retention among new and existing midwifery staff.
CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Our inspection at Wye Valley NHS Trust highlighted a number of concerns, in particular surrounding the accident and emergency department and medical care. There were a number of other areas where the trust also needed to make improvements and the trust has been given an overall rating of ‘Inadequate’.
“I have made a recommendation to the Trust Development Authority (TDA) that the trust is placed in to special measures and we have informed the TDA of the breaches. The TDA will make sure these are appropriately addressed and that progress is monitored through the special measures action plan.
“Inspectors found some examples of outstanding practice and staff at the trust were seen to be caring, but changes are necessary and the trust faces a number of challenges to ensure it meets the required standards.
“We have told the trust where it needs to be and it is aware of what action it now needs to take.”