Recommendation Addenbrooke's Hospital be put into special measures after CQC inspectors rate hospital "inadequate"
PUBLISHED: 00:01 22 September 2015 | UPDATED: 08:33 22 September 2015
Addenbrooke's Hospital should be put into special measures, according to the chief hospital inspector.
Concerns raised by inspectors
• All patients awaiting an outpatient appointment must be assessed for clinical risk and prioritised according to clinical need.
• Systems or processes must be established and operated effectively to enable the outpatients department to assess, monitor and improve the quality and safety of services.
• Services around end of life care must be reviewed to allow for fast track or rapid discharges to be undertaken in a timely way.
• Patients must be discharged from critical care units to the wards in a timely manner in order to minimise the number of patients being discharged after 10pm.
• Consistent foetal heart rate monitoring must be provided in maternity services.
• Medicines must be managed in line with national guidance and the law.
The Cambridge University Hospitals NHS Foundation Trust has been rated inadequate by the Care Quality Inspection after a visit from inspectors in April and May, leading to the recommendation the trust be put into special measures.
Inspectors said the trust, which is one of the largest in the country with more than 1,000 beds, had a shortage of staff in a number of areas, including critical care services. This resulted in staff being moved across services with gaps being filled by bank or agency staff, which sometimes meant staff lacked the proper skills and training, presenting a risk to patient safety, the inspectors said.
The CQC said the hospital was already working to resolve this issue.
Inspectors also found routine operations were frequently cancelled and patients were waiting longer for surgery due to pressure on surgical services. There were also long delays in getting outpatient appointments, with one patient waiting 51 weeks for a first meeting in the ophthalmology department.
Outstanding areas of the trust
• The allergy clinic had a one-stop allergy service that provided diagnosis and management of a wide range of allergic disorders. This clinic was dynamic and comprehensive.
• Virtual clinics had been set up in a number of areas, each consisting of a multidisciplinary team of staff including nurses and consultants. The purpose of the clinic was to review patient tests to make treatment decisions without the need for the patient to attend an appointment.
• The chaplaincy and bereavement service offered a one-stop appointment where bereaved relatives could see all trust staff that they needed to see in one visit. Bereaved relatives were also invited back six weeks after the death to enable staff to provide emotional support and answer any questions.
• The online educational resource developed by the trust’s neurological critical care team, is a repository of educational resources for trainees, both locally and internationally.
• The birthing unit in The Rosie Hospital had state-of-the-art facilities, including; ten birthing rooms with en-suite bathrooms, mood lighting and music systems, as well as access to a sensory garden and comfortable equipment.
• Team working in the critical care unit was outstanding. Given the limited resources, all members of the multidisciplinary team worked collaboratively to ensure patients received kind and compassionate care. Nursing staff were observed doing everything they could to ensure patients’ carers were well informed of their loved ones’ condition.
The report highlighted excellent maternity services, however concerns were raised over pressures that led to regular closures and other serious issues.
One example inspectors raised was high levels of nitrous oxide detected in the Rosie Birthing Centre, which senior managers were aware about for more than two years. The only action to resolve the issue so far was staff were asked to open windows where possible. However, it is believed the problem will be sorted by December.
Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “We found a number of serious problems when we inspected the services run by Cambridge University Hospitals NHS Foundation Trust and I have made a recommendation to Monitor that the trust should be placed into special measures.
“We made Monitor aware of our concerns following the inspection and it has begun to work with the trust to make sure these are appropriately addressed and that progress is monitored.
“We were concerned that in some services, staff were caring for people in areas unfamiliar to them, meaning patient safety and welfare was placed at risk. However, staff were hard working, passionate and caring throughout the trust, prepared to go the extra mile for patients, but having to swim upstream against the pressures they faced. Because of the quality of care delivered by the staff, we rated the trust as Outstanding for caring.
“The trust has a vision, values and strategy for front line care. However, this was heavily focused towards research, academia and specialist service provision. Staff felt that senior managers were unaware of the issues they faced. Ward staff felt well supported by their local managers but reported that they did not see the senior management team, apart from the chief nurse, in ward areas
“There was a significant disconnection between the values of the board and the values of the frontline staff which must be addressed. For example, the chief executive stated that the trust was a tertiary specialist hospital and not a district general hospital. However, ward staff believed that they were a district hospital with specialist services.
“The trust managers have told us they have listened to our inspectors’ findings and have begun to take action where it is required. We have maintained close contact with the trust since the inspection and will undertake further inspections, including unannounced visits to check that the necessary improvements have been made.”