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Home > News > North Cumbria's hospital Trust out of special measures

North Cumbria's hospital Trust out of special measures

Posted on Wednesday 29th March 2017
WCH CQC MARCH 2017

WCH staff celebrate CQC report

England’s Chief Inspector of Hospitals has recommended that North Cumbria University Hospitals NHS Trust should come out of special measures, after an inspection by the Care Quality Commission (CQC) in December 2016.

During the inspection, the CQC found many improvements had been made across the Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven. In recognition of this, the CQC made the recommendation to NHS Improvement for the Trust to exit special measures after nearly four years – a recommendation that has been approved.

Overall, the Trust has maintained a rating of ‘requires improvement’. However, this inspection saw the majority of services being rated as ‘good’.

As with previous inspections, every single service across both hospital sites was rated as ‘good’ for providing a ‘caring’ service to patients. The CQC found patients to be positive about the care they received and staff who considered patients ‘to be central to everything they did’ and who were committed to delivering high quality care. They witnessed staff interactions with patients which were ‘compassionate, kind and thoughtful’ and they noted that patient privacy and dignity were ‘maintained at all times’.

In addition, for the first time, the Trust was rated as ‘good’ overall for providing ‘effective’ services. The CQC found that the Trust has developed ‘a number of evidence-based, condition-specific care pathways to standardise and improve patient care and service flow, such as ambulatory care and hot clinics’. Patients informed the inspection team that their pain was managed well and their nutritional and hydration needs were being met. It was also found that staff across disciplines were working to secure good outcomes and ‘seamless care’ for patients with staff working well together for the benefit of patients.

Previously rated as ‘requires improvement’, urgent and emergency services have been rated as ‘good’ at both hospital sites despite the pressures the service faces on a daily basis. The inspection team noted that patient care and treatment followed ‘best practice standards’, staff interacted with patients ‘empathetically’ and responses to their needs were ‘prompt’. Care and treatment were explained to patients in a way they understood; patients were involved in decisions about their care and received ‘emotional support’. Incident reporting had increased and serious incidents had reduced as well as learning from incidents being shared. It was also noted that staffing had improved and there was a ‘positive culture apparent in the emergency department’ with staff working well together. In addition, it was recognised that the Trust is taking steps to address performance as part of its improvement plan for emergency care.

End of life care has also now been rated as ‘good’ across both hospital sites. It was noted that the Trust has developed a ‘Care of the Dying Patient’ plan that provides prompts and guidance for ward-based staff when caring for someone at the end of life.  The inspection team saw specialist palliative care nurses working closely with medical staff on the wards and recognised that staff demonstrated ‘compassion, respect and an understanding of preserving dignity and privacy of patients following death’.  There was a commitment at all levels within the Trust to raise the profile of death, dying, and end of life care. This included improving ways in which conversations about dying were held and engaging with patients and their families to ensure their choices and wishes were achieved.

Following the 2015 CQC inspection, outpatient services had both improved with services at West Cumberland Hospital rated as ‘good’. This year, outpatients at both hospitals has received a ‘good’ rating with the inspection team noting that services are offered throughout the week and on weekends to ensure that patients were seen and to meet demand. It was also recognised that staff were positive about their roles, leadership and team work with daily huddles in the department ‘increasing information sharing’.

In 2015, the Trust received one rating of ‘inadequate’ for the safety and responsiveness of medical care at West Cumberland Hospital as a result of ongoing issues with regard to recruitment of medical staff and the high number of vacant consultant posts. This year the Trust has received no inadequate ratings with medical care now rated as ‘requires improvement’ at both hospital sites. While medical staffing is not at full substantive compliment at West Cumberland Hospital, there had been recruitment and the Trust has secured longer term locum contracts as well as further support provided from colleagues at the Cumberland Infirmary. The composite workforce model which has been developed to bring additional stability to the hospital is progressing and nurse staffing was also found to have improved.

The CQC also commended the Trust for 11 areas of ‘outstanding practice’, including:

  • The only surgeon between Leeds and Glasgow doing meniscal augment knee surgery
  • One of only 18 hospitals referred to in an audit for contributing examples of best practice in care of patients undergoing emergency laparotomies
  • The ‘expert patient programme and shared care initiative’ in renal services
  • The Trust’s monitoring and collating of ‘real-time’ patient experience
  • An ‘innovative and progressive’ frailty unit at the Cumberland Infirmary
  • Growth, expansion and development of the Medical Procedures Unit
  • Implementation of dance-related activities for vulnerable patient groups to stimulate social interaction, patient involvement, family partnerships and exercise

A series of recommendations have also been set out by the CQC in order to further improve services provided, including concerns around staffing, particularly within services for children and young people and the reliance on locum support which leaves the Trust vulnerable to changes or departures. Concerns were also expressed about the challenge of patient flow relating to the emergency department, medical care, surgical services and outpatients which remains one of the Trust’s main priorities in order to ensure that patients receive timely care and treatment.

Stephen Eames, chief executive at North Cumbria University Hospitals NHS Trust, said: “We wholeheartedly welcome this CQC report and the news that we are now out of special measures. This is a momentous day for our staff who have been working relentlessly hard for four years to reach this achievement and I am immensely proud of our teams. I also hope this milestone assures our local communities across West, North & East Cumbria that their hospitals are providing quality services.

“Of the possible 78 ratings our services received, we now have 57 ‘goods’ which is the most we have ever had. The majority of our services are also ‘good’ overall and I must commend urgent and emergency services and end of life care for the marked improvements they have demonstrated. In addition, I would like to congratulate the services who have maintained their ‘good’ rating and a special mention to critical care who have achieved ‘good’ in every domain across both hospitals. Our infection prevention & control team also must be recognised for their hard work and commitment as recognised by the inspection team.

“While we have a lot to celebrate today, I am also under no illusions that we still have work to do. Our services that ‘require improvement’ in medical care, surgery and maternity & gynaecology are all working equally as hard as the rest of our teams but are experiencing challenges. We will continue our close focus alongside our health and social care partners to tackle improving patient flow and ensure patients are receiving care in the right setting which is not always in an acute hospital bed.

“As the CQC has recognised, we have experienced some successes in medical recruitment over the past year but we still have a way to go and we remain determined to increase our recruitment again this year, particularly in children’s services which we will be working on in partnership with our local community. 

“Being in special measures has not been an easy label to have and it has affected our staff morale. Following recent decisions taken by NHS Cumbria Clinical Commissioning Group regarding the future development of a number of our services and the news from the CQC today, the future has never looked brighter for our Trust. We have a clear vision for the future and we are continuing to develop our close relationship with local and health and care partners for the benefit of our staff and patients.

“Coming out of special measures is an accolade to our fantastic staff who have worked long and hard to improve services for our patients and the local community. Now we must focus on working equally hard together towards achieving a ‘good’ rating or better in the future. I remain determined to make acute services in West, North & East Cumbria amongst the best in the country.”

You can read the full report at http://www.cqc.org.uk/provider/RNL