York and Scarborough NHS Foundation Trust has been ordered to make significant improvements to some of its acute health care services, following a raft of negative inspection findings by the health care regulator.
The Care Quality Commission (CQC) has today published the reports from a series of inspections of medical care, maternity services, and urgent and emergency care at York Hospital and Scarborough Hospital.
CQC initially carried out inspections in October, and consequently issued a letter of intent demanding the trust make rapid improvements in maternity services at both hospitals, and in the emergency department at York Hospital.
Issues identified included inadequate staff numbers and skills mix, inadequate management of people whose health was deteriorating, long waiting times for care, as well as medicines management issues.
While a CQC inspection in November found some improvement in urgent and emergency care, this was not the case in maternity services, so urgent conditions were placed on the trust in these areas to ensure patient safety by driving rapid improvement in risk management.
Following the November inspection, CQC received information of concern in relationto staff behaviours, bullying, harassment, and discrimination, and extended the well-led inspection, which continued until March.
Since the inspection, the CQC's overall rating for the trust as well as for how safe it is, remains rated as 'requires improvement'. How effective and responsive the trust are, have dropped from 'good' to 'requires improvement', and how well-led the trust is has declined from 'requires improvement' to 'inadequate'. Caring remains rated as ''good’. CQC has also told the trust it must also improve its leadership after finding a decline in how well-led they were.
The ratings at York and Scarborough hospitals following this inspection are:
- Medical care – previously suspended, now rated 'requires improvement'
- Maternity services – has declined from 'requires improvement' to 'inadequate'
- Urgent and emergency care - remains rated 'inadequate'
- Medical care – remains rated 'requires improvement'
- Maternity services – has dropped from 'good' to 'inadequate'
Services Not Well Led
Sarah Dronsfield, CQC deputy director of operations in the north, said: "When we inspected York and Scarborough NHS Foundation Trust, we didn't find well-led services. We were concerned to find leaders didn’t always understand or effectively manage all the priorities and issues the trust faced."
Inspectors found that in some areas there wasn't always an open culture where staff could raise concerns without fear, which needs to be tackled, she said, adding that leaders must also address poor behaviour between staff.
"This lack of poor leadership was having an impact across all of the services we visited. We saw people using services being put at risk of harm from a lack of good processes, such as staff not completing risk assessments or keeping people's care plans up to date. We also saw infection control processes weren't effective in urgent and emergency care, with dirty equipment and premises, and clinical waste not being managed appropriately. Processes must be improved so all staff can be supported to have the relevant information and environment to give people appropriate care, in a safe way."
CQC also found the trust wasn't always providing maternity care in a planned way to meet the needs of local women and people using services. However, Ms Dronsfield said most staff treated people with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
Ms Dronsfield said the CQC expects to see rapid and widespread improvements at the trust. "We've been working closely with the trust and partner organisations to make sure people are safe, and will return to check improvements have been made and embedded so people receive the high standard of safe care they deserve."
Services Under Sustained Pressure
In response to the CQC's findings, Simon Morritt, chief executive of York and Scarborough Teaching Hospitals NHS Foundation Trust, said: "We welcome the CQC's findings. As is the case across the NHS, we have been under sustained pressure and this has impacted our ability to consistently provide the standard of care we all want, which is reflected in the concerns highlighted by the CQC. Nevertheless, we accept the CQC's findings and recognise that we have much more work to do to make sure all our services are of the high standard that our patients and staff expect."
Ms Morritt said leaders were pleased that the hospital received a rating of 'Good' for the key question of care, and that the CQC recognises the kindness and compassion of staff "who continue to put our patients first despite the most challenging of circumstances".
"I am also encouraged that the CQC found positive improvements against some of their previous concerns," she added.
Also commenting, Dr Karen Stone, medical director at York and Scarborough Teaching Hospitals NHS Foundation Trust, said: "We continue to work with the CQC to address their recommendations and have plans to focus on the key priority areas where we know we need to continue to make sustained improvements.
"We responded immediately to the urgent findings identified at the time of the inspection, and in the months since the visits we have made positive progress against areas highlighted in the report."