CQC scathing of leadership at special measures trust

Isle of Wight Trust was rated inadequate in three of the five domains by the Care Quality Commission, including safe and well led.

The CQC’s report, published today, comes 12 days after chief executive Karen Baker stepped down after five years at the helm.

Isle of Wight is one of four trusts put in special measures in less than a week. Kettering General Hospital Foundation Trust also enters the regime today, following United Lincolnshire Hospitals Trust yesterday and Northern Lincolnshire and Goole Hospitals FT last Thursday. 

The £160m-turnover Isle of Wight trust provides acute, ambulance, community and mental health services to 140,000 people on the island.

A number of leadership issues were highlighted by the CQC. Inspectors found:

• The trust’s senior leadership “did not have sufficient capability or capacity to support and move the organisation at a necessary pace… to ensure quality and safety of services”.
• “Overreliance” on external reviews to solve problems and a “lack of understanding of the issues”.
• Evidence of “insufficient challenge of the executive team by the board”.

The CQC added: “There was an acknowledgement that despite being unhappy with the cost improvement programmes the board approved them nevertheless.”

Senior staff told the CQC there was a “slow and tick-box approach” by the leadership to implementing recommendations, which “suggested that the leadership did not understand the issues and so missed the point”.

There was no representation or leadership of mental health services at board level, and “poor representation” of community and ambulance services.

“This was of significant concern given the level of safety and quality concerns in the mental health services and the lack of board awareness,” the CQC said.

It rated the trust’s mental health services as inadequate in all domains except caring.

Following the inspection in November, the CQC immediately imposed conditions on the trust’s registration in relation to community and inpatient mental health services. It said it had “reasonable cause to believe a person would, or may be, exposed to the risk of harm”.

Other issues highlighted by the CQC included:

• Insufficient consultant and junior doctor staffing in the emergency department and “across medical services”.
• Ambulances and equipment stores were left accessible after being left unlocked.
• Multiple patient moves across acute services, including end of life care patients.

CQC inspectors also reported the trust’s mobile data terminal used to provide ambulance staff with patient information and navigation was unreliable because the system “sometimes froze”. This was raised as a concern by the CQC during its previous inspection two years ago.

Some staff also raised concerns to the CQC about bullying.

NHS Improvement, which confirmed the trust has been placed in special measures, has already appointed former Heatherwood and Wexham Park Hospitals Foundation Trust chief executive Philippa Slinger as improvement director.

The trust said it had made “a number of service improvements” following the inspection, including: establishing a mental health improvement group and recruiting two psychiatrists and a head of operations for the service; implementation of new arrangements to prevent patients’ bed moves; and increased nurse staffing.

Trust chair Eve Richardson said: “We have let down our patients and our local community and on behalf of the trust board and our staff I apologise unreservedly for this failure.”

Medical director Mark Pugh took over as acting chief executive after Ms Baker’s departure.

He said: “We have already begun work on the development of a robust and achievable plan for major and rapid improvement.”

Isle of Wight of is one of four trusts to enter special measures in the last six days, alongside Kettering General Hospitals, Northern Lincolnshire and Goole FT and United Lincolnshire Hospitals Trust.