Updated: West Herts to be placed in special measures

HSJ revealed on Wednesday that the trust faced being imminently placed in the regime. The provider has a long history of care quality and governance problems.

In the inspection report published today, chief inspector of hospitals Sir Mike Richards has recommended the trust be placed in special measures.

Two of West Hertfordshire’s sites were given an “inadequate” overall rating: Watford General Hospital and St Albans City Hospital. The trust’s third site, Hemel Hempstead Hospital was rated “requires improvement”.

An independent probe concluded last year that the trust missed an opportunity to uncover major problems in its cancer waiting times management due to poor complaints handling and “lack of continuity in leadership”. This came after the trust apologised for administrative errors that could have led to cancer diagnoses being delayed.

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There has been significant change at the top of the organisation within the past 18 months, with a new human resources director, transformation director, chief executive, deputy chief executive, finance director, chief nurse and two operations directors all joining the organisation since July last year.

The trust had a £16.2m cash boost from the Department of Health in late 2013 to refurbish its hospitals – although bosses said at the time the organisation needed £67m over six years to ensure facilities were fit for purpose.

Until January this year the provider’s chief executive was Samantha Jones, who stood down to become NHS England’s director for new models of care. Ms Jones won HSJ’s prestigious chief executive of the year award while leading the trust in 2014. She joined West Hertfordshire in early 2013, succeeding Jan Filochowski.

During her tenure, the trust invested in extra nurses in an attempt to address a longstanding shortfall in staffing levels, and successfully cut mortality rates. The trust also received £43.6m in bailout funding from the Department of Health in 2014-15.

Ms Jones also sought to improve the trust’s governance and management of clinical risk through initiatives such as “Operation Onion”, a forum for staff, the executive team and patients to discuss concerns.

Staff numbers, and recruitment and retention, were identified as a problem at the trust.

Among the other concerns identified by inspectors were:

• the quality of the environment, particularly in the emergency department;
• arrangements for risk management at all levels in the organisation;
• compliance with the Mental Capacity Act;
• the ability of staff to carry out mandatory training;
• cancelled outpatient appointments; and
• incident and accident reporting systems.

However, inspectors praised the quality of the children and young people’s service at Watford Hospital, and noted a “significant reduction” in mortality rates over the past two years. A dementia care team and a pre-operative telephone call service were also singled out for praise.

Jac Kelly, the trust’s interim chief executive, said: “I am confident that the energy and focus of staff in continuing to deliver improvements that are already making a difference for patients, together with the support we will receive through special measures, means we will progress even faster.

“The report is clearly disappointing news for staff who daily go above and beyond to ensure our patients receive the care and treatment they deserve and need. The majority of our staff were found to be caring and compassionate but we are very sorry for where we have fallen short. We welcome the special support we’ve been offered as we know that we have a big challenge ahead to ensure our care is consistent across all our services.”

This story was updated on 10 September to include information from the CQC’s inspection report and comment from the trust.