The must-read stories and debate in health policy and leadership.

Not keeping up with demand

Six months ago, one of the most troubled trusts in the country got a boost from the Care Quality Commission — Worcestershire Acute Hospitals Trust had its overall rating raised to “requires improvement”. There was even talk of lifting the trust out of special measures, where it has lingered for about four years.

But high demand has seen two of the trust’s accident and emergency departments — upgraded to “requires improvement” in September — flipped back to “inadequate” after an unannounced inspection.

The CQC saw lengthy ambulance handovers at the overcrowded Worcestershire Royal Hospital as a particular problem. In December, 797 handovers lasted more than an hour, the bulk of which took place at the site. That number has since fallen to 566 in January and 89 in the first 10 days of February.

As one HSJ commenter points out, the unit’s emergency department is simply too small to meet local demand. Like many private finance initiative projects, it was built with the view that demand for beds would drop, not soar.

But there are cultural issues at play, too. A mortality report published last year found overwhelmed trainees were making decisions in the place of consultants. The latest CQC report noted staff were still failing to follow escalation protocol for patients in need of specialist care.

The news will be a blow to chief executive Matthew Hopkins and the staff who have worked hard to improve standards at the trust. On Thursday, Mr Hopkins said more A&E staff are in place and promised to open 33 more beds next week. But, appealing to system partners, he added the emergency care problems could not be solved by the trust alone.

A question of timing

And from one kind of CQC multisite trouble to quite another: Does the Care Quality Commission’s risk-based inspection scheduling disadvantage those with more than one site — when they are on the road to improvement?

North West Anglia Foundation Trust chief executive Caroline Walker thinks so, and she’s not alone, with other chief executives also telling HSJ they are sympathetic with the concerns she raised. You can read those concerns here.

The CQC insisted multisite trusts were not at a disadvantage by the current regime. But HSJ understands the regulator will look more widely at its inspection scheduling approach as part of the development of its new strategy. HSJ will keep an eye on submissions to the consultation, which begins in the autumn.