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Apparent downgrades

Most trusts would be delighted with a Care Quality Commission report which rates almost every aspect of their operation as either “good” or “outstanding”, culminating in a very strong “good” rating overall. 

But Frimley Health Foundation Trust’s first full rating since a merger four years ago was always going to have some bittersweet moments.

Frimley Park FT was the first trust to be rated “outstanding”, having taken the brave decision (helped by a wodge of money) to merge with failing neighbour Heatherwood and Wexham Park FT. Since then, Wexham Park has been re-inspected and has substantially improved, with its rating moving from “inadequate” to “good”.

The merged trust was still referred to as “outstanding” on the CQC’s website, and it is only now that a full re-inspection has taken place. That has seen Frimley Park Hospital retain its “outstanding” rating and Wexham Park its “good”, but the trust overall classified as “good.”

Merged trusts – with more than one rating – present methodological issues for the CQC until they are re-inspected: it would not be surprising to see more apparent downgrades on re-inspection where a highly-performing trust takes over a troubled neighbour. The risk of this must be on the mind of every chief executive asked to acquire a failing organisation.

But this should not distract from a very good CQC report which showed that Frimley Health FT had much to be proud of – and was aware of many areas where it could improve. In particular, the trust had responded to concerns around surgery, which the CQC had raised last year after a run of never events. There was particular praise for learning from concerns and complaints, and for the vision of the trust for what it wanted to achieve. And Heatherwood Hospital and the trust’s community inpatient services (which had not been rated before) were found to be “good” across the board.

Search for the truth

Last summer, HSJ highlighted several new concerns about maternity care at the Shrewsbury and Telford Hospital Trust as the families who were part of an initial group of 23 cases called for the probe to be widened. Although the NHS initially resisted this, health and social care secretary Matt Hancock agreed to broaden the review.

Then, last week, there was widespread criticism of NHS Improvement for what was perceived as an attempt to interfere with the independent review being led by Donna Ockenden by setting up a review panel, which was eventually disbanded after it was revealed many of its members had a conflict of interest. 

Now, in response to those concerns, Ms Ockenden has written to families involved in the inquiry, making it clear her team of experts are determined to “search for the truth”.

We also learned from the message that the review is looking at more than 250 separate cases – more than 10 times the initial number.

The Shrewsbury and Telford Hospital Trust – which the CQC rated “inadequate” last year, while highlighting ongoing maternity safety concerns –  initially accused HSJ of inaccurate reporting around the expansion of concerns. It has continually insisted its maternity services are safe.

Ms Ockenden’s message reveals the concerns about care standards at Shrewsbury and Telford are sufficiently widespread, with hundreds of families potentially affected.

It will be interesting to see how the board’s “culture of defensiveness”, as the CQC’s inspectors branded it, fares when faced with Ms Ockenden’s final report.