The Care Quality Commission warned Britain’s only privately run NHS hospital that it could take enforcement action after its inspectors raised serious concerns about care quality, management and culture.
The regulator told Hinchingbrooke Health Care Trust, which is run by private company Circle, it might exercise powers under section 31 of the Health Act 2008 to impose conditions on the trust due to concerns about patients’ welfare.
This threat of regulatory action was revealed in a letter to the CQC from trust chief executive Hisham Abdel-Rahman.
The letter said the trust had taken inspectors’ concerns “extremely seriously”, and had drawn up eight action points to address issues and taken some immediate action.
Mr Abdel-Rahman’s letter said: “I am writing to confirm receipt of your letter dated 19 September 2014 in which you have alerted me to the potential use of section 31 of the Health and Social Care Act 2008: Imposition of condition on registration.”
Mr Abdel-Rahman told HSJ today that the concerns referred to in this letter had since been resolved.
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“We have not received a Section 31 enforcement,” he added.
“The CQC asked questions about a single ward, to which we responded. After a subsequent unannounced inspection, they confirmed our actions were satisfactory and no order was issued.”
As revealed by HSJ last week, early findings from an inspection that took place between 15 and 18 September included allegations of patients being treated in an “undignified and emotionally abusive manner”, hygiene failures, staffing problems and that the trust had appeared to adopt “a blame approach”.
As part of its response to the CQC’s concerns, Hinchingbrooke had held an “extraordinary board meeting… to share the learning and direct activity to seek further assurances throughout our ward areas”, the letter said.
“I have personally communicated your feedback to stakeholders, namely [Cambridgeshire and Peterborough Clinical Commissioning Group], the [NHS Trust Development Authority], Circle executive and trust chairman.”
Since receiving the feedback, the trust has reduced the number of patients on its Apple Tree Ward to its “normal capacity of 25 beds” and stationed senior managers on site over the weekends, it added.
Senior figures will check the ward at least every two hours overnight and at weekends, according to the letter.
Several members of the management team will also be stationed at the hospital “for periods throughout the weekend, to provide direct management oversight and support for ward staff”.
The Apple Tree Ward was criticised in the CQC’s early feedback letter. Inspectors said they “observed evidence of poor care provided to patients, particularly on Apple Tree Ward”.
Neil Grant, a partner at Ridouts, a law firm which specialises in health and social care, said the CQC could use the section 31 powers when it believed “service users will or may be exposed to the risk of immediate harm, if CQC does not act”.
“Typically the condition will require the trust to stop doing something, such as requiring it not to take new admissions to a part of the hospital service like maternity or to take positive action to improve an aspect of the service,” he added.
“Section 31 is a draconian power which CQC is using more frequently. However, CQC generally reserves its use for what it considers to be the more serious cases.”
Once a condition is imposed, any breach could constitute a statutory offence with a fine of up to £50,000, Mr Grant said.
“There is, however, a fast track appeal to a specialist tribunal by which a provider can seek to overturn the condition.”
A spokeswoman for the CQC said it would be able to comment “after the publication of the inspection report”.
HSJ understands the trust could receive a final draft of the CQC’s report as early as next week. It will then have 10 working days in which to contest the factual accuracy of any of report’s content before it is published.
Hinchingbrooke’s immediate remedial action plan letter
- The trust immediately reduced the level of patients on the Apple Tree Ward and is now operating at its normal capacity of 25 beds. The day room will return to its normal function once cleaning has been completed.
- A safeguarding audit by the trust’s operating safeguarding lead of 10 of the 25 current in-patients, with no specific risks identified.
- An assessment of all remaining patients has been undertaken to confirm the staffing levels and mix needed for the weekend shifts, ahead of a forward planning exercise taking place to review the medium and longer term needs of the ward.
- The site management team will visit the Apple Tree Ward at a minimum of every two hours overnight and throughout the weekend. In addition, several members of the senior management team will be based on site for periods throughout the weekend, to provide direct management oversight and support for ward staff.
- On call executives for the weekend period are Deirdre Fowler, director of nursing and Cara Charles Barks, chief operating officer [and former nurse director in Australia].
- The ward matron has confirmed that all agency staff on duty over the weekend are competent and are not subject to any professional concerns.
- All risk assessments for current in-patients, for example visual infusion phlebitis scores and Waterlow, have been reviewed by ward matron and executive clinical lead Sally Bashford and assurance sought that appropriate personalised management plans are in situ.
- The shift coordinator is complying with duty of candour standards by discussing the identified concerns with the patients and their carers, where possible.