• “Lack of trust” between Northamptonshire organisations preventing system integration
  • CQC found “limited evidence” that system was able to “ensure sufficient capacity and quality” in services
  • Poor discharge processes led to cases of patients suffering “avoidable harm”

A review of the Northamptonshire health economy found several examples of patients being harmed by poor hospital discharge processes, as well as a “lack of trust” between organisations that was hampering progress towards system integration. 

The Care Quality Commission’s inspection of how well the area’s organisations worked together, said: “It was widely acknowledged that relationships had been challenging and a barrier to change”. 

Professor Steve Field, the CQC’s chief inspector of general practice, said: “While there is an intent from the system’s leadership to improve how people move through health and social care services, the reality for people has been variable with fragmented services leading to disjointed care and unsatisfactory experiences.” 

The regulator found “unsafe” practices in discharging patients from the regions hospitals; Northampton General Hospital Trust; Kettering General Hospital Foundation Trust; and Northamptonshire Healthcare Trust. 

The report said

  • One person was readmitted to hospital after spending a night in the NGH’s discharge lounge due to a lack of capacity on the trust’s wards. A lack of reassessment and “poor” monitoring meant staff did not notice he had become unwell. 
  • Two people experienced “avoidable harm as a direct result of a prolonged hospital stay”, with one developing a hospital acquired infection and the other suffering a fall and requiring 24 hour care. 
  • CQC found “unsafe and inappropriate discharges [because of] poor communication and insufficient discharge information.” In April 2018, only 42 per cent of KGH patient discharge summaries and 67 per cent of NGH summaries were accurate against a contractual expectation of 85 per cent accuracy. 
  • A safe pharmaceutical discharge scheme at KGH had been “stopped due to a lack of resource, which meant people were more at risk of an unsafe discharge”. 
  • Staff “lacked any sense of urgency” around discharge, with one patient delayed over a week due to staff not filling out a form. 
  • System pressure meant there was a perception of “some people being discharged from hospital before they were medically ready, and were therefore more likely to be readmitted”. 

Northamptonshire’s “sustainability and transformation programme” was reset in September 2017. At the same time, Angela Hillery, NHT chief executive, took over as STP leader. 

While system leaders told the CQC that there was “greater optimism” that the STP would succeed, the regulator said “severe financial pressures, and a history of siloed working and poor relationships between organisations” was creating “significant barriers” to integrating health and care. 

The report said that due to these “major” problems the STP might not be able to “move away from past behaviours of siloed working” and there was evidence that staff were “retreating” into their own organisations due to internal pressures. 

The CQC did find “good examples” of multidisciplinary team work in the region but said the best of these had to be upscaled and duplication reduced. The report also praised frontline staff being “committed to delivering high quality and person centred care”.

A spokesman for the STP said: “We recognise and accept the findings of the report and believe that these are indicative of national challenges. Once again we would renew our commitment of the importance of working together to improve health and social care for the people of Northamptonshire.”