The Care Quality Commission has raised serious concerns about care quality, management and culture at the UK’s only privately run NHS hospital, HSJ can reveal.
The regulator’s concerns about Hinchingbrooke Health Care Trust include allegations of patients being treated in an “undignified and emotionally abusive manner”, hygiene failures, staffing problems and “a blame approach”.
They were raised in a letter sent by the regulator to the trust this week, outlining “early feedback” from an inspection which took place between 15 and 18 September.
Hinchingbrooke is run under franchise by private health provider Circle Health. It is the only NHS trust run in this way and is seen by some as an example which should be followed.
The inspection process is ongoing and the full report is expected to be shared with the trust in about three weeks. Trusts have the right to contest its contents before publication.
The CQC said the “inspection process has not yet concluded” and the letter was “not a judgement on the trust”.
The CQC’s letter, sent on 23 September, alleged a range of serious concerns. These include:
- instances of “poor care provided to patients”, including patients who “lacked the capacity to consent” being sedated and staff treating patients in an “undignified and emotionally abusive manner”;
- poor hygiene including hand washing;
- allegations of a “lack of recognition of the level of concerns” by the chief executive and “the length of time it took to grasp the seriousness to patients”;
- a “lack of robust challenge of the executive team through the governance system” – the inspection team said it “found little internal or clear external oversight of how the trust managed risks to the quality of care”; and
- a lack of “clarity or coherence” as to who was “responsible for the oversight and scrutiny of the trust’s quality agenda”.
The letter, to Hinchingbrooke chief executive Hisham Abdel-Rahman, said: “We were also concerned as to the lack of recognition of the level of concerns when raised with yourself and the length of time taken to grasp the seriousness of the situation for patients.
“There were also concerns that the current culture within the organisation does not lend itself to enable concerns, particularly related to nursing and caring issues, to be easily raised. The response seen and otherwise noted suggested a blame approach, rather than that of a supportive and patient focused approach.”
CQC chief inspector of hospitals Sir Mike Richards, responding to HSJ’s inquiry about the letter, said: “Following our recent inspection of Hinchingbrooke, we wrote to the hospital to expand on matters raised in verbal feedback given at the conclusion of the announced part of the inspection.
“This is to enable the hospital to take improvement actions without delay and is not a judgement on the trust. It is important to note that the inspection process has not yet concluded. Our inspection report and rating will be published in due course.”
The CQC inspection follows Circle reporting last month that the financial losses built up by Hinchingbrooke in its first two years under private management are just £150,000 short of the £5m ceiling at which the contract could be terminated. Circle’s half year report this year admitted to “uncertainty over Hinchingbrooke’s profitability over the next year”, raising the possibility that the limit could be broken this year.
The letter highlighted some good areas. It said: “There were services where staff were providing good care with positive outcomes for patients. These included maternity, critical care and outpatients.”
A Circle spokesman said: “It’s normal for the CQC to ask for further information and reassurance during an inspection. That’s the process we’re working through now. It would be completely inappropriate to comment on specific aspects of that until the CQC publish their final report, other than to say we are working closely with them and are confident our plans will meet their approval.
“Hinchingbrooke has come a long way in two years. Patient safety and care is our top priority and we are constantly looking for ways to improve our care.”
Other concerns listed in the letter include:
“The trust is facing significant difficulties in recruiting and retaining medical and nursing staff to work at Hinchingbrooke Hospital and its heavy reliance on agency and bank staff is impacting upon the care delivered to patients.
“In the theatre department there are no dedicated paediatric lists and paediatric staff are not available to care for children.
“Ward care planning does not clearly take into account the risks to individual patients in that risks due to pressure area care, catheter care, IV care and the risks associated with bed rails are not adequately assessed or acted upon.
“Care plans across the hospital were not updated to reflect the changing needs of the patients in your care.
“The team noted that sedation was being used on patients within the medical wards who lacked capacity to consent, without appropriate best interest decisions in place and safeguarding procedures across the hospital were poor. The use of sedation without best interest decisions in place can be classified as restraint or a Deprivation of Liberty safeguarding concern.”
“An incident whereby staff failed to follow hand washing guidance after seeing to a patient isolated for C difficile.
“We were concerned in the [accident and emergency] department as well as other wards about the practice of hand washing which we observed to be very variable.
“Concerns were expressed… with respect to the security of controlled medications in the A&E department.”