• Norfolk and Norwich issued with fresh warning about culture and leadership
  • But trust lifted from “inadequate” rating
  • Will remain in special measures

A major teaching hospital has been issued with its second warning notice over the leadership and culture of its emergency department, despite inspectors upgrading the trust’s “inadequate” rating. 

The Care Quality Commission has served Norfolk and Norwich University Hospital Foundation Trust with a fresh notice under section 29A of the Health Act 2008. This orders the trust, which will also remain in special measures, to make improvements and draw up an action plan for the CQC of how they will be made. It does not restrict the provision of the services. 

The trust’s accident and emergency department previously received a S29A notice in October 2017 and was re-inspected as a result in November 2018.

Although the trust was upgraded from “inadequate” to “requires improvement” overall, inspectors said ongoing concerns remained about the “culture, leadership and the management of patient flow through the emergency department and staff recognising and responding to patient risks”. 

A statement by the CQC added: “The trust must continue to take definitive steps to improve the culture, openness and transparency throughout the organisation and reduce inconsistencies in culture and leadership.”

CQC chief inspector of hospitals Ted Baker said in a statement: “While we found improvements in medical care, surgery and critical care, targets for mandatory training in medical care were not being met and governance process were not embedded. This meant there were inconsistences in how risks were reviewed.”

The inspection report has been published today, and showed the trust’s ratings in the “well led” and “safety” domains had moved from “inadequate” to “requires improvement”. The rating for whether services are “effective and responsive” remained “requires improvement”, and its rating for whether services were “caring” remained as “good”.

The inspection followed the trust being placed in special measures in June 2018, after the CQC cited a “deterioration in how the trust was being run” and a “bullying culture”.

Chief executive Mark Davies, who has been in charge since August 2015, announced in January he would step down from the role “by the autumn”. Chair John Fry is also leaving the trust, having taken up the chair role in May 2013, after completing two terms at the helm this year.

Mr Davies said in a statement the trust was on a five-year journey to be outstanding.

He said: “We welcome the CQC’s report which recognises the significant improvements we have made in many areas across the trust. First and foremost I would like to thank every one of our amazing staff who have been working so hard to deliver the trust’s clear, comprehensive improvement programme. It is their dedication, commitment and hard work mainly through the winter months which has helped to improve our ratings in such a short period of time. We are now well on our way on our five year journey to outstanding.”

He added that the CQC had recognised a number of outstanding practices at the trust, including the use of robotic surgery and improving the safety culture through human factors training.

“It is also recognised that the hospital has some of the lowest infection and mortality rates in the country,” he added.