Updated: Hinchingbrooke in special measures after care judged 'inadequate'

It is the first time the CQC has rated a NHS provider inadequate on how caring it is.

The Cambridgeshire district general hospital was given a rating of inadequate overall, in an inspection report issued this afternoon.

The news comes just hours after Circle Partnership announced plans to pull out of its 10 year contract to run Hinchingbrooke, the UK’s only privately managed NHS trust.

During their inspection the CQC found examples of patients who did not have call bells within reach, with one patient telling inspectors they had soiled themselves waiting for assistance. The regulator saw drinks repeatedly left out of reach of patients, despite inspectors raising the issue with staff on the first day of their inspection.

And the CQC reported particular concerns about accident and emergency, and medical care at the hospital. There was a lack of paediatric cover within the emergency department and theatres which meant children were at times “potentially unsafe”.

Six patients said they had experienced delays in getting pain relief, which they felt were due to insufficient staffing.

The CQC also flagged concerns with the trust’s leadership.

It was told by both the Circle management team and the trust board that the other was responsible for holding the trust’s executive team to account.

After inspectors raised “serious concerns” about Hinchingbrooke’s Apple Tree Ward, they found the ward leadership team “did not wish to raise [the issues] to a higher level”, meaning the CQC had to take their worries directly to the executive team.

The regulator said it found some staff that wished to care for patients in the best way, but felt unable to raise concerns, with one nurse telling inspectors: “We are always told to do incident forms, but who has the time and nothing changes, therefore we don’t do them.”

HSJ revealed in September that the CQC had raised serious concerns about care quality, management and culture at the hospital following its inspection, which took place between 15 and 18 September.

Other trusts have been rated inadequate in three of the five questions which the CQC inspects against, but Hinchingbrooke is the first to receive the rating on the question of whether services are caring.

The trust was rated “requires improvement” for whether services were effective and responsive. The CQC also said there were some examples of good practice, such as care in maternity and critical care.

The CQC’s chief inspector of hospitals, Sir Mike Richards, said the findings highlighted “significant failings at Hinchingbrooke”, which had led him to recommend to the NHS Trust Development Authority that it be placed in special measures.

“We have informed the TDA of the breaches and it will make sure these are appropriately addressed and that progress is monitored through the special measures action plan.”

“Where hospitals are failing to promote good care, we will say so regardless of who owns and runs them,” he added.

In a statement issued shortly after the report’s publication, the TDA confirmed that it would place the trust in special measures. The statement said that despite Circle’s decision to withdraw from the Hinchingbrooke franchise, special measures would “provide the hospital with additional support to ensure the delivery of improvements and high quality patient care on a sustainable basis”.

It added: “Alongside the special measures process, the TDA will work closely with the trust to ensure patient services continue to operate fully, staff are given security and a long term sustainable solution is found that safeguards the provision of high quality services to patients. The trust is also fully engaged with sustainability planning with partners for the local health system.”

Under special measures, Hinchingbrooke can expect to be “buddied” with a high performing trust.

It will have to agree an action plan to turn around performance with its regulator, the TDA, which will appoint an “improvement director” to hold it to account against delivery of the plan.

Circle today criticised the CQC and its anticipated conclusions. Its chief executive Steve Melton said in a statement this morning: “We understand their report will be published soon, and fully expect it to be unbalanced and to disagree with many of its conclusions.”

He added: “We recognise the importance of a regulator focused on quality, but we are not the only hospital to find their process problematic. We believe that inconsistent and conflicting regulatory regimes compound the challenges for acute hospitals in the current environment.”

The Department of Health said in a statement: “The CQC’s rigorous inspection regime shines a light on standards of care in the NHS. The special measures process has already helped turn six trusts around, and we want to see improvements in services at Hinchingbrooke.”