PERFORMANCE: Northern Devon Healthcare Trust has been rated as “requires improvement” by the Care Quality Commission after inspectors found a raft of concerns, including do not resuscitate forms being filled in without discussion with patients and relatives.

The regulator has also said that the community and acute provider must do more to detect and tackle healthcare acquired infections and improve the effectiveness of current patient flow and escalation policies.

However, the trust received a “good” rating in the categories of leadership, effectiveness and caring by staff.

The watchdog found that while the majority of the community and acute provider’s services were safe, action needs to be taken to improve standards in accident and emergency and end of life care.

The regulator also found that delays with admissions and patients not being sent to the most appropriate places for care as particular issues for concern.

While the trust’s community services were found be good, the CQC said that the responsiveness of A&E, surgery and critical care at North Devon District Hospital required improvement.

The trust, which serves a population of 484,000 across 17 sites in north and east Devon, was inspected between 2 and 4 July under the CQC’s new inspection regime and received an overall “requires improvement” rating.

Inspectors also returned unannounced on three occasions.

Areas singled out for praise included the trust’s multi-disciplinary approach in community services, “outstanding”  care of patients diagnosed with dementia and  the good management of nutrition and hydration of patients.

The CQC’s chief inspector of hospitals, Professor Sir Mike Richards, said: “Northern Devon Healthcare Trust has a lot to be proud of.

“In particular I am very pleased to recognise the outstanding care on the medical wards, where we found high levels of patient satisfaction with the service.

“But we’ve also seen some examples of care which clearly require improvement. In A&E there were significant infection control issues, and on the wards at Barnstaple, we had concerns about the practice of moving patients overnight.

“It is a matter of concern that treatment escalation plans, including do not attempt cardio-pulmonary resuscitation decisions, were not always completed appropriately, with a significant number that did not show there had been discussions with patients or relatives. That must be addressed.”

Trust chief executive Alison Diamond said: “There are so many areas in this report that our staff can feel proud of. The CQC inspectors recognised the caring and excellent services that our patients receive.

“We were disappointed that the overall rating had to be that we required improvement and they are areas we are taking seriously.”