Weekly updates and essential insight into the NHS in the South West, by Will Hazell

In the last few weeks the Care Quality Commission has published reports for three acute trusts in the South West: Great Western Hospital Foundation Trust, Royal United Hospitals Bath FT and Dorset County Hospital FT.

The reports provide a snapshot of the specific issues each organisation is grappling with, but also tell a wider story about the challenges which the NHS is facing in the South West and across the rest of the country.

More to do at Great Western

First up is Great Western in Swindon. The CQC issued the trust with a warning notice following an inspection in September 2015, which found significant concerns in the Great Western Hospital emergency department. It followed up with an unannounced inspection in April to see what progress had been made.

Unfortunately, the regulator judged that the warning notice had not been fully met, so it remains in place.

Edward Baker, the CQC’s deputy chief inspector of hospitals, said that while the trust had made “some great improvements”, the regulator could not be “certain that people are getting the consistent high quality care that everyone should expect”.

Taking and recording patient observations, reducing the risk of falls, and thoroughly investigating incidents and learning lessons, were all areas where the trust was found to be lacking.

The CQC found the department was “frequently overcrowded… with unprecedented numbers waiting on trolley beds”.

While nurse staffing levels had increased by 20 per cent, the regulator judged that “in the context of increasing demand, safe levels of staffing were not consistently provided”.

A&E troubles but outstanding caring at Bath

NHS England and NHS Improvement have made addressing accident and emergency underperformance one of the health service’s key priorities this year.

As with Great Western, the CQC found A&E was an area where the Royal United Hospitals Bath is struggling. That won’t come as a surprise to the trust – it has long had difficulties in its emergency department.

As HSJ has previously reported, the CQC has recalibrated its language in relation to workforce in an attempt to square the circle between safe staffing levels and the pressure NHS Improvement and NHS England is putting on trusts to reduce costs.

So in its inspection report, the CQC takes Bath to task for “periods where staffing and skill mix were not as planned”, rather than directly upbraiding it for not employing enough nurses.

Bath appears in NHSI’s list of trusts which have had “significant paybill growth in excess of inflation and pension effects”, so it’s obvious why the CQC has to tread carefully with its comments.

The good news for Bath in a mixed inspection report was that the CQC found the standard of its caring to be outstanding.

Professor Baker said patients were “being treated with kindness and compassion throughout the trust”, but particularly in children’s and end of life care services “where patients and their families were universally positive about the way they were treated by staff”.

Dorset County requires improvement

Like Bath, Dorset County Hospital received an overall rating of requires improvement.

Unlike Bath, which was rated requires improvement or good across all its inspection areas, with a few outstandings thrown in for good measure, Dorset had one major blot on its copybook – an inadequate rating in the well led domain of its end of life care service.

The CQC said leadership of the service needed to improve to ensure action plans were implemented and quality, performance and risks were monitored and managed.

The palliative care consultant clinical lead worked part-time and therefore had “limited time or capacity for strategic planning or leadership of the service”.

The CQC also observed there were “not always enough nurses or doctors to provide safe care”.

Like Bath, Dorset County appeared in the list of trusts with excess pay growth. As my colleague Sharon Brennan has reported, many of the trusts in that list have also been told by the CQC to improve their staffing.

It’s difficult not to feel sorry for provider leaders at the moment – they’re caught between the hammer of NHS Improvement and NHS England on the money, and the anvil of the CQC on quality.

Deep South

Deep South is HSJ’s email briefing on the NHS in the South West of England.

It takes an in-depth weekly look at a region which is one of the NHS’s most innovative, but also one of its most turbulent. The patch includes the cities of Bristol and Bath, through Wessex and Dorset, and all the way down the peninsular to Lizard Point.

Please get in touch with any suggestions about what you’d like to see covered and any story tips: will.hazell@emap.com