CQC tells struggling hospital trust to move faster on improvements

A CQC report, published this morning, has again given Worcestershire Acute Hospitals Trust an inadequate rating, highlighting concerns about long surgery waits and crowded emergency departments.

CQC chief inspector of hospitals Professor Ted Baker said: “Although we found some improvements had been made across the trust, it was disappointing to find that some areas had not improved and others had declined since our last inspection. Progress with improvements in services has not been fast or consistent enough.”

The trust has been in quality special measures since December 2015 and has long-running governance, finance and care quality problems.

The CQC inspections were carried between 23 January and 22 March 2018, at a time when the trust was reporting some of the worst accident and emergency and ambulance waits in the country.

The main headline area of improvement was trust leadership, with its well-led rating moving from inadequate to requires improvement and inspectors noting a more stable leadership team after years of upheaval. The trust appointed a new chief executive, Michelle McKay, in March last year and most of its senior management team have been replaced in the past 18 months.

However, since those inspections, the trust’s chair Caragh Merrick has resigned and been replaced by former NHS England chief executive Sir David Nicholson.

The CQC has issued six requirement notices to the trust, focused on urgent and emergency care, surgery, maternity, services for child and young people, outpatients, and diagnostic imaging.

The CQC report highlighted:

• A stroke patient waited 26 hours in an ED observation unit for a stroke bed
• Long waiting lists meant outpatients were not being treated in line with good practice. 
• Continuing concerns about the use of corridors to care for patients in ED, particularly those admitted by ambulance. During three separate inspections there were, on average, 16 patients waiting in the ED corridor at Worcestershire Royal Hospital. Average wait between being referred to a specialist and seeing a specialist was three hours.
• Between January and March this year, 796 patients waited for more than an hour in ambulances before being handed to the emergencey department at Worcestershire Royal. During the same period, the department was “critical/overwhelmed” about 88 per cent of the time.
• Staff at Worcestershire Royal Hospital A&E did not routinely clean their hands between patients.
• Poor reporting of breaches and safety concerns.
• The trust’s rating for well-led improved from inadequate to requires improvement. However, significant concerns remained, including a lack of “vision or strategy” and poor visibility of data that would flag up emerging risks or safety concerns.
• The trust’s Meadow Birth Centre was the one area highlighted as demonstrating outstanding practice, and maternity was rated “good” overall.

Responding to the report, trust chief executive Michelle McKay said she welcomed and highlighted improved rating for several specific services, including diagnostics, maternity and children and young people, and leadership.

Ms McKay said one of the biggest problems was patient flow, and that upcoming capital work, such as increased bed capacity, would help improve flow.

“Everyone in our trust, from ward to board, understands the challenges which we still face on our improvement journey and we share the desire of our inspection and regulatory bodies, as well as people in our local communities, to see progress continue to be made quickly and sustained.”