• West Hertfordshire trust now rated requires improvement, 15 months after it was rated inadequate
  • CQC recommends it remains in special measures as it “was clear” that the trust had benefited from the support regime
  • Concerns raised about emergency care across all three of the trust’s hospital sites but praise given for low HSMR rate

West Hertfordshire Hospitals Trust will remain in special measures despite the Care Quality Commission upgrading its rating from inadequate to requires improvement.

The regulator’s latest inspection, last September, resulted in three of the five domains improving overall. The safe and well led domains moved from inadequate to requires improvement, and caring is now rated as good.

The CQC inspection team said that the effectiveness and responsiveness of the trust still requires improvement.

West Herts was placed in special measures in September 2015. Professor Sir Mike Richards, the chief inspector of hospitals, recommended that it does not yet exit special measures but recognised that the trust had made significant improvements in the 12 months between reinspections.

The trust’s new chief executive, Katie Fisher, was credited with helping turn the trust around. Formerly a Royal Free director, she was appointed in June 2016 as part of a buddying arrangement implemented as one element of its special measures support package.

Sir Mike said: “There had been a change in leadership at the trust since our last inspection and, good progress had been made, particularly with regard to improving safety.

“I am recommending that the trust remains in special measures so that it can continue to receive the right support to ensure further improvements are made [because] it was clear the trust had gained from the support it has been receiving through the special measures regime.”

The CQC inspection did raise significant concerns about the emergency care at the trust’s three hospitals in Watford, St Alban’s and Hemel Hempstead. The latter was rated inadequate overall, with the medical care it offered also rated inadequate. The other two sites received a requires improvement rating.

The inspection found that there was no clear streaming process at the urgent care centre at Hemel Hempstead or the minor injury unit at St Alban’s. It added that: “This had not improved since the last inspection.”

Patients were also not “consistently receiving treatment in a timely manner” at Watford’s A&E department either, with pain relief or water not routinely provided to patients waiting to be seen. It added that breaches of A&E performance had become “acceptable”.

It also found that delayed transfers of care was 26.7 per cent, 10 per cent higher than the proportion for all trust in England, and that medical patients were transferred numerous times out of hours.

The report did however praise the environment of paediatric A&E as “outstanding” and gave the trust credit for a having a lower than expected Hospital Standardised Mortality Ratio rate of 85.25, which had been sustained for 18 months. Maternity care and critical care at Watford hospital had also seen strong improvement and are now both rated as good, an upgrade from inadequate.

Katie Fisher said: “We are increasing medical and nursing expertise in our emergency department, including using advanced nurse practitioners and we have reviewed our facilities for patients with severe mental health issues. There are plans for the estate which would help us expand the capacity in our emergency department and there is a real determination to provide a better experience for our patients.”

A spokeswoman for the trust added that the trust “will do all it can” to reduce its delayed transfers of care but said “this is an issue requiring a whole system approach as many factors are out of the trust’s control”.