CQC Rates Colchester and Ipswich Hospitals as Requires Improvement

The Care Quality Commission (CQC) published its Inspection Report of East Suffolk and North Essex NHS Foundation Trust on 8 January 2020. The report rates the overall trust, which comprises of both Colchester Hospital and Ipswich Hospital, as requires improvement.

The CQC inspects and regulates healthcare service providers in England. They ask the same five questions of all services: are they safe, effective, caring, responsive to people’s needs, and well-led? Where they have a legal duty to do so, they rate the quality of services against each key questions as outstanding, good, requires improvement or inadequate. Where necessary, the CQC take action against service providers that break the regulations and help them to improve the quality of their services. The CQC’s decision on the overall ratings takes into account the relative size of the service and its professional judgment to reach fair and balanced ratings.

The CQC inspected both hospitals in 2017 under their previous registration at which time Colchester Hospital was rated as requires improvement.

From 11 June to 18 July 2019 the CQC inspected 14 core services provided by the trust. These included urgent and emergency care, medical care, surgery, maternity services, and outpatients at Colchester Hospital. They also inspected urgent and emergency care, medical care, surgery, critical care, maternity services, children’s and young people’s services, end of life care and outpatients at Ipswich Hospital and community health in patient services.

What the CQC found – Overall trust

The CQC’s rating of the trust stayed the same; “requires improvement”.

It rated the overall key questions as:-

Are services safe?

The CQC report sets out the reasons for the rating as including that:-

• Not all services had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• Issues providing mandatory training in key skills to all staff. Medical staff did not meet the trust’s compliance target in most courses.
• It observed several examples where systems and processes to maintain cleanliness and control infection were not being implemented effectively. Staff did not use control measures consistently to protect patients, themselves and others from infection.
• The design, maintenance and use of facilities, premises and equipment did not always keep people safe.
• Risks to patients who used services were not always assessed, monitored and managed on a day-to-day basis. In the emergency departments staff did not always complete risk assessments and environmental risk assessments for each patient in a timely manner, particularly for patients with mental health needs.
• Staff did not always keep appropriate records of patients’ care and treatment. Within the emergency department at Ipswich Hospital, staff did not keep detailed records of patients’ care and treatment. Records were not always clear, up-to-date, stored securely or easily available to all staff providing care.

Are services responsive? is rated as requires improvement because:

• People could not always access services when they needed it and received the right care promptly. Waiting times for referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards. It found particular issues with admission and access and flow across the surgery services and within the emergency departments.
• Access to mental health services in the emergency department within Ipswich Hospital was pressured out of hours and was not always available in a timely fashion 24 hours a day, seven days a week.

Areas for improvement

The CQC found areas for improvement that the trust MUST put right to bring services into line with legal requirements including:-

• Ensuring that mandatory training attendance improves to ensure that all medical staff are aware of current practices.
• The trust must ensure patient care records are accurate, complete and contemporaneous and that pertinent risk assessments are completed and updated for all patients across the trust.

For Colchester Hospital action also includes ensuring:-

Urgent and Emergency Care

• That risks to patients are identified, documented and regularly reviewed to ensure patients are safe from avoidable harm.
• That staff have the necessary skills and competencies to safely carry out their role.
• That medical records and confidential patient information are stored securely to ensure patient confidentiality.
• That there is an effective governance and risk management framework in place to identify, manage and assess all risks relevant to the emergency department.
• That there are clear lines of accountability for patients in the emergency department. Standard operating procedures should be developed and embedded in all areas.

Medical Care

• That the governance and risk management processes are embedded and consistently applied to maintain oversight of identified risks.

Surgery

• It effectively audits compliance with the World Health Organisation’s Five Steps to Safer Surgery checklist.
• Medicines are recorded and stored in line with trust policy.
• Resuscitation equipment is checked in line with professional guidance.      
• Medical staff complete mandatory training, in line with trust targets and national guidance.
• Changes made following never events are fully embedded in clinical practice to minimise the risk of reoccurrence.

For Ipswich Hospital the action includes ensuring:-

Urgent and Emergency Care

• Staff comply with infection prevention and control measures.
• Staff undertake thorough risk assessments, including environmental risk assessments, to ensure its premises and facilities are suitable for the safe care and treatment of patients with mental health needs.
• All medications are appropriately and securely stored.
• All patient records, including medication and fluid charts, provide a detailed record of patients’care and treatment and both paper and electronic records are appropriately and securely stored.
• There is an effective governance and risk management framework in place to identify, manage and assess all risks relevant to the emergency department.
• There are clear lines of accountability in the emergency department. Standard operating procedures should be developed and embedded in all areas.

Medicine

• That venous thromboembolism (VTE) assessments are completed for all patients in line with guidance.
• That food and fluid balance charts are completed accurately and contemporaneously.

Surgery

•  Learning from incidents is embedded into clinical practice.

Critical Care

• That consent and best interest decisions are documented clearly in patient records, and that mental capacity assessments are carried out as soon as there is reason to doubt whether a patient has capacity to make decisions about their care.
• That mandatory training compliance and appraisal completion improves in line with the trust target.

Maternity

• That all risk assessments are completed for women.
• That women have their physiological observations taken in accordance with the service’s policy.

Outpatients

• That the administration of hospital prescriptions is monitored and recorded.

The CQC also found 30 things the trust SHOULD improve to comply with a minor breach that did not justify regulatory action, to prevent breaching a legal requirement, or to improve the quality of services.

Whilst there are several areas that need improvement the report identifies areas of outstanding practice in urology services at Colchester Hospital and in critical care and maternity services at Ipswich Hospital. It also identified that staff worked well together and treated patients with compassion and kindness. 

For more information you can read the full CQC report here.

Stacey Anderson, FCILEx in the Clinical Negligence team at Thompson Smith and Puxon, said “It is disappointing that the trust has been rated as requires improvement again by the CQC, the same rating as the previous inspection in 2017. Hopefully the trust will use the report to make the necessary improvements to ensure patients accessing the trust’s services are kept safe.”

If you think you may have been the victim of a medical accident or inadequate care, contact our Clinical Negligence team on 01206 574431 or by email at info@tsplegal.com to find out more about how we can help you with your potential claim.