Further progress required at Stockport NHS Foundation Trust

3rd October 2017

The Care Quality Commission (CQC) has told Stockport NHS Foundation Trust that it must make further improvements following two inspections in March and June 2017.

During the first inspection of Stepping Hill Hospital in March inspectors visited the urgent and emergency department and medical care, to follow up on concerns identified in the trust’s previous inspection.

Inspectors returned to the hospital in June 2017, where they focused on concerns that had been identified by CQC’s routine monitoring of intelligence.

As a result of the inspection, the urgent and emergency services department has been rated Inadequate. Although medical care remains rated as Requires Improvement, the Safe domain in medical care was rated as Inadequate as a result of the inspection. The trust’s overall rating remains as Requires Improvement.

A full report can be found at http://www.cqc.org.uk/location/RWJ09

CQC found that safety within the emergency department was still not a sufficient priority. Nurse staffing was a significant challenge with patients experiencing delay in treatment.
During the inspection of medical care in June, CQC requested immediate assurance from the trust that it had addressed the shortage of nursing staff.

Incident reporting was poor. Staff did not always report incidents in line with the trust’s policy and procedure and there was insufficient oversight of incident data from the management team.

In medical services, patients were waiting too long to be discharged from the hospital; this in turn meant that patients needing treatment were waiting too long to be admitted. The numbers of delayed discharges had increased since the last inspection.

The hospital had opened a community unit where patients ready for discharge could be accommodated until arrangements had been made to be cared for at home.

Inspectors found that services were planned to meet the needs of the local population and that staff were committed to delivering good, compassionate care.

The Chief Inspector of Hospitals, Professor Ted Baker, said: “It is disappointing to report that the care provided by Stockport NHS Foundation Trust has deteriorated since our inspection in 2016.

“It is clear that access and flow is still a major concern. Too many patients are waiting in the emergency department to be admitted, transferred or discharged – well below the standard set by the Department of Health.

“Although we recognise the pressures that the trust is under – it is clear that there are several areas where the trust can and must improve. We will return in due course to check the trust’s progress.”

CQC has identified a number of areas where the trust must make improvements, including:
• The trust must ensure that records are securely stored, legible and completed fully.
• The trust must ensure that patients with diabetes receive safe and effective care.
• The trust must ensure that incidents are managed and reported in line with their own policy.
• The trust must ensure that medications are managed appropriately and secured safely.
• The trust must ensure there is an adequate skills mix on all medical wards and that staff have the right level of competence to effectively nurse the patients they are asked to care for.
• The trust must ensure that it is compliant with the Mental Capacity Act and that all staff have the required level of training in this area.
• The trust must ensure there is consistent categorisation of the same type of incident in the trust’s incident reporting system.

Ann Barnes, Chief Executive of Stockport NHS Foundation Trust, which runs Stepping Hill Hospital and community health services in Stockport, said: “We are upset and disappointed that we have not been getting it right for every patient, and we apologise to the individual patients and their families where the reports show we were failing to provide the best care.

“We have committed and skilled staff who, despite facing many pressures, come to work every day wanting to provide the absolute best for each patient. They care deeply about what they do and this is reflected in the ‘good’ rating we received for having ‘caring’ services.

“We launched a major safety and improvement plan several months ago. A huge amount of work has taken place, with both short, medium and long-term measures being implemented.

“These improvements include work around incident reporting, extra training for the care of diabetes patients and those with mental health issues, records management and stock checking.

“Significant work is taking place across our hospital and in the community to address the continuing challenges in our A&E department. This includes better management of patients coming in overnight and at weekends, and improving the flow of patients through the hospital with timely, safe discharge so that beds are available for seriously ill patients needing to be admitted.

“We will continue the momentum of improvement at pace, both now and in the future.This includes working with our health and social care partners on new ways of delivering care to build a system that works for patients. Nothing is more important to us than ensuring that they receive the highest quality care at all times.”

Dr Colin Wasson, Medical Director said: “We are stretched and under pressure, but staff have been working incredibly hard to make improvements.

“Medical and nurse recruitment remains a challenge, as there is a national critical shortage in some areas, but our intense recruitment efforts continue locally, nationally and internationally.

“We are also developing a ward accreditation scheme with clinical staff and setting the high standards of care that we expect to see in our clinical areas.

“The impact of our efforts was recognised when Health Education England in the North West undertook a quality monitoring visit to our A&E department and medical care areas just over a week ago, to help inform the CQC.

“They found that we have made positive steps and concluded that ‘there was considerable improvement in morale, staffing levels and senior leadership in the emergency medicine department and systems in the acute care pathway’.

“The care of our patients will always be our top priority”.

Dr Ranjit Gill, Chief Clinical Officer for NHS Stockport CCG said:
“We are disappointed in the latest CQC report, however, we know that the safety and quality of patient care remains a top priority for everyone at the Trust. Despite the disappointment, we are aware that the CQC acknowledged that staff treated their patients with compassion and dignity.

“We have seen improvements in safety and quality over the recent past. This has been achieved by the trust, commissioners, regulators and partners working closely together. However, we are aware that far more is required and a plan of action has already been implemented.

“Further changes and improvements are planned and we are working with the many excellent staff at the Trust to ensure these are implemented in a timely fashion on behalf of the public. We will continue to work with the trust to identify additional changes that will lead to further improvements.

“This is not an issue of funding as comparatively more is spent on hospital care in Stockport than other similar areas.

“As commissioners, we are providing all the support we can and will continue to provide the robust scrutiny needed to ensure that future improvements result in the best care possible for all of our patients”