Cumbria Crack

CQC Report: North Cumbria University Hospitals NHS Trust “requires improvement”

Stephen Eames

‘Staff offering kind and compassionate care’ is what the Care Quality Commission (CQC) found when they inspected services at North Cumbria University Hospitals NHS Trust (NCUH) in July and August 2018.

In the CQC’s report published today (Thursday 22 November), the overall rating for the Trust remains as ‘requires improvement’ however more services are now rated as ‘good’ overall and staff who ‘promote dignity and respect privacy’ were praised throughout the Trust.

The CQC inspected five services within NCUH; urgent and emergency services, medical care, surgery, maternity and services for children & young people, as well as how ‘well led’ the organisation is. It covered services across the West Cumberland Hospital, Whitehaven (WCH), the Cumberland Infirmary, Carlisle (CIC) and the Birthing Centre at Penrith Hospital.

The inspection considers whether services are safe, effective, caring, responsive and well-led and a rating is given for each of these as well as an overall rating for the service between inadequate, requires improvement, good and outstanding. Across the Trust, services were rated as follows:

  • Maternity: good
  • Medical care (including older people’s care): requires improvement
  • Services for children & young people: good
  • Surgery: good
  • Urgent and emergency services: requires improvement

In all services staff were recognised for their hard work and the kind and compassionate care they provide and all were rated as good for caring. Comments from the CQC included:

“Patients were supported by staff who were kind and compassionate despite being under pressure. Feedback from people who used the service and those who were close to them was positive about the way staff treated people.”

Improvements were recognised in several key areas including surgery and maternity which are both now both rated as good overall. For surgery this was as a result of several factors including adopting the innovative composite workforce model, a lower than average length of stay and positive patient feedback. In maternity services the rating reflected improvements in team working across the hospital sites and patients feeling supported and positive about their care with services planned to take account of women with complex needs.

Services for children and young people retained their good rating from the 2017 inspection. Areas for improvement identified in 2017 had been addressed and a good culture was identified, with staff feeling valued, respected and proud to work for the Trust. Patients and their families felt fully informed and were positive about the compassionate and sensitive care staff delivered.

Several areas of outstanding practice were identified including Disablement Services, the Trust’s Advanced Care Practitioner (ACP) programme and the fact that the Trust was rated top in the UK in a patient satisfaction survey on kidney care. Disablement Services, one of nine specialist rehabilitation services in the country, provides enhanced services to veterans who lost a limb because of their service in the armed forces. In addition, the ACP programme trains clinical professionals from a non-medical background to work at ‘registrar’ level in acute medicine and is being used to successfully address shortages of medical staff in north Cumbria.

Other areas recognised by the CQC include the new Reach Out delirium service which has drastically reduced the number of patients staying in hospital who develop delirium and as a result has helped to reduce the average length of a hospital stay. Joint working across the health system in north Cumbria, through the development of Integrated Care Communities (ICCs), was also highlighted. In particular the CQC noted the impact of the Home First team, based in A&E, which works with community health teams to help people avoid a hospital stay by putting extra support in place at home.

The CQC also published a Use of Resources report based on an assessment by NHS Improvement. This area was also rated as requires improvement however they noted outstanding practice in joint working to reduce Delayed transfers of Care (patients who are medically fit to leave hospital but experience delays), innovative recruitment efforts, use of technology and a significant reduction in MSK referrals thanks to earlier screening.

Several areas for improvement were also raised by the CQC and work is already underway to address these. Some issues raised during the inspection were addressed immediately and this has been recognised within the report. For example, changes have been made to mental health assessment areas in the A&E departments at WCH and CIC to improve safety and upgrades to WiFi have improved access to electronic systems.

Stephen Eames, chief executive of NCUH and Cumbria Partnership NHS Foundation Trust, said: “The report shows that we have made some significant improvements since the last inspection in 2017 despite the pressures our services are under. In particular, our surgery and maternity services have both received improved ratings of good which is fantastic news for our staff and patients.

“I said throughout the inspection that we were aiming for good and although we didn’t achieve this overall, we have made real progress which we should all be proud of. The fact that all services were rated as ‘good’ for caring is testament to our hard working staff and I want to thank every one of them for the dedication they show day in, day out.

“Our urgent and emergency services are now rated as requires improvement and we are addressing the issues that were raised by the CQC. We know the pressures that these services are under not just in north Cumbria and as we move into winter we have plans in place to improve patient flow and to ensure patients are being treated in the right place at the right time. It was encouraging to see that the report highlighted the impact that working together across the health system is already having and by continuing to do this we will ensure people are treated in the best place for their needs.

“I’d like to thank all staff once again for their continued commitment to improve services to enable us to provide the best care for people in north Cumbria.”

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