The Care Quality Commission (CQC) has told York and Scarborough NHS Foundation Trust it must make improvement in some of their services following inspections undertaken from October to March. CQC told the trust it must also improve its leadership after finding a decline in how well-led they were.
CQC initially inspected medical care, maternity services and urgent and emergency care, during inspections at York Hospital and Scarborough Hospital in October. Due to concerns found in relation to maternity services at both hospitals, as well as in urgent and emergency care at York Hospital, CQC issued a letter of intent asking the trust to make rapid improvements in the following areas:
- Maternity services at both hospitals, relating to managing people whose health was deteriorating, people who were waiting for care, as well as medicines management issues.
- In the emergency department at York Hospital, the mental health room was unsuitable and there were concerns regarding managing people with deteriorating health.
- When CQC returned to reinspect the above services during the well-led inspection in November, there had been some improvement in urgent and emergency care.
However, improvements had not been made in maternity services, so urgent conditions were placed on the trust in these areas to ensure people’s safety by driving rapid improvement. This related to having effective systems in place to monitor and manage risks to people’s safety.
Following the November inspection, CQC received information of concern and extended the well-led inspection, which continued until March.
Since the inspection, the overall rating for the trust as well as for how safe it is, remains rated as requires improvement. How effective and responsive the trust are, have dropped from good to requires improvement, and how well-led the trust is has declined from requires improvement to inadequate. Caring remains rated as good.
The ratings for these services at each of these hospitals following this inspection are:
- Medical care – previously suspended, now rated requires improvement
- Maternity services – has declined from requires improvement to inadequate
- Urgent and emergency care – remains rated inadequate
- Medical care – remains rated requires improvement
- Maternity services – has dropped from good to inadequate
- Urgent and emergency care – improved from inadequate to requires improvement
Sarah Dronsfield, CQC deputy director of operations in the north, said:
When we inspected York and Scarborough NHS Foundation Trust, we didn’t find well-led services. We were concerned to find leaders didn’t always understand or effectively manage all the priorities and issues the trust faced. Although improvements had been made in medical care since we issued a warning notice in March last year, at our visit in October we found further serious concerns around maternity services and urgent and emergency care.
In some areas we found there wasn’t always an open culture where staff could raise concerns without fear. It’s important the leadership team tackle this as a priority, as everyone should feel they are able to speak up and be listened to. Staff have important information to share that can keep people safe. Also, leaders must address poor behaviour between staff which shouldn’t be tolerated. All staff should be able to work in a friendly and supportive environment to enable them to deliver high quality care.
This lack of poor leadership was having an impact across all of the services we visited. We saw people using services being put at risk of harm from a lack of good processes, such as staff not completing risk assessments or keeping people’s care plans up to date. We also saw infection control processes weren’t effective in urgent and emergency care, with dirty equipment and premises, and clinical waste not being managed appropriately. Processes must be improved so all staff can be supported to have the relevant information and environment to give people appropriate care, in a safe way.
The trust wasn’t always providing maternity care in a way that was planned to meet the needs of local women and people using services. It was concerning people couldn’t access services when they needed to.
However, most staff treated people with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
Following the inspection, we fed back our serious concerns to the trust leadership team and we expect to see rapid and widespread improvements. We’ve been working closely with the trust and partner organisations to make sure people are safe, and will return to check improvements have been made and embedded so people receive the high standard of safe care they deserve.
Inspectors found the following during this inspection:
- There weren’t enough staff with the right qualifications, skills, training or experience to keep people safe from avoidable harm and to provide the right care and treatment.
- Staff didn’t always meet the trust target for mandatory, role specific and safeguarding training.
- Maternity services and urgent and emergency care at both hospitals, medical care at York Hospital didn’t manage medicines well.
- Managers didn’t always investigate incidents and share lessons learnt promptly.
- In maternity services, staff didn’t always monitor the effectiveness of care and treatment so they could learn from it and make improvements in order to achieve good outcomes for women and people using the service.
- Urgent and emergency care at York Hospital and maternity services at both hospitals didn’t always plan and provide care in a way that met the needs of local people.
- People couldn’t access some services when they needed it to receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge people weren’t in line with national standards.
- Senior leaders weren’t always visible and didn’t always support staff to develop their skills. The vision and strategy had not yet been embedded. They didn’t always use systems to manage performance effectively or make decisions and improvements.
- Staff didn’t always feel respected, valued, and supported. They weren’t always clear about their roles, responsibilities, and accountabilities.
- Leaders and staff didn’t always engage with people, staff, equality groups, the public and local organisations to plan and manage services.
- Most staff helped people understand their conditions and provided emotional support to people, families, and carers.
- Across the trust staff advised people on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
- Key services were available seven days a week.
Simon Morritt, Chief Executive, York and Scarborough Teaching Hospitals NHS Foundation Trust, said:
We welcome the CQC’s findings. As is the case across the NHS we have been under sustained pressure and this has impacted our ability to consistently provide the standard of care we all want, which is reflected in the concerns highlighted by the CQC. Nevertheless, we accept the CQC’s findings and recognise that we have much more work to do to make sure all our services are of the high standard that our patients and staff expect.
We were pleased that in giving a rating of ‘Good’ for the key question of ‘Care’, the CQC recognises the kindness and compassion of our staff who continue to put our patients first despite the most challenging of circumstances.
I am also encouraged that the CQC found positive improvements against some of their previous concerns. This includes improvements in systems related to nutrition and hydration for patients on medical wards on both sites, and the impact that the introduction of our new electronic assessment system is already having on saving staff time and reducing risk.
They also talked positively about the improvements to systems for managing demand within Scarborough emergency department, and it is fantastic to see that the overall rating for urgent and emergency care at Scarborough has been lifted to requires improvement.
Dr Karen Stone, Medical Director, York and Scarborough Teaching Hospitals NHS Foundation Trust, said:
We continue to work with the CQC to address their recommendations and have plans to focus on the key priority areas where we know we need to continue to make sustained improvements.
We responded immediately to the urgent findings identified at the time of the inspection, and in the months since the visits we have made positive progress against areas highlighted in the report.