Immediate improvements needed at Horton hospital trust, says CQC

The Care Quality Commission (CQC) has demoted Oxford University Hospitals NHS Foundation Trust to an overall rating of ‘requires improvement’ following inspections in November, December and January.

As a result of concerns about the state of operating theatres at the John Radcliffe Hospital, revealed in January, the watchdog has imposed conditions on the trust to ensure changes are made.

Improvements are also needed around the safety at the trust and its leadership, as well as staff being treated equally and ‘urgent and emergency services’ at the Horton.

But staff at the trust were praised for treating patients with compassion, described as a ‘strong and engaged workforce’, and feedback from patients is consistently positive.

Trust chief executive Bruno Holthof said: “I would like to thank all staff whose compassion and kindness has quite rightly been recognised by the Care Quality Commission.

“Thanks to their dedication and hard work, the CQC has rated our services as ‘good’ for being caring, responsive and effective.

“However, we recognise that we are only partway through a journey to improvement and this is reflected in our overall rating by the CQC as ‘requires improvement’.

“We look forward to working together with our staff, patients, foundation trust governors, and partners in the local health and social care system to continue to address those areas identified by the CQC where we know we need to do better.”

Oxford University Hospitals trust runs four hospitals in Oxfordshire: the Horton, the JR, the Churchill and the Nuffield Orthopaedic Centre.

Inspectors visited the trust’s multiple sites to check the quality of five core services – urgent and emergency care, medical care, surgery, maternity, and gynaecology – as well as looking specifically at management and leadership.

The Horton was highly praised at the last inspection in 2014, where the trust was rated as ‘good’ overall, but the Banbury hospital’s emergency department (ED) was heavily criticised in the latest report.

The report says the environment was not always suitable for services provided, privacy and dignity was compromised for some patients and there was not always enough nursing staff, with the right mix of qualification and skills.

“There was no vision for what the ED at the Horton General Hospital wanted to achieve and no workable plans developed with involvement from staff, patients, and key groups representing the local community,” it adds.

At the JR, the CQC used its urgent enforcement powers to impose three conditions on the trust’s registration within surgical services. These are:

• To ensure patients’ privacy is always maintained, including when they are asleep, unconscious or lack capacity when in the main operating department. This included ensuring all windows in doors to theatres are obscured.

• To produce an action plan to assess and mitigate the risk of infection and the risk to the health and safety of service users receiving care and treatment and the risk to staff in the main operating department.

• Each week the trust must submit a report to the CQC, which describes the action taken and sets out the evidence which demonstrate those actions are being taken in regard to the points above.

Inspectors found that department managers had the right skills and abilities to run a service providing high-quality care. But, at board level there were some key areas where the team lacked expertise.

There was a drive to develop future leaders, but there was no formal board development plan in place for this, according to the CQC.

The trust did have systems in place for identifying and reducing risks, but these were not always effective. There were areas where poor practice presented a risk and had not been recognised as such.

In the emergency department at the John Radcliffe Hospital, demand for services frequently outstripped the availability of appropriate clinical spaces to care for patients.

Emergency department waiting times from referral to treatment and discharge were not always meeting national standards.

However, the way staff cared for patients was applauded, as they provided emotional support to patients to minimise their distress and involved patients and those close to them in decisions about their care and treatment.

CQC deputy chief inspector of hospitals Nigel Acheson said: “Since our last inspection, Oxford University Hospitals NHS Foundation Trust has not sustained the momentum and imbedded the improvements that were necessary.

“As a result, the trust’s overall rating has moved from ‘good’ to ‘requires improvement’.

“We have made it clear to the trust where it must take action to improve and have placed urgent conditions on the trust’s registration to ensure these improvements do take place.

“We will remove those conditions when we are satisfied that the trust has made sufficient progress to provide the quality of services that its patients are entitled to expect.

“However, I am pleased to note that the trust has a strong and engaged workforce who worked together for the benefit of patients, although it is concerning to find that some staff particularly those with protected characteristics under the Equality Act, did not always feel they were treated equitably.”

A trust spokesman said refurbishment works to the operating theatres are being carried out, including further minimising infection risks, carrying out remedial work to floors and cupboards, improving storage facilities, and adding privacy screens to all anaesthetic and theatre doors.

While work planned before the inspection, including sealing cracks on doors and walls and repairing floor tiles and damaged walls, began in April and are progressing well, the spokesman added.

The trust listed several ways it has addressed concerns raised by the CQC:

• Building work on a major expansion of the emergency department at the JR started in April in order to meet increasing demand for services – new facilities will include an extra nine bays for the immediate care of seriously ill patients

• Significant progress has been made in reducing waiting times at the JR’s A&E – performance improved by 4.2 per cent year on year in 2018/19

• A major ‘culture and leadership review’ was launched in May to ensure that all staff – including those with protected characteristics under the Equality Act – experience a compassionate and supportive culture

• Following an independent review of leadership and governance by Deloitte last year, the trust is now implementing changes at executive level to strengthen areas where more expertise was required and investing in divisional management teams to improve clinical and managerial leadership

• The design of a formal trust board development plan is also being progressed

Banbury MP Victoria Prentis commented: “Almost all of my constituents will have used the trust’s services at some point. Safety matters to us all.

“I was very concerned to read the CQC’s report and will be following up with the trust to ensure residents of north Oxfordshire receive the best quality care.”

To read the full report, visit www.cqc.org.uk/provider/RTH.