Chief Inspector of Hospitals recommends Hinchingbrooke Health Care NHS Trust is placed in special measures following Care Quality Commission inspection

England's Chief Inspector of Hospitals has recommended Hinchingbrooke Health Care NHS Trust is placed in special measures after a Care Quality Commission inspection resulted in it receiving an overall rating of ‘Inadequate’.

The trust was judged as ‘Inadequate’ with regard to whether services were safe, caring and well-led. It was rated as ‘Requires Improvement’ for whether services were effective and responsive.
Inspection teams had particular concerns about Accident and Emergency and medical care. Critical care, maternity and outpatients were all judged as good.

The inspection team included doctors, nurses, midwives, hospital managers, trained members of the public, and a variety of specialists.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“We have given the trust an overall rating of ‘Inadequate’ and I have made a recommendation to the Trust Development Authority (TDA) that the trust is placed into special measures. We have informed the TDA of the breaches and it will make sure these are appropriately addressed and that progress is monitored through the special measures action plan.

“Our inspection at Hinchingbrooke Health Care NHS Trust highlighted a number of serious concerns, surrounding staffing and risks to patient safety particularly in the A&E department and medical care. There were substantial and frequent staff shortages in the A&E department. There were a number of other areas of concern, some of which related to the way in which the trust is led and run. This is the first time that CQC has rated a trust inadequate for ‘caring’.

“Our findings highlight the significant failings at Hinchingbrooke hospital. They are not a judgment on the role of the private sector in the NHS or on franchise arrangements. Where hospitals are failing to promote good care, we will say so regardless of who owns and runs them.

“Inspectors also found some examples of good practice at the trust, but changes are necessary and the trust faces a number of challenges to ensure it meets the required standards.

“We have told the trust what action it now needs to take.”

The inspection highlighted serious concerns and CQC has told the trust it must improve. The areas for improvement include:

• Providing safe care for children in A&E. A lack of paediatric cover within the A&E department and theatres meant that the care of children in these departments was, at times, potentially unsafe.
• Making sure call bells are answered promptly. In particular, we saw some patients who did not have call bells within reach; a patient told inspectors they had soiled themselves waiting for assistance. We were told that the response of nurses to call bells was routinely poor at night time.
• Ensuring that patients’ had their food and drink needs were met. On the first day of our inspection we saw drinks out of reach of patients. We told staff, who moved the drinks closer, but the next day we saw the same problem.
• Ensuring patients’ needs are met. Six patients told us they had experienced delays in receiving pain relief. They believed this was because there were not enough staff on duty.
• Leadership. Both the Circle management team and the trust board told us that the other was responsible for holding the trust’s executive team to account.
• We identified serious concerns on Apple Tree Ward. When we raised this with the ward leadership team, they did not wish to raise it to a higher level, or through their reporting of concerns. CQC inspectors informed the executive team of the concerns. In other parts of the hospital we found staff wishing to care for patients in the best way, but unable to raise concerns. One nurse told inspectors: “We are always told to do incident forms, but who has the time and nothing changes, therefore we don’t do them”. Staff said trust policies and procedures to protect patients and staff were not effective.

Inspectors found examples of good practice at the trust, including:

• Good care in maternity and critical care which focused on patients’ needs and met national standards.
• The support chaplaincy staff gave to patients and hospital staff was outstanding.

CQC inspectors and analysts spent five days at the hospitals in September 2014. The inspection included unannounced inspections on 21 and 28 September which followed three consecutive days of inspection from 16 September which had been announced. We undertook a further unannounced inspection on 2 January 2015. This showed improvements in some areas but further improvements are needed.