CQC Report

22 October 2015

England's Chief Inspector of Hospitals is recommending that Burton Hospitals NHS Foundation Trust should come out of special measures following an inspection in July by the Care Quality Commission (CQC).

Special measures were introduced to help support trusts to make improvements in the quality of care for patients. If Monitor, the body responsible for Foundation Trusts, accepts the recommendation, Burton will be the tenth trust taken out of special measures since the regime began in July 2013.

Professor Sir Mike Richards and his inspectors found sufficient improvements across services at the trust – particularly in medical care, critical care, the emergency department (A&E), children’s services and in regard to safety and leadership– to make the recommendation.

Professor Sir Mike Richards, CQC’s Chief Inspector of Hospitals, said: “I am pleased to be able to make my recommendation to Monitor to take Burton Hospitals NHS Foundation Trust out of special measures.

“I can say with some confidence that special measures is doing what it intended to do.

“This is the latest example of what can be achieved by a trust in special measures when there is a clear commitment from the senior leadership team to improve the quality of care, a concerted effort by staff and a package of support.

“The trust has made significant progress in the services we looked at since our last inspection. Staff spoke positively about the trust and were keen to demonstrate how much had changed and improved since previous inspections. Staff described an open culture that empowered them to work collaboratively to meet patient’s needs. It was also reassuring to note that formal complaints had nearly halved since the previous year.

“There was a positive culture of reporting incidents and learning from them, with safety concerns reported and investigated. Staff are aware of their safeguarding responsibilities and are trained effectively. There is good communication throughout the organisation and the morale and culture of the organisation has improved. This has, I have no doubt, led to the improvements in the quality of care as we found staff were kind, caring and compassionate towards patients.

“I am recommending that the trust has some short term support in the first few months of exit to allow it to embed a post-special measures plan. However, I am confident that the trust has made the appropriate clinical improvements.”

The inspection report notes that there is still further work to do, particularly regarding delays in the outpatient department, the lack of clear pathway for patients needing emergency gynaecological treatment and concerns regarding patient flow throughout services. Inspectors did not see any evidence that the trust had set any clear and realistic goals beyond specials measures or developed a leadership plan as to how they would do this.

The trust was placed into special measures in July 2013 after concerns were raised about mortality rates and standards of care.

A further inspection in April 2014 rated the trust as Requires Improvement, but there was a recommendation to extend the time in special measures.

Following the inspection in July 2015, CQC has rated Burton Hospitals NHS Foundation Trust as Requires Improvement overall. It was rated as Good for whether its services were effective and caring and rated Requires Improvement regarding whether it was safe, responsive and well-led.

The inspectors noted some outstanding practice, including:

  • Critical care had developed an organ donation group to improve and promote organ donation within the hospital and the local community.
  • The maternity service was awarded the Excellence in Maternity Care award by the Comparative Health Knowledge Systems (CHKS) in 2014. The quality of care at Burton Hospitals NHS Foundation Trust was judged to be the best out of 148 NHS maternity providers in England, Wales and Northern Ireland.
  • The trust had been awarded a UNICEF Baby Friendly Initiative accreditation. This meant that the trust supported women and babies with their infant feeding choices and encouraged the development of close and loving relationships between parents and baby.
  • Inspectors saw innovation in practice on a male surgical ward where infection control nurses had worked with staff to reduce the risk of infection and increase hand hygiene.

However, there are some areas that must improve, including:

  • The trust must improve the uptake of statutory and mandatory training among emergency department staff.
  • The trust must take steps to minimise the number of medical outliers across the hospital to ensure patients are cared for in the place best suited to their health needs by staff with the right skills to meet their needs.
  • The trust must review the number of bed moves made by patients, especially at night.
  • The trust must review the use of agency staff on surgical wards, and ensure staffing levels and skills mix are maintained and all staff have access to the relevant records.
  • The trust must ensure that all identified learning from investigations into recent Never Events are fully implemented and signed off to ensure that learning and changes to practice have been put in place.

CQC will return in due course to check that improvements have been made.

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