CQC unannounced inspection raises concern

MEDICAL and end-of-life care at the Royal Cornwall Hospital Trust’s Treliske hospital have been rated Inadequate in the latest report by the Care Quality Commission (CQC), while Emergency Services has been rated as Requires Improvement.

During the unannounced visit in January, a team of inspectors focused on areas for improvement as identified at the previous inspection in January 2016. This included patient flow.

CQC’s Chief Inspector, Professor Sir Mike Richards, said: “It is disappointing to report that despite our previous concerns, we have found little sign of real improvement since our last inspection.

“We are well aware of the demands on the service – but once again we have found that too many patients are waiting to be diagnosed, treated, admitted or discharged.”

In May 2016 Healthwatch Cornwall spent 12-hours in the emergency department (ED) reviewing patient flow, talking with non-urgent patients about the reasons they had ended up at the ED.

Overall, on this day, most people had tried other ways of seeking help such as minor injury units but circumstances beyond their control meant they still ended up at the ED.

Healthwatch Cornwall Chief Executive Amanda Stratford said: “We shared this feedback with the hospital as part of its work to improve alternative options so it is frustrating to see that despite some valid effort there is no easy cure.

“We will continue to work to ensure patient experiences influence RCH decision making and we are pleased to note that this report acknowledged some outstanding work in the ED, including that it was calm and professional during the unannounced inspection and that it had experienced, committed, caring and strong local leadership.”

The latest CQC findings did acknowledge that issues relating to discharge were not solely the responsibility of RCH, citing a “lack of effective support from the wider healthcare community” as a contributor.

Since January, health and social care commissioners and providers have been streamlining Cornwall’s sustainability and transformation plans, known locally as Shaping Our Future. This will provide an opportunity to ensure both NHS and local authority can join forces effectively to address system-wide issues.

Healthwatch Cornwall attends its board, which looks at how all services are commissioned and delivered in Cornwall, enabling us to feed in public opinion directly to those making potential changes to services.

In January 2016 Healthwatch Cornwall brought together more than 100 health and social care organisations dealing with end-of-life at our A Good Death conference to review the situation and work towards improvements, including the fulfilment of one of our recommendations to create a multi-agency end-of-life care review group.

Amanda added: “In light of our previous end-of-life work it is a shame to see the Inadequate rating, which relates particularly to processes at the Royal Cornwall Hospital (RCH).

“We are aware of the effort put in place to make improvements and it is good to note the high regard in which the specialist end-of-life team is held.”

Medical care was found to have low levels of staff satisfaction, high levels of stress and work overload.

The CQC will return to the hospital in July to re-evaluate and decide on further actions needed.

Kathy Byrne, Chief Executive at RCH said: “We have an opportunity with the full CQC inspection in July to demonstrate the action we have taken to improve and to provide the evidence that our care is safe and effective.

“The unannounced inspection in January took place on two of the most difficult days for our services with demand throughout the trust at the most extreme levels but it is right that we confront the issues raised in this report.”

In addition to these findings, Healthwatch Cornwall is concerned that a recent CQC inpatient survey of more than 1,000 patients, which, overall, showed confidence in care, fell down on patients being asked their views on quality of care during their stay and access to information on how to make a complaint.

To improve this we are meeting with the hospital’s patient experience team to discuss these points further as we believe it is our ability to provide patient feedback that will help the health and social care sector in Cornwall make the best choices.

You can read the full CQC report here:

Access the inpatient report here:

The CQC has told the trust that it must make a number of improvements including:

  • The trust must review the emergency department to ensure that it recognises and addresses risks, safety, and quality of care. This must also include actions from avoidable patient harm, progress with audits, and demonstrable learning and improvements when there are incidents, complaints, and other indications of emerging or existing risks.
  • There must be a review of how end-of-life patient care is captured within the trust’s incident reporting system. The trust must address timeliness and inconsistencies in the quality of investigation reports for all serious incidents, including patient deaths.
  • The trust must continue to review and put in place measures to address and manage patient access and flow, and ensure patients are appropriately discharged, working closely with system partners to achieve workable solutions to the current barriers.

The inspection team also found a number of areas of Outstanding practice:

  • Inspectors found an outstanding commitment to medical simulation training in the emergency department and this extended to the production of detailed and valuable case studies.
  • There had been an outstanding response to trauma and stroke patients in the emergency department. The department was among the top hospitals in the country for providing timely and appropriate care.

The Care Quality Commission will present its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings. Healthwatch Cornwall will update on the outcome.