Wednesday, 8 February 2012

Watchdog threatens closure of RLI A&E Department

Royal Lancaster Infirmary
Health Watchdog The Care Quality Commission (CQC) has issued a formal warning to University Hospitals of Morecambe Bay NHS Trust, saying it must do more to improve standards of care or face further action.

The Trust was authorised by independent regulator Monitor to become an NHS Foundation Trust in October 2010. In October 2011 Monitor found the Trust to be in breach of its authorisation and a formal intervention was announced. A further announcement of intervention was issued by Monitor on Monday. 

CQC and Monitor have different powers and look at different aspects of the Trust’s performance - CQC assess quality of services while Monitor looks at leadership - but both regulators stress that they are working together to ensure that action to improve services for patients is co-ordinated. 

Debbie Westhead, North West Regional Lead for the Care Quality Commission said:
“An unannounced inspection of the Accident and Emergency department just before Christmas raised real concerns about staffing levels – staff themselves told our inspectors that these were “at crisis level”.

‘The advice CQC gave earlier this month still holds - local people should continue to use accident and emergency services if they need to. However, we are telling the Trust in very clear terms that they must urgently address their staffing issues to make sure that the department is safe going forward."

RLI Accident & Emergency Department failed inspection

The inspection of the accident and emergency department at the Royal Lancaster Infirmary took place on 21 December, with subsequent examination of staffing records. CQC inspectors found that staffing levels did not always meet the needs of people using the department. They noted a number of failings, including:

  • On 6 December, three of the registered nurses on shift were occupied in resuscitation bays, leaving only one nurse in the main department for medication administration
  • On 9 December, by 23.00 hours, the department was ‘blocked’ and only one resuscitation bay was available
  • On 15 December, the corridor was full with people awaiting attention and assistance. The shift report showed 11 four-hour waiting time breaches and five six-hour breaches.
  • On 17 December, no cover was provided for a registered nurse who was off sick
  • On 20 December, patients were waiting in the corridor and the staff shift reports stated that staff were unable to complete all the paperwork required clinically – staff were drafted in from wards to help.
  • Staff told inspectors “often staffing is at crisis level”

Maternity Unit deaths in Barrow linked to race?

The Morecambe Bay NHS Trust has been under investigation by the police since September 2011 on the coroner's advice following the deaths of four babies and two mothers in eight months at the maternity unit at Furness General Hospital in Barrow in 2008.

Out of the six deaths in 2008 involving women and babies, five were from ethnic minorities. Hospital data also showed that although just 2 percent of mothers treated at the baby unit in 2008 were from ethnic minorities,  83 percent of “serious untoward” cases involved ethnic minorities.

An inquest heard how nine-day-old Joshua Titcombe was killed by a common infection which could have been cured if hospital staff had not ignored the concerns of his mum Hoa, 32, a charity worker from Vietnam.

Former Army medic Carl Hendrickson, 46, told an inquest he had pleaded with a midwife for his Thai-born wife Nattaya, 35, and their son Chester to be examined by a doctor after she had collapsed, but his pleas were ignored and both died.

While the hospital denied any wrongdoing the health watchdog, Care Quality Commission, condemned the hospital in a report, particularly the poor standards of the maternity services.

Changes in staff have been made in the maternity unit at Furness general hospital, including the removal of a matron and the suspension of a paediatrician. However the independent regulator Monitor said Morecambe Bay NHS foundation trust would continue to be "red rated" until further notice as concerns about leadership at the trust had been reinforced by the findings of reviews into maternity services and overall governance.

Backlog of missed appointments

Monitor also noted that the Trust failed to recognise that a backlog of missed appointments was a major clinical problem. Guaranteed access dates on 37,000 access plans on the trust’s system, which covers Furness General Hospital, the Royal Lancaster Infirmary and Westmorland General Hospital, had been missed. The number of patients who missed this date and needed to be seen is thought to be around 14,000.

Monitor ordered a review into the problem, which was carried out between November last year and January this year. It found that there was no one single cause for the backlog, but the biggest problem was that trust staff had not recognised the problem. There were also concerns that false assurances had been made to the hospital management team, there was a shortage of staff and staff capacity to handle the volume of follow-ups, and changes had been made to the booking system without a full risk impact assessment being carried out. Other problems highlighted as a result of the review were the failure to bring anyone to account and poor governance.

Monitor said in recent weeks the director of operations, chairman and one of the trust's non-executive directors had resigned. It deemed the trust's governance processes and systems to be inadequate. Executive directors spent too much time on operational issues and operated "in a largely reactive manner. They should focus on making key decisions more quickly and in setting a clear direction for continuous improvement of quality," the regulator said.

Clinical leadership roles were poorly defined and clinical leadership was weak, according to Monitor. Where policies existed they were not consistently applied and understood by staff.

Morecambe Bay NHS Trust chair Professor Eddie Kane resigned in December 2011 five months before his contract was due to expire.  On Monday the independent regulator Monitor intervened in the running of the hospital trust, bringing in an interim chair, Sir David Henshaw, from Alder Hey hospital in Liverpool.

Trust's response

Responding to the Monitor reports, Chief Executive Tony Halsall said:

"The three key reports undoubtedly make uncomfortable reading for the Trust but we accept their findings. Everyone has been working hard to make the changes that are needed to resolve the current issues at the Trust and considerable progress has already made.

"However, the appointment of Sir David Henshaw as interim Chair and two new directors will give us the additional resources and expertise at the top of the Trust to drive through the changes that we still need to make, whilst also ensuring longer term improvements to our services.

"This has been a difficult time for the organisation and the on-going commitment and hard work of our staff during this time is very much appreciated." He went on to itemise a number of improvements that have been made in the Trust's services in response to regulators' findings and you can read his full response here.

1 comment:

StarlingUK said...

I don't know about anyone else, but I'd rather have a bad A&E department than no A&E department.

"It's rubbish so we'll close it". What kind of attitude is that?!