West Suffolk Hospital loses 'outstanding' rating and is told to improve
West Suffolk Hospital has lost its 'outstanding' rating and has been told to improve by the health regulator.
The Bury St Edmunds hospital's trust has been judged 'requires improvement' by the Care Quality Commission (CQC), which found 'significant concerns and risks to patients' in the maternity service with a warning to improve by the end of this month.
Although staff were praised for treating patients with 'compassion and kindness', inspectors highlighted issues with the trust's leadership and how some staff felt unable to raise concerns 'without fear of retribution'.
Staff did not feel listened to and saw others who raised concerns 'be penalised'.
There was a failure to consistently identify or address safety concerns 'quickly enough' and the trust 'continued to underperform across a large range of national access standards'.
Of the trust's five acute core services, maternity, medical care and outpatients were rated as 'requires improvement' while urgent and emergency care and surgery were 'good'.
It found areas of 'outstanding practice' in community health services for children and young people.
Dr Stephen Dunn, chief executive of the trust, said they had 'addressed the immediate safety concerns' and recognised they 'must continue to quickly and effectively fix the issues raised'.
Earlier this week, the Government revealed it had ordered a 'rapid and independent' inquiry into the hospital's handling of a whistle-blowing incident.
Professor Ted Baker, chief inspector of hospitals for the CQC, said the trust's decline after two years as 'outstanding' was 'disappointing'.
“We had particular concerns about the assessment of risk to mothers and babies in maternity services and have issued a warning notice meaning that improvements must be made by the end of this month," he said.
“We also found that the style of executive leadership did not demonstrate an open and empowering culture.
"There was an evident disconnect between the executive team and some consultants.
“Safety concerns were not consistently identified or addressed quickly enough, and incidents were not always reported in a timely manner.
"Wider lessons were not identified or shared effectively to improve patient safety.
“Not all staff felt respected, supported and valued or felt that they could raise concerns without fear of retribution.
"This has been exacerbated by the way the trust has managed recent issues of concern.
“However, we found that staff worked well together for the benefit of patients across the trust and supported them to make decisions about their care.
“Across services, leaders actively engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.
"A family centred approach was observed in the community children and young people service.
“The trust has told us they have listened to our inspectors’ findings and its board knows what it must do to ensure it makes the necessary improvements.
"We will return to check on the progress they have made.”
Actions the trust must take to improve include:
- Take definitive steps to improve the culture, openness and transparency throughout the organisation and reduce inconsistencies in culture and leadership.
- Ensure the culture supports the delivery of high quality sustainable care, where staff are actively encouraged to speak up and to raise concerns, and where clinicians are engaged and encouraged to collaborate in improving the quality of care.
- Maintain effective process for the management of human resources (HR) processes, including staff grievances and complaints, in line with trust policy.
- Ensure processes for incident reporting, investigation, actions and learning improve are embedded across all services and that risks are swiftly identified, mitigated and managed.
- Implement a nationally recognised monitoring vital observations tool for women attending triage on labour suite and the maternity day assessment.
- Implement a national recognised monitoring vital observations tool for new born babies on the labour suite and F11 ward.
- Ensure outpatients can access the service when they need it and receive the right care promptly in line with national targets.
Dr Dunn said: "We are clearly disappointed, as this is not the standard that our patients and community deserve.
"We’ve addressed the immediate safety concerns and the trust has taken action - including the introduction of nationally recognised monitoring for women and their babies.
"We’ve listened to what the CQC has said and getting things right for our patients is our top priority."
He added they were pleased 'hardworking staff have been recognised'.
The CQC received 10 whistle-blowing concerns between September 2018 and September 2019, five of which were received in the three months leading up to inspection.
Several of the whistle-blowing concerns included 'factors around poor engagement, communication and leadership'.
It noted: "Six of the 10 whistle-blower contacts we received between September 2018 and September 2019 raised concerns that there was an apparent reluctance by the senior executive team to hear and accept feedback of a negative nature.
"We heard examples from staff that information they had provided in confidence, to various individuals including the FTSU (Freedom to Speak Up) guardian, had become known."
Communications sent during a complex serious incident investigation were seen by some staff as 'quite threatening in nature with a focus for apportioning blame'.
A meeting was held to address concerns but a subsequent letter to the medical staffing committee chair 'could be considered intimidating, and confirmed the continued disconnect around communication'.
Trust chair Sheila Childerhouse said: "We will be reviewing our culture and openness to make sure there is an environment where everyone – including our patients, our staff and our commissioners – has an opportunity to contribute and play a full part in our improvement.
"I am still immensely proud of the work our staff do, every day, to care for people in their time of need.
"We will make the improvements required."
Addressing the maternity services concerns, Healthwatch Suffolk said its own data shows 'themes that align well with the issues reported by the regulator'.
"This includes that mothers have told us about their worries related to the availability of staff, the extent to which their pain levels are monitored and infection control measures," a spokesman said.
"Whilst feedback concerning maternity staff is mixed in sentiment, there is a high level of praise for midwives and the kind support offered to mothers during and after the birth of their baby.
"This is also consistent with the CQC report, which rates the department as ‘good’ for whether staff are caring."
He added that Healthwatch Suffolk hopes to be 'involved in the improvement plans the trust will be developing to respond to CQC'.
Dr Ed Garratt, chief executive of the NHS West Suffolk Clinical Commissioning Group, said it will work 'closely with the trust to help it bring about the necessary improvements required to deliver the very best patient care possible'.
Health Secretary Matt Hancock, West Suffolk MP, said: "Obviously this is a disappointing report, and I know everyone who relies on and works at the West Suffolk will be concerned to read the findings.
"The hospital is much loved locally, and I know the hospital accept the report and are determined to put things right.
"I will do all I can to support the West Suffolk as it deals with the challenges it faces, and I offer my support to all staff in addressing them."
Bury St Edmunds MP Jo Churchill, who is a junior health minister, said: “The outcome of the CQC report is disappointing and I have real concerns with some of the findings.
"The comments around midwifery and culture need to be addressed as a matter of urgency.
"Every parent should feel confident in the maternity care they receive, and it is imperative that every procedure and safety precaution is implemented by the hospital when delivering care.
"I am also concerned with the processes for incident reporting and investigation at the hospital, as all staff should feel that they can speak up and have the confidence that anything they raise will be taken seriously and the improvements they suggest are acted on.
"However, I have been assured by the chief executive and leadership team that the comments have been taken on board and they are proactively working hard to implement the CQC recommendations in order to deliver the high quality standards patients expect and deserve.
"I have previously offered to meet with stakeholders at the hospital and will do so again, if this is felt to be of use.
"I would urge stakeholders now to work together to drive forward the recommended improvements to ensure that patients at West Suffolk Hospital receive the best care possible."