Unsafe, poorly led and dysfunctional - Shocking report into Norfolk hospital
PUBLISHED: 09:10 13 September 2018 | UPDATED: 15:25 13 September 2018
"Things have gone wrong." That was the admission from the Queen Elizabeth Hospital (QEH) in King's Lynn today as it was revealed the trust had been judged unsafe and poorly led, leading it to be put into special measures by inspectors.
The report details a litany of failures and sees QEH join the Norfolk and Norwich University Hospital (NNUH) in its inadequate rating.
It leaves the James Paget University Hospital (JPUH), in Gorleston, as the only acute hospital in the county not in special measures. JPUH is rated as good.
The report into the QEH found particular problems with maternity.
Waiting areas for antenatal clinics were shared with patients who had fertility concerns, and women who suffered miscarriages or still births were placed in close proximity to women giving birth.
The report said “leadership within the service had broken down” and midwives said they thought consultants had downgraded the level of harm on incidents after reviewing them.
It said: “There was a breakdown in the relationship between consultants and midwives and between senior leaders within the service.”
And the culture in the department was described as “dysfunctional”. Staff who spoke to inspectors were “very emotional” and repeatedly told them consultants did not engage with the midwives. While consultants said they did not receive support from senior management or respect from midwives.
The report said: “Professional working relationships between the midwifery staff and the consultant body were fragmented to such a point that the safety of patients within the service was impacted.”
Nearly a quarter of midwifery staff were not trained in resuscitation, nor were 35pc of medical staff. And resuscitation trolleys were not fully stocked or included out of date medicine.
The CQC’s chief inspector of hospitals, Professor Ted Baker, said: “On our return to the The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust found there had been a deterioration in the service provided since our last visit and a number of improvements were needed.
“Our inspection found concerns in urgent and emergency care, maternity and medical care. All three departments are now rated as inadequate overall following our inspection and surgery, which was previously rated as good, is now rated as requires improvement.
“Our concerns in relation to the maternity service were such that we raised these with the executive directors while on site, issued a warning notice to the trust, identifying areas where it must improve, and placed conditions on the trust’s registration. We know the trust initiated an immediate action improvement plan for maternity services and we will return to check on improvements in the service.
“We have reported our findings to the trust leadership and it knows what it must do now to bring about the necessary improvements.
“The trust has been told it must make improvements in a number of areas and this includes that patient care records must be accurate, complete and contemporaneous, including those relating to weight and nutritional assessments and fluid balance charts. Mental capacity assessments must be consistently and competently carried out where required.
“Processes for incident reporting, investigation, actions and learning must be embedded across all services. And serious incidents must be identified, reported and investigated in a timely manner.
“The duty of candour must be carried out as soon as reasonably practicable and the trust must ensure clear processes are in place for sharing learning from incidents, complaints and audits with staff.
“The trust must ensure that the information used to monitor, manage and report on quality and performance is accurate, valid, reliable, timely and relevant.
“It must improve the culture, working relationships and engagement of consultant staff across all services and make sure effective process for managing staff grievances and complaints are in place.
“However, we found outstanding practice in the multi-disciplinary rapid assessment team which worked in the emergency department to help patients who didn’t need to be admitted avoid being admitted to hospital or swift discharge for patients who were able to be discharged.”
QEH chief executive Jon Green said: “Reading the report leaves me saddened. We fully accept all that the CQC have said and I would like to apologise to those patients who we have let down and to our dedicated staff who work so hard under sometimes extreme pressures. I am determined to ensure this organisation improves and meets their expectations.
“We have already started to address the issues highlighted in the report and have comprehensive plans in place to ensure we turn this situation around. Our vision is to deliver high quality, patient centred, integrated care and we continue to work towards this.”
“The leadership of the QEH are committed to this organisation and evidence shows the longer leaders are in place, the more that stability helps drive up standards. We are strengthening the trust’s leadership and are working with our system partners to make the necessary improvements to our services and the hospital estate.
“When we welcome the CQC back into our organisation next year I feel confident we will be able to demonstrate significant improvements to them, many of which are already under way.
“I know from the letters and compliments I receive the importance of the Queen Elizabeth Hospital to the community it serves. We and our dedicated staff are working hard to meet our patients’ expectations. We are listening to them and the wider community. Patients should feel confident about being cared for at the QEH.”
Darren Barber, chairman of the QEH Joint Staff Consultative Committee, added: “This report makes sad reading for everyone at QEH, especially the staff and our patients.
“Things have gone wrong and they must be put right as quickly as possible.
“We have a long track record of working with and supporting the management of this hospital. They continue to have our support and we will continue to work with them in the coming weeks and months.”
Not enough nurses and risk of abuse
Elsewhere in the hospital, there were not enough nursing staff to keep people safe.
Inspectors said: “For example, on Terrington ward we saw a patient on the edge of their bed appearing distressed and pulling on their intravenous line, which we escalated immediately and a nurse went to check on them.”
In the diagnostic imaging department, there was potential risk of abuse to staff and patients as chaperones were not always offered in intimate procedures.
The situation in maternity and midwifery services, surgical procedures, termination of pregnancies, and the treatment of disease was so bad the Care Quality Commission issued two enforcement notices to prevent people from receiving unsafe care and treatment.
There were also six legal requirements the trust was not meeting in various areas.
Staff praised for caring
The one area inspectors found was performing well was the caring category, which often reflects staff.
The report said in urgent and emergency care: “We observed many examples of caring interactions between staff and patients. Staff were observed to be supportive and respectful.”
In surgery it said: “Staff delivered compassionate care and patients gave positive feedback about the service.”
Staff had addressed concerns from the last inspection around privacy and dignity in the breast care unit.
And in maternity: “Women spoke positively about their experiences using the service and told us that staff were kind.”
Emotional support was provided to minimise distress.
In end of life care inspectors said “dignity and respect was embedded across all disciplines” and in outpatients “staff involved patients and those close to them in decisions about their care and treatment”.
Sir Henry Bellingham, MP for North West Norfolk, said: “This really is a retrograde step and one that is especially disheartening given all the hard work that has gone into the hospital since it came out of the last special measures programme in 2015.”
“I do not believe now is the time for a change in senior management, as this is the first time in a long time that we have had a permanent senior management team, and I have every confidence they will be successful in turning the hospital around.
“Furthermore, I have no doubt that the majority of staff at the QEH are highly-professional, highly-dedicated, highly-compassionate and they will make the recovery plan work.”
Sir Henry added: “Indeed many of my constituents who have contacted me have done so to highlight the truly excellent care they have received whilst staying at the QEH. Time and again constituents tell me that they leave the QEH having had a really positive experience, and this is, of course, in part due to the professionalism, kindness and compassion shown by the staff they dealt with.
“Some people might say all the CQC does is go around looking for negative points in a hospital. Nevertheless they are there to provide protection to my constituents and the wider public. This is why we cannot ignore this report, and I will be looking to have an early meeting with the chairman Edward Libby and the chief executive Jon Green to discuss their recovery plan. It is vital the lessons flagged up in the report are dealt with as soon as possible and acted on.”