HOSPITAL boss Sir Jonathan Michael said action is being taken to address failings at Oxford’s John Radcliffe after the biggest ever inspections of county hospitals.
He said increasing demand on the hospital was putting staff and beds under pressure and said Care Quality Commission (CQC) inspectors visited on February 25 – the busiest day of the year – amid winter pressures.
Concerns included long A&E and surgery waiting times, cancelled operations and under-staffing at the Headington hospital.
The chief executive of Oxford University Hospitals NHS Trust (OUHT) told the Oxford Mail the JR rating is “perhaps a bit disappointing”.
The trust has been told it has to improve in six areas.
Sir Jonathan Michael, chief executive of the Oxford University Hospitals NHS Trust, being interviewed by Oxford Mail health reporter Oliver Evans.
He said: “The overall rating for the trust is good, that is really pleasing, that is a satisfactory outcome.
“The John Radcliffe is the largest and most pressured of the trust’s hospitals and undoubtedly where we see the highest level of emergency activity.
“We have been experiencing increasing demands which has put quite a lot of pressure on services.”
Between 2009/10 and 2012/13, the trust saw emergency inpatient admissions go from 79,940 to 88,316 and outpatient attendances from 771,237 to 835,448.
He said: “They are pressure points we already know about and were working on. There was nothing there that came as a surprise.
“They are being addressed, they are in process, most of those areas we knew there was work to be done.”
One breach was that the trust did not have an efficient booking system for out-patient appointments, leading to long waiting times.
Sir Jonathan said: “We are making sure we have the right balance between new patient appointments, follow ups and the right number of clinics.
“We will never get anything perfect. What we take out of the report is that overall, our systems are good.”
He said the 11 breaches of the Health and Social Care Act had to be measured against the 104 areas it was found in compliance.
Sir Jonathan said of staffing shortages: “It is an expensive place to live. These are the kind of things that impact on our ability to recruit and retain staff.”
A spokesman for Healthwatch Oxfordshire – the official health and social care regulator – said: “It is important that action is taken to address the shortfalls described in the outpatients, accident and emergency and surgical areas at the John Radcliffe Hospital.”
The watchdog acknowledged action had been taken and that there was “strong evidence” of positive work but raised concerns the JR report said some senior surgical clinicians “felt disempowered and believed they had no voice”.
The spokesman said: “Creating a working culture in health and social care services which enables staff to speak out safely about pressures and challenges is a particular priority for Healthwatch Oxfordshire.”
Oxford East Labour MP Andrew Smith congratulated staff on the “positive report” as the JR has “been working under such pressure”.
He said: “I do, though, also get some complaints, and there are important areas in the CQC report, like the preparation of care for vulnerable patients, including those with dementia, where remedial action is required.”
Oxford West and Abingdon Conservative MP Nicola Blackwood said the trust’s good rating is “very much in line” with what constituents tell her. Pledging to monitor progress, she said: “It finds our local hospitals are safe and caring even though they are coping with very high demand, especially in A&E.”
KEY FINDINGS OF THE REPORT.
- WHERE ACTION IS NEEDED.
The eleven breaches include: five within treatment of disease, disorder or injury; two in surgical procedures; two in maternity and midwifery services; and one each in family planning and termination of pregnancies.
- WAITING TIMES.
The CQC said the trust is “regularly missing waiting-time targets due to the lack of available beds to discharge people effectively” in A&E.
Its outpatient consultation clinics are “failing to provide an effective booking service, failing to meet national standards for timely referral to treatment”.
It said in “some surgical specialties waiting times for surgery were too long and operations were cancelled too often.”
For example, a maxillofacial surgeon said they “struggled to meet increasing demand and that access to emergency theatre was a particular problem” and this had hit the quality of their care and waiting times.
In the week the CQC visited, some 284 of the 2,352 patients who attended A&E at the JR and Horton were not seen in four hours. This meant 87.9 per cent were seen against a target of 95 per cent.
ACTION: The trust must plan and deliver care safely and effectively to people requiring emergency, surgical and outpatient care.
The trust had “failed to consistently safeguard the health, safety and welfare of patients because they did not ensure that at all times there were sufficient numbers of suitably qualified, skilled and experienced staff employed” in maternity, surgery, termination of pregnancy, and family planning theatres.
For example, the JR delivery suite “had been without a manager for the 18 months prior to our inspection due to difficulties in recruitment” and was being covered by three midwives.
The CQC found: “This did not provide consistency in the management of the delivery suite.
“Although the delivery suite provided women in labour with one-to-one care, staffing levels were not always sufficient to ensure women received the care and support they needed.”
It said the trust “has difficulties in recruiting and retaining sufficient staff, particularly nursing staff and healthcare assistants” at its four hospitals.
It said: “The high cost of living in Oxford coupled with the difficulty and cost of parking is felt to be an issue.”
ACTION: There must be enough qualified, skilled and experienced staff to safely meet people’s needs at all times.
- ASSESSING VULNERABLE PEOPLE.
The CQC said “there was not suitable attention paid to the identification, assessment and planning of care needs for vulnerable people, particularly those with dementia in surgery and A&E”.
For example, it found: “We observed a lack of support for a patient with dementia, who was restrained by security guards.”
A Sunday visit to A&E found three unaccompanied children in the waiting area, which reception staff could not see and four nurses walked past without noticing them.
The CQC said: “When we asked the reception staff about these children they did not offer a solution to providing any supervision.
“One of the parents returned to the children 15 minutes after we first became aware of them.”
- PRIVACY AND DIGNITY.
It said of the JR: “The use of the accident and emergency triage room, the atrium area, and layout of the reception did not give patients privacy and dignity.”
It said two visits found the window blinds were open to the corner room and inspectors “heard the discussion with the patient” and “no-one questioned our presence”.
It said the patient told them: “I’m really glad you witnessed that and have told me who you are, but you could have been anyone. This seems normal around here, and has no-one thought about it?”
ACTION: The trust must plan and deliver emergency care to people in a way that safeguards people’s privacy and dignity.
- PATIENT RECORDS.
The CQC said: “There was no suitable information within care records to inform staff about the individual care patients needed. This was particularly in relation to the needs for vulnerable people, particularly those with dementia and patients requiring complex wound management.”
It said “risk assessments, monitoring records and care plans were not all fully completed and were not explicit in how risks were to be managed”.
The report said a lack of information “could mean that patients’ care was not as effective as it could be”.
For example, fluid and food charts had not always been completed when sought by dieticians.
ACTION: Patient records must accurately reflect the care and treatment for each patient in line with good practice.
The report said: “Some of the new nursing staff coming to work at the hospital did not have sufficient induction into the A&E department.”
It said newly-qualified midwives “did not always receive adequate” support from a senior staff member and, along with some nurses qualified overseas, were not all “appropriately supervised”.
It recorded one overseas nurse saying: “They said they had been trained in their own country in a different skill set from the nurses in the UK and were expected to perform tasks which they had not been trained to do.”
ACTION: Staff must receive suitable induction in each area that they work.
ACTION: The trust must ensure that newly-qualified midwives are appropriately supported.
Read the full reports below:
- CQC John Radcliffe Hospital report May 2014.pdf
- CQC Oxford University Hospitals Trust report May 2014.pdf
- CQC Nuffield Orthopaedic Centre report May 2014.pdf
- CQC Churchill Hospital report May 2014.pdf
- CQC Horton General Hospital report May 2014.pdf
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