A&E: REQUIRES IMPROVEMENT

THE trust responsible for Oxfordshire’s hospitals has admitted ‘significant’ further work is needed within A&E at the John Radcliffe.

Citing long patient waits, overcrowding and staffing issues, the Care Quality Commission again gave the department a ‘Requires Improvement’ rating.

The inspection took place well before OUH, which dealt with 13,286 A&E attendances that month, had been hit by the most severe winter pressures.

Medical director Dr Tony Berendt said: “In the current context where all services are under enormous pressure, with lots of issues around staffing and patient demand, we are pleased with the progress made in the last two and a half years.

“We are disappointed for all the hard-working staff who have put a lot of effort in.

“But we recognise some elements will require quite significant further work at a system level.”

In the report it was noted that patients were waiting far longer than 15 minutes, the accepted standard, to be assessed on arrival at A&E and the JR performed ‘significantly worse’ than the England average on the A&E four-hour waiting time target.

Concerns were also raised over ‘variable’ levels of staff training in areas such as resuscitation, Mental Capacity Act training and conflict management, which Mr Berendt attributed partly to the high turnover.

Overcrowding was also reportedly a problem. Inspectors said: “The space and layout of the department significantly affected efficiency.

“The resuscitation area contained four bays and was often used to accommodate more than four patients.

“In cases when capacity did not meet demand a screened corridor was used to accommodate more than four patients.”

The trust is currently building a business case to regenerate its estates that will include expansion of the space, but no immediate change is planned.

Other issues raised by the CQC included patients with mental health conditions not being treated in a ‘secure’ environment, which had reportedly led to absconsions from A&E in the past.

Patients were not always offered refreshments and the CQC said pain relief was not always given in a timely manner.

OUH is also in the process of going ‘paperless’, partly its iPad-based SEND system to keep electronic patient care records some of the time, and using paper elsewhere, which the CQC said was leading to difficulties.

Dr Berendt said: “From August we expect to be entirely paperless. When you make that transition there are some risks and we are moving through that transition as rapidly as possible.”

A page-long series of areas for OUH to take action in was included in the CQC report.

Dr Berendt said: “I am very confident we will sort out these things.

“It will be work, but the CQC picked up on the dedication of staff, openness and willingness to learn and that is an enormous resource.”

STILL TO DO

Oxford University Hospitals NHS Foundation Trust has been told it must:

• Improve mandatory training levels for medical and nursing staff

• Improve safeguarding children level 3 training for medical and nursing staff

• Ensure patients receive an initial assessment in A&E within 15 minutes of arrival

• Provide an appropriate, safe environment for the care and treatment of patients who have been detained under the Mental Health Act

• Review the use of paper and electronic records in A&E to make sure notes are contemporaneous

• Make sure staff are correctly following the sepsis pathway

• Ensure pain is appropriately managed in a timely manner

• Ensure patients in A&E are offered food and drinks

SURGERY: RATED GOOD

WORLD-CLASS surgical skills and the dedication of teams at the John Radcliffe Hospital has been recognised by inspectors in a newly-published report.

The compassion and care of staff across eight operating theatres at the Headington site was praised by the Care Quality Commission following a visit on October 11 and 12 last year.

Surgery at the JR, formerly rated ‘Requires Improvement’, has received a ‘Good’ rating across all areas in the report published yesterday.

In their summary, inspectors said: “There was a safe number of staff with appropriate skills, training and experience to keep patients safe.

“Ward and theatre areas were clean and tidy; we saw most staff following good infection prevention. There was strong multi-disciplinary working across teams.”

More than 35,000 surgical procedures were carried out at the JR in the 2015/16 financial year, of which more than a third are emergency and almost half are day cases such as cataract operations and appendectomies.

The eight theatres that were visited are used for emergency, spinal, vascular, cardiac and plastic surgery, as well as trauma and neurosurgery.

The CQC noted: “We saw staff treated patients with compassion and care. They were kind and treated them with dignity and respect.

“There were systems to support patients with additional or complex needs. Patients felt informed and involved in their care.”

Surgical procedures at the John Radcliffe Hospital have been televised many times over the years and staff are often first in line to use cutting-edge technology due to cross-over with the Oxford Biomedical Research Centre (BRC).

The CQC inspectors also pointed out that when things did go wrong surgical staff were quick to flag up problems and learn from them.

Between October 2015 and July 2016 there were six ‘never events’ in surgery, defined as incidents that should never happen, including an incorrect lens implant and an incorrect nerve block during cataract surgery.

But inspectors said: “The trust had investigated each incident and had an overarching action plan in place with a particular focus on human factors training.

“These events were published in the trust newsletter for all trust staff to learn from the incident.”

Elsewhere in its report the CQC praised the efforts and caring nature of NHS staff across the board.

Professor Richards said: “Staff we spoke to valued and respected the needs of patients and their families.

“Staff took account of the needs of different people, including those with complex needs when planning and delivering services.

“There was an open culture within the hospital.”

Yesterday Oxford University Hospitals NHS Foundation Trust welcomed the report despite improvements needed in emergency care.

Chief executive Bruno Holthof said: “The positive overall tone of the report is extremely encouraging and our staff should be rightfully proud, particularly given ongoing heavy demand on our services.

“The Trust Board and I also recognise that there have been great improvements as part of urgent and emergency care, and we would like to thank staff in our Emergency services for their continued hard work.

“The CQC has identified aspects of care in which the trust must improve and we are already in the process of producing an action plan to address these areas.”