1. Care and welfare of people who use services

CQC: The inspectors noted there had been substantial improvements in stroke care and a reduction in time taken to produce radiology reports.

But waiting times for cancer patients were too long, and too many patients waiting to be transferred from hospital to their own homes or to care homes.

ORH: The trust has introduced additional weekday and weekend operating sessions across all three hospitals, including 30 extra sessions over the next 12 weeks, to meet the 18 week standard waiting time in the coming months.

It is offering patients the option of attending other hospitals for quicker treatment if possible.

It has significantly reduced the number of patients waiting over 18 weeks.

The trust has an excellent new cancer centre at the Churchill Hospital with world class facilities with many clinical outcomes above the national average.

There has been a steady rise in referrals of patients with suspected cancer and the trust needs to improve capacity and performance to respond to this increase.

It has been working with the Department of Health to look for ways to improve the efficiency and timeliness of investigation and treatment of cancer patients.

2. Staffing

CQC: The trust’s own data showed there were not enough staff in parts of the trust, including shortages of obstetricians and midwives, and a shortage of nursing staff in the surgical emergency unit at the John Radcliffe Hospital.

On some wards, there was an urgent need to supplement shortfalls caused by vacancies, maternity leave and sickness. There was a high use of agency and bank staff in some areas to support wards and ensure patient safety.

ORH: Staffing levels are reviewed each month by the trust board and bank and agency staff are used to keep staff at agreed levels. The trust is continuing to fill vacancies to reduce the need for expensive agency staff. There have been real improvements in staffing levels since September, specifically within the surgical emergency unit and the number of midwives.

It is introducing electronic rostering, a computerised system to improve the organising nursing and nursing support staff rotas.

3. Supporting workers

CQC: Inspectors said staff shortages meant attendance was too low at essential training, including safeguarding training and health and safety management. The level of supervision of clinical staff varied, and many staff did not receive an annual performance appraisal.

ORH: Clinical divisions are working to improve attendance at statutory and mandatory training, and actions plans are being developed to improve the uptake of the training. The appraisals process is continuing and new procedures have been approved, including a revised appraisal policy.

4. Assessing and monitoring the quality of service provision

CQC: The trust has measures to assess and monitor the quality of its patient care, with improvements in the information made available to members of the trust board. Serious incidents are also investigated thoroughly.

While the trust had introduced a new monitoring and governance structure, it was not yet clear that there was a systematic process in place to show how changes were implemented, followed up and monitored.

Inspectors said that since these changes needed time to embed, the trust was not yet able to demonstrate that the systems were working effectively.

ORH: There have been significant and positive changes at the ORH in the last year, including a new chief executive and new executive directors.

The trust has undertaken a review of governance arrangements and is improving reporting and assurance processes.

It has also reorganised its clinical management structure so doctors and nurses have direct authority and responsibility for the running of clinical services.