The Norfolk and Norwich University Hospital NHS Foundation Trust is being put into special measures following a Care Quality Commission (CQC) inspection which has rated it as inadequate.
Between 10 October 2017 and 28 March 2018, a team of CQC inspectors visited the trust and inspected urgent and emergency care, surgery, end of life care, outpatients and diagnostic imaging services.
Inspectors say the running of the trust has deteriorated since their last visit and now 'requires improvement.'
There are particular concerns over whether the trust is well led, and several unannounced inspections were made to investigate between January and March 2018 after concern from whistle blowers.
The Trust, based in the county of Norfolk, serves a population of 822,500.
The trust is also rated as Inadequate for whether its services are safe, Requires Improvement for whether its services are effective and responsive and Good for whether its services are caring.
- Click below to watch a report on the Norfolk and Norwich Hospital
The Chief Inspector said it was worried about a 'bullying culture' at the trust.
He felt the trust should be put into special measures so it can receive more support.
“We will continue to monitor the trust’s progress and this will include further inspections.”
There are a number of areas where the trust must make improvements.
- Bed management and site management processes need to be reviewed in order to increase capacity and patient flow, and to ensure there are effective processes which ensure patient safety.
- The relationship and culture between the site management team and the senior nursing and clinical teams must improve so that patient safety is equally weighted against operational pressure to reduce risk to patients and staff.
- Processes for whistleblowing must be reviewed and the trust’s leadership must take definitive steps to improve the culture, openness and transparency throughout the organisation.
- Mandatory training attendance must improve so that all staff are aware of current practices and the trust must review the knowledge, competency and skills of staff in relation to the Mental Capacity Act and Deprivation of Liberty safeguards.
- The completion of staff annual appraisals must improve and there needs to be an effective process for quality improvement and risk management across all departments.
The CQC’s inspection also found some areas of outstanding practice.
Inspectors found there were impressive pathways for the management of stroke and fractured neck of femur patients. The urgent and emergency service worked with the trust’s specialist teams, even in the ambulance bay, to assess and treat patients quickly and effectively as possible.
The cardiology outpatients’ department had a physiotherapy cardiology breathing pattern disorder clinic and, through this, had produced significantly improved the outcomes for patients.
A forum for outpatient staff, established in 2017, provided opportunities for networking and communication across divisions, grades and specialties and, as part of this, staff explored shared issues and set up project groups to resolve those issues.
Some outpatient areas were offering innovative treatments. This included the dermatology outpatient area which offered the ‘gold standard’ treatment for basal cell carcinoma (BCC), known as Mohs surgery. This procedure allows for the removal of all cancerous cells for the highest cure rate while sparing healthy tissue and leaving the smallest possible scar.
The report is available here
In response to the report, the Norfolk and Norwich University Hospital NHS Foundation Trust issued a statement saying it welcomed the report and accepted the findings.
The Trust's Chief Executive Mark Davies said: "Lack of capacity and sustained high levels of demand over winter put our services under extreme pressure and I would like to apologise to our patients that we were not always able to provide the level of service that we would have