1. ITV Report

'Inadequate' hospital to be placed in special measures

Hospital due to be put into special measures Credit: ITV Anglia

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

“It is extremely disappointing to see a trust that not only hasn’t improved since our last inspection, but where there has been an obvious deterioration in how the services are run.

“Although staff at the trust were clearly caring and committed to helping patients, and we found some areas of outstanding practice, we were very concerned by how the trust is being led and with many of its systems and processes.

– The Chief Inspector of Hospitals, Professor Ted Baker
The hospital is likely to be put into special measures Credit: NNUH

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 Chief Inspector said it was worried about a 'bullying culture' at the trust. Credit: ITV News Anglia

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

The hospital says lack of capacity and sustained high levels of demand over winter put services under extreme pressure. Credit: ITV News Anglia

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

“The NHS has been through one of the longest, toughest winters on record and I would like to thank staff across all professions and support services at the Trust for everything they have done, and continue to do, for our patients and colleagues. The CQC team also recognised the consistently caring approach by our staff.

“In the nine months or so since the start of the inspection process we have continued to work on many improvements, which, in line with CQC recommendations.

“We are starting to see the positive impact of these and other changes Across all services the CQC has rated us as “Good” for Caring, this year the Trust has the fifth most improved staff survey in the country.

"NNUH has one of the lowest mortality rates in the East of England (a key indicator for quality in hospitals).

“However, we absolutely recognise there is still much to do and that we have some significant challenges to deal with, particularly in relation to staff feeling able to speak up and raise concerns."

– Mark Davies, Chief Executive, Norfolk and Norwich University Hospitals NHS Foundation Trust