East Riding NHS trust sent back into special measures after patient care gets even worse

The Care Quality Commission (CQC) made the recommendation that Northern Lincolnshire and Goole NHS Foundation Trust should return to special measures following its latest inspection.

The trust, which provides services to 350,000 people across the East Riding, north and north east Lincolnshire, was one of the first in the country to be put into the special measures regime in July 2013 after being identified as having higher than expected death rates.

It came out of the regime in April 2014 following improvements in care.

But during the latest visit to two sites run by the trust, Scunthorpe General Hospital (SGH) and Diana Princess of Wales Hospital in Grimsby, inspectors identified significant concerns in urgent and emergency care, outpatient and maternity services.

Although the latest mortality rates have been found to be “as expected”, the health regulator still rated the trust as “inadequate” after identifying the issues.

The trust apologised for “letting down” its patients.

The latest inspection, which took place late last year, highlighted a number of shortcomings, including:

• A “deterioration” of waiting times in a number of areas - data from November 2016 showed that two patients had been waiting for surgery for more than a year.

• Inspectors said they were “not assured” that emergency patients at SGH were offered food and water - out of 33 sets of notes reviewed, only one had documented that a patient had a drink of water.

• The regulator said it did not feel confident that if a child’s health deteriorated that it would be recognised. The Paediatric Early Warning Score - an assessment to pick up when a child’s health is in decline - was not in use in the emergency department at SGH and although used at the Grimsby hospital, it had not been consistently completed.

• The numbers of nurses and doctors on shift were not always high enough to meet the needs of patients.

• Inspectors said they found “poor leadership” in a number of services, particularly maternity services and urgent care.

• There were “poor infection prevention and control processes and standards of cleanliness” at SGH in the emergency department - inspectors noted several equipment trolleys were dirty and dusty, sharps bins were overflowing and cleaning schedules showed that the resuscitation room had not been cleaned since April 2016.

• Officials said they remained concerned about the organisation’s culture, adding: “there was a sense of fear amongst some staff groups regarding repercussions of raising concerns and bullying and harassment”.

CQC said the trust needs leadership support to develop a robust improvement plan.

NHS Improvement said that it had accepted the recommendation that the trust should be put in special measures.

The trust was also placed into financial special measures by NHS Improvement last month - which means it is given support to help it get back on a stable financial footing.

Richard Sunley, interim chief executive at Northern Lincolnshire and Goole NHS Foundation Trust, said: “We are disappointed with, but fully accept, the shortfalls the Care Quality Commission has identified.

“We are sorry we have let down our patients, their families and carers by not meeting the quality standards they rightly expect.

“Whilst we had made some improvements since the inspection in October 2015 - our critical care, end of life care and community services have improved and are now ‘good’ - we recognise we have not addressed all the Care Quality Commission’s concerns.

“We are determined to move forward and make changes with pace and focus so we can consistently deliver high quality standards for patients across all of our services.”

Ellen Armistead, deputy chief inspector of hospitals at CQC, said: “Having seen improvements to patient care previously, we are disappointed that our latest inspection of Northern Lincolnshire and Goole NHS Foundation Trust found these improvements had not been sustained and there had been an overall deterioration in quality and patient safety.

“We will continue to monitor the trust and will return to check on the progress it must make. NHS Improvement will be working closely with the trust to ensure full support is available to make the improvements needed.”

NHS Improvement’s executive medical director Dr Kathy Mclean, added: “The trust is facing a number of challenges at the moment and we’re absolutely focussed on helping it to improve quickly for its patients. Our work with the trust will make sure that it has strong plans in place to bring about rapid improvements to patient care.”