Inspectors from the Care Quality Commission have found improvements at Lynn’s Queen Elizabeth Hospital but there is still more work to be done.
The CQC’s chief inspector of hospitals Prof Sir Mike Richards is recommending that healthcare regulator Monitor lift special measures from the QEH.
The hospital was rated as requires improvement but received three good ratings out of the five categories.
Key findings from the report, which was issued today (Thursday, July 30), found staff to be kind, caring and compassionate along with “significant improvements” throughout many specialities including A&E, surgery and medicine.
Outstanding areas were the new A&E children’s waiting area, commitment of midwifery service and relatives praising the “well organised and effective” paediatric team.
But it found that nurse staffing was “insufficient” in the neo-natal and paediatric unit and the total number of cancelled operations remained high but there was a downward trend.
Sir Mike said: ““There is good communication throughout the organisation and the morale and culture of the organisation has improved. This has, I have no doubt, led to improvements in the quality of care as we found staff were kind, caring and compassionate towards patients.
“There is still further work to do, particularly in bringing maternity services up to the same standards. I hope the trust continues the momentum so that all services are providing the level of care which the people who live in Lynn deserve.”
The trust was rated as “requires improvement” under the safe services category.
The report states: “When we inspected in 2015 we found that the trust made significant improvement in all areas to ensure the patients were protected from avoidable harm. There remained areas where this work was on going but the trust was monitoring all these areas. We have rated this domain as requiring improvement as there remained issues around documentation of care, medicines storage and the duty of care of patients with single organ failure.”
The report states that the trust continues to have challenges recruiting specialist posts in medical and nursing disciplines.
It states: “We found that recruitment to palliative care consultants, endoscopy consultants, and within nurses with paediatric and neonatal skills as well as registered midwives was ongoing and this meant that services were not always covered by staff with the appropriate skills and experience. The trust had taken action to mitigate these risks but further improvements were required to ensure that patients were protected from avoidable harm and received a high quality service.”
A good rating was recorded for the effective services section.
Inspectors reviewed the effectiveness of urgent and emergency medicine, which had been previously rated as requiring improvement or not rated.
The report states: “We found that the effectiveness of the urgent and emergency services was good and patients experienced good outcomes.
“In medicine, we had previously rated this service as requiring improvements in this domain due to issues with staff not receiving feedback from audits and service improvement not being made following audits. At this inspection we found that improvements have been made.”
The hospital received a good rating for providing caring services but the team did not formally assess the care given to patients.
The report states; “However we observed patients being treated with dignity and respect. We saw that staff and patient interactions were positive and staff genuinely wanted to provide good care for patients.”
But the hospital received a requires improvement rating for responsive services.
The report adds: “During our inspection in 2015 we found that all services had improved although maternity, end of life and outpatients still required further improvements to ensure that they met people’s individual needs. We found that surgery had moved from inadequate to good as services had worked hard to improve their responsiveness to patients through improved waiting times for surgery and reduced cancellations of operations.”
Bed occupancy ranged between 79 per cent and 83 per cent between April 2013 to September 2014. Inspectors also found that a service had been introduced to help women who had previous complications in pregnancy and more women were being offered water births after the pool room had been refurbished and increasing staffing levels.
Inspectors said that some of the clinics were not well signposted around the hospital and extra seats had been purchased for outpatients.
The report states that the layout of emergency department in individual zones made it “challenging” to observe the capacity and flow throughout the department.
Inspectors found that the flow of the service had been improved by the management of the bad capacity within the hospital.
The report states: “With capacity in the hospital available we observed that the flow within the ED worked well throughout the duration of the visit.”
A good rating was given for the service’s leadership.
The report says: “Whilst there are some local leadership issues which require improvement in maternity and in end of life care services overall the trust leadership is strong and cohesive with a clear vision and strategy there we have rated this as good.”
Chief-executive Dorothy Hosein said work had started to make further improvements with a new midwife led unit later this year and further recruitment campaigns.
She said: “When I came into post in November 2014 I was very blunt that we would require at least six months to prepare for inspection.
“In this short timeframe it has been a challenge but clearly the CQC saw positive changes and we are, as we say at the Trust, on our journey towards excellence.
“We adopted an evidence based approach to our preparation for the inspection. This approach meant that we were able to clearly demonstrate to inspectors that we understand every aspect of our hospital and have control of it.
“We could show them we know where further improvement is needed and are already well on the way to addressing the areas of concern highlighted.”