Ongoing concern as Worcestershire trust placed in special measures

Worcestershire Acute Hospitals NHS Trust, which serves over half a million people, has been placed in special measures amidst severe concerns over understaffing, overcrowding and unstable leadership.

The Care Quality Commission (CQC) had already identified safety risks in the trust’s two emergency departments at Worcestershire Royal Hospital and Alexandra Hospital, during a previous inspection in March.

In its annual report for 2014-15, the acute trust predicted a deficit of £31.3m for this financial year, as well as large volumes of older, sicker patients resulting in delays to discharges and high numbers of temporary medical staff required to cover vacancies.

In April of this year, the NHS TDA launched an investigation into the trust after West Midlands Ambulance Service had to dispatch a doctor to treat patients in the corridors of Worcestershire Royal’s A&E department after the hospital refused to admit them for an extended period of time. The body also appointed an improvement director that has been giving the provider ongoing support ever since.

But the trust is also responsible for a third hospital in Kidderminster, where the CQC identified a series of other problems in the maternity and gynaecology wards during its latest inspection.

“One of the reasons we rated the trust as inadequate for being well-led and safe was because when things went wrong, they were not investigated promptly or thoroughly and there was a lack of learning from these incidents to prevent patient harm in the future. This was particularly the case in the maternity and gynaecology service,” said Professor Sir Mike Richards, CQC’s chief inspector of hospitals.

“While the trust had a vision and a set of values, these were not well embedded or understood by staff. The way some divisional teams were run was not effective.”

Latest inspection

In the latest inspection, carried out in July, the CQC found that the trust had an over-reliance on temporary staff as a result of staff shortages. This was particularly worrying within medical staff, with a reliance on locum doctors putting extra strain on some services.

The trust also demonstrated a lack of staffing stability at board level, which in turn affected how issues were addressed. Its executive team has undergone significant change recently, meaning the majority of directors were in interim positions and many were new to the organisation.

Other issues were again raised within the emergency departments, where consultant cover did not meet the Royal College of Emergency Medicine’s workforce recommendations.

There was still overcrowding in these areas posing an ongoing risk. While action was taken to improve patient take-up and flow, waiting times were still not meeting national standards.

 “My inspection team found that the majority of staff were hard working, passionate and caring, but had to struggle against the pressures they faced,” said Prof Richards.

The inspectorate also found the trust had an outstanding caring approach to patients in maternity and gynaecology, despite a high dependence on locums to fill in for middle-grade doctors. Good practice was also highlighted in the critical care unit, end of life service, surgery and in medical care.

Prof Richards continued: “The trust managers have told us they have listened to our inspectors’ findings and have begun to take action where it is required. We have maintained close contact with the trust since the inspection and will undertake further inspections, including unannounced visits, to check that the necessary improvements have been made.”

The trust’s chief executive, Chris Tidman, agreed that both its board and health commissioners recognised the improvements left to be made, and said the decision to temporarily suspend birthing services at Alexandra Hospital had “significantly reduced” service risk recently.

“Everyone working at our hospitals will be very disappointed that overall we are rated as inadequate, especially following the efforts all our teams have made in the last four months since the inspection to improve our services,” he said.

“We recognise that we have achieved a great deal in a short space of time, including improving against key performance targets, but we are by no means complacent.”

Jeffrey Worrall, portfolio director at the NHS TDA, said the body accepted the CQC’s recommendation for special measures and that it will ensure the provider continues to receive “intensive support to embed long-term improvements”.

“There is an ongoing improvement plan in progress across the trust and all partners recognise the need for continued, enhanced support to remain in place for the foreseeable future,” he said.

“We will also identify high performing organisations for the trust to work with and focus improvements in specific areas.”


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