King's Lynn hospital bosses welcome 'significant improvements' in CQC inspection report

Improvements have been found at Lynn's Queen Elizabeth Hospital following an inspection report, but bosses are guarding against complacency to ensure further progression can be achieved.

The Care Quality Commission (CQC) made two unannounced inspections at the hospital between September 14-23 with all of its core services now rated as ‘Good’ for caring in the report, which was published today.

Following the inspection, the hospital remains in special measures with an overall rating of 'Inadequate' but scores for four of the services have improved from the previous inspection in March and April 2019.

Chairman of the Trust, professor Steve Barnett said: "It has been a massive team effort to score these significant improvements at a time of greatest challenge, which is testament to the competence and willingness to deliver high quality care."

Medical care, urgent and emergency care, end of life care and diagnostic imaging ratings have improved from 'Inadequate' to 'Requires Improvement' overall. The ratings for the trust’s maternity service and surgery remain unchanged, both being rated as 'Requires improvement' overall.

Additionally, all the six services are rated as 'Good' for whether the services are caring, with both the emergency department and medical care’s ratings in this key question improving from 'Requires Improvement' to 'Good'.

The rating for whether services are safe in medical care also improved from 'Inadequate' to 'Good'.

Commenting on the inspection report North West Norfolk MP James Wild said: “This positive report and the improved ratings are well deserved recognition of the determination and commitment of QEH’s staff to deliver better care for patients.

"It is particularly welcome that the Trust’s core services are now rated as good for caring and everyone at QEH should be proud of what they have achieved. The challenge now is to maintain these standards and to deliver further improvements and I’ll continue to support the hospital’s efforts in doing so.”

Inspectors have told the Trust to make improvements to ensure that anaesthetists in maternity complete PROMPT (Practical Obstetric Multi-Professional Training) training, and that staffing levels in diagnostic imaging are adequate to provide safe care and treatment to patients in a timely way.

Regarding maternity, the reports says: "The service should ensure that there are enough maternity staff with the right qualifications, skills, training and experience to provide the service."

CQC inspectors also state that there must be assurances that the out of hours staffing arrangement is sustainable and robust to provide safe care and treatment to patients in diagnostic imaging.

Trust chief executive, Caroline Shaw CBE said the overall improvement within the report was a "lovely Christmas present" for staff, but emphasised plans are in place to meet these additional targets.

She said: “We very much look forward to welcoming back the CQC to the Trust in 2021 and we are hopeful that a full inspection of all our services will result in the Trust leaving special measures and the removal of our overall ‘Inadequate’ rating.

"In the meantime, we remain very much focussed on making the further improvements required of us, including the areas identified by the CQC following their latest inspection.”

The Trust will also receive staff survey results in January in order to work on required changes.

Inspectors say they found real cultural change had taken place across the Trust and staff were "demonstrably more positive and engaged".

Mrs Shaw added: "There is recognition that the culture is changing. That does not change overnight, we are on a journey where we focus on caring for staff as well as patients which has not always been the case in the past."

She said changing the culture has entailed being clear about the leadership and values, focusing on LGBT rights, and an emphasis on rewards and recognition for staff. The annual staff awards ceremony night takes place this evening, while there have also been 'Team of the Week' and other regular awards.

Both Mrs Shaw and Mr Barnett said they have seen an increased amount of interest from prospective employees over the last 18 months. They view culture and improving performance as big recruitment drivers.

But the CQC report says the service should continue to work on the culture within the maternity department.

The CQC report notes that between April 2019 to March 2020, there were 44,281 medical admissions, 25,736 surgical admissions and 1,087 deaths.

Regarding end of life care, the report says: "All staff were committed to continually learning and improving services. They had good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research."

On the challenges presented by the pandemic, it says: "Due to Covid- 19, there had been a reduction in face-to-face mandatory training. This included life support training and safeguarding adults and children’s’ training.

"The Trust had changed face-to-face training to eLearning modules where possible, however, mandatory training compliance was below the trust target across all core services."

But it notes that staff prioritised infection control and prevention. And it says staff observed wearing appropriate personal protective equipment (PPE) and encouraged visitors to wash their hands and wear PPE when attending.

On the findings, CQC’s chief inspector of Hospitals, Ted Baker, said: “Our inspectors found improvements at Queen Elizabeth Hospital's King’s Lynn NHS Trust, but more work is needed to ensure patients always receive the care they should be able to expect.

“We have told the Trust it must take immediate action to ensure anaesthetists have the right training in maternity services and that staffing levels are sufficient to provide safe care in diagnostic imaging. We have also highlighted a number of other areas where the trust should make improvements including ensuring all mandatory staff training is completed.

“However, we found real cultural change had taken place across the Trust and staff were demonstrably more positive and engaged. Our inspection team particularly noted how caring staff were and found examples of staff who exceeded expectations to help people.

“The Trust had also successfully implemented a number of positive changes in the emergency department.

"Changes had been made to the department’s physical environment to improve patient safety and experience, infection control and prevention was maintained, the service collected information about performance so it could improve, and patients were treated respectfully, with compassion and kindness.

"The dedicated work of staff deserves recognition, a number of improvements have been made at the most challenging time for hospital services, and this is to be commended.

“The Trust’s leadership team is clear about the steps it needs to take to ensure further improvement takes place. We will continue to monitor the Trust’s progress closely and will inspect again to check on whether necessary improvements have been made.”

Alex Stewart, Healthwatch Norfolk chief executive officer, said “The CQC report demonstrates that QEH has made vast progress in extremely trying times and all the staff should be commended for their hard work.

“It’s a shame that due to COVID-19 that the CQC have been unable to undertake a complete inspection but we will look forward to the results when the final part of the inspection is undertaken in 2021. We are very fortunate to have such a dedicated team of professionals working with us in Norfolk.”