Newcastle's NHS Trust told to make improvements following CQC inspection

The Newcastle-upon-Tyne Hospitals NHS Foundation Trust has been ordered to make improvements following an inspection from the Care Quality Commission (CQC).

Inspections carried out in June, July and September last year saw the Trust's overall rating drop from "outstanding" to "requires improvement".

The CQC carried out unannounced inspections in surgery, services for children and young people, and medical care at the Freeman Hospital and the Royal Victoria Infirmary (RVI), as well as urgent and emergency care at the RVI.

The Trust's patient transport service, known as NECTAR, was also inspected as part of the CQC's continual checks on the safety and quality of healthcare services.

A targeted inspection also took place in the cardiothoracic surgery department at the Freeman Hospital in September.

This was carried out in response to concerned raised by whistleblowers regarding the culture, specifically about bullying and harassment and safety concerns. Another focused inspection of maternity services at the RVI in response to whistleblowing concerns about safety and culture.

CQC inspectors found the following during their visits to Newcastle's NHS Trust:

• The trust did not always store and manage medicines safely.
• Not all staff reported incidents in a consistent and standardised way. Staff CQC spoke to did not always receive feedback or learning from incidents.
• Care and treatment were not always delivered in accordance with national guidance or evidence-based practice.
• Managers did not always monitor the effectiveness of the service they were providing or always work well together for the benefit of people.
• Staff did not always feel respected, valued, and supported.
• The trust did not always promote equality and diversity in daily work.
• Although governance processes were in place, they did not always operate effectively across the trust to ensure risk and performance issues were identified, escalated appropriately, managed, and addressed promptly.

Regardless of the negative points, the CQC found that staff treated people with compassion and kindness while respecting their privacy and dignity, took account of their individual needs, and helped them understand their conditions.

It was also ruled that staff had received training in key skills and understood how to protect people from abuse, as well as showing ongoing examples of innovation and research.

Ann Ford, CQC’s director of operations in the north, stated the the Commission's experience suggests that Newcastle's NHS Trust "isn't well-led".

She said: "When we visited The Newcastle upon Tyne Hospitals NHS Foundation Trust, we found a significant deterioration in how well the trust was being led.

"Our experience tells us that when a trust isn’t well-led, this has a knock-on effect on the standard of services being provided to people.

“We found leaders had the skills and abilities to run the trust but they weren’t using them to always manage the priorities and issues they faced in a timely way.

"Also, the board had a lack of oversight at all levels to effectively manage and reduce risks to people.

“We were also concerned to hear the trust didn’t have an open culture where staff could raise concerns without fear of blame or punishment.

"Some staff told us that bullying was a normal occurrence, and they were encouraged to ‘turn a blind eye’ and not report this behaviour.

"This is completely unacceptable and must be addressed by the leadership team as a priority to enable staff to provide the best possible experience to people.

“I want to thank the staff who came forward to give feedback, I know speaking up in these circumstances isn’t easy, but it’s really important because it helps us understand where organisations may need to focus its attention to identify and address any issues."

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Despite poor results in the CQC inspections, Ann praised staff at the Trust for their work in providing care to those who needed it.

She added: "Although we found a number of concerns across the trust, we also found staff were proud to work for the organisation and were providing good care.

“Inspectors also found some outstanding practice. For example, in children and young people’s services at both hospitals, staff were exceptional in supporting families and loved ones to understand a child’s condition and they knew when to escalate concerns, so the child received appropriate care as soon as possible.

“Since these inspections, a new chief executive and other senior leaders have joined the trust and know where improvements need to be made.

“We will continue to monitor the trust and will return to carry out another inspection, to ensure the necessary improvements have been made and embedded so people receive the safe care they deserve.”

Sir James Mackey, Newcastle Hospitals’ new chief executive, has confirmed that a programme of improvements is already underway.

Sir James commented: “We fully accept the CQC’s reports.

“Their clear recommendations for attention and improvement are being worked on as a matter of urgency and I am confident we can fix this by working together across the organisation and focussing on what matters to patients and staff.

“A detailed programme of activity is already underway and will continue until we, and the CQC, are assured the issues have been addressed.

"This will involve some tough decisions but it’s important we get this right and that people can see change happening.

“Of course, it is a huge disappointment that our overall rating has been reduced and to hear of the difficulties experienced by some colleagues.

“I know from speaking to many staff over the last few weeks that providing the best possible patient care remains an absolute priority for everyone at Newcastle Hospitals. 

“While this is a challenging time, it’s important to emphasise that the inspectors saw and highlighted the compassion and kindness of our teams and rated ‘caring’ as ‘good’."

The CQC's report can be viewed by visiting: https://www.cqc.org.uk/provider/RTD.

Members of the public can also view the report for the further targeted inspection of cardiothoracic surgery at: https://www.cqc.org.uk/location/RTD01/inspection-summary#surgery.