Last week, Addenbrooke’s Hospital and the Rosie Maternity Hospital in Cambridge, and Cambridge University Hospitals NHS Foundation Trust, which runs the hospitals, were placed in special measures, following a review by the Care Quality Commission in April this year.
The Trust is one of the largest in the United Kingdom with around 1,096 beds. Addenbrooke’s Hospital and the Rosie Maternity Hospital provide a major trauma centre for the East of England and specialist services in immunology, maternity and fetal medicine, IVF, neurosurgery, ophthalmology, genetics and metabolic diseases, specialised paediatric, cancer and transplant services. Two years ago, the Trust was not even on the CQC’s radar, having been considered to be one of the safest.
The CQC reports for both the hospitals and the Trust make interesting reading. In terms of the 5 “domains” rated, the outcome for the Trust was as follows: “safe”, “responsive” and “well-led” are all rated as inadequate; “effective” requires improvement and “caring” is outstanding. The overall rating is inadequate. In the summary of its findings, whilst the CQC explained why it had reached the overall conclusion of inadequate, it also made the point that the staff were exceptionally caring.
One of the key aspects of the review relating to “safety” was there was found to be significant shortages of staff which impacted upon the care being delivered. For example, “the critical care areas were not staffed in line with national guidance nor had the hospital systems in place to ensure that patients were not placed at risk of potential harm”. This lack of staffing extended beyond the crucial care areas and, where staff were available, there were situations in which they had insufficient experience with respect to the patients they were looking after, which posed a risk to patient safety. To compound this, the CQC identified that some of the equipment in the maternity unit was old: for example, there was a broken lithotomy pole. One of the problems the CQC appears also to have identified was that the hospital has difficulties in recruiting nursing staff, as evidenced by the high number of nursing vacancies.
With respect to “effectiveness”, the CQC rated the hospital as requiring improvement because clinical staff were not able to access information that they required, for example basic diagnostic tests such as electrocardiographs (ECGs). The CQC did identify that up-to-date guidelines were in place, but noted that they were not always followed, partly because of a lack of staff but also partly because of problems with the EPIC computer system. This was particularly identified in the maternity services, where guidelines that were not always followed included Fetal Heart Rate monitoring, venous thromboembolism and early warning score guidelines. This is worrying, given that maternity cases represent a significant percentage of clinical negligence claims. Also worryingly, staff had limited knowledge of their responsibilities under the Mental Capacity Act and were unclear about the procedures to follow when reaching decisions regarding patients’ best interests.
The hospital was also found to be inadequate regarding the domain of “responsive”, as there were significant numbers of operations that had been cancelled due to bed capacity issues. There was also a significant backlog of patients waiting for initial and follow-up appointments within the outpatients service, and governance systems in outpatients were not in place to address these responsiveness issues.
The hospital was also considered not to be “well-led”, because the arrangements for governance and performance management did not always operate effectively, an example being the lack of consideration of good practice guidance in relation to staffing in areas such as critical care. Sadly, an example being that the senior management team were unaware that staffing levels for patients with complex conditions did not meet national guidance. Staff morale and motivation had fallen and 79% of staff worked extra hours, which reflected the capacity issues referred to above.
With respect to the hospital, the two inadequate areas were maternity/gynaecology and outpatients. Only the service for children and young people was classed as good, the remaining areas (medicine, A&E, surgery, critical care and end of life care) were all requiring improvement.
Part of the fall-out of the CQC’s assessment is that Dr Keith McNeil, the hospital’s chief executive, has resigned after almost 3 years in the post, with his successor now having to address the fact that the Trust is losing £1.2m a week. In standing down, McNeil criticised the CQC’s report, apparently telling the BBC that people’s lives were saved every day by the hospital and that he could not see why anybody would want to describe it as inadequate, seemingly feeling that there had been some rather rough justice in the special measures introduction during his tenure (but also seemingly rather missing the point). Addenbrooke’s and its Trust are the latest of a rather long list of hospitals and Trusts to be rated as inadequate by the CQC. This increasing list of inadequate hospitals is a worrying trend in an era in which the government’s response is to shackle appropriate legal redress for patients who are avoidably injured by poorly performing hospitals: perhaps that is where the justice is truly rough.
The full list as set out on the CQC’s website is below, including the domains in which the Trusts or hospitals are rated as inadequate (safe, effective, caring, responsive and well-led) and the date of the CQC’s report (the most recent is listed first):
- Addenbrooke’s and the Rosie Hospitals: safe, responsive, well-led (22 September 2015)
- Cambridge University Hospitals NHS Foundation Trust: safe, responsive, well-led (22 September 2015)
- East Sussex Healthcare NHS Trust: safe, well-led (22 September 2015)
- Conquest Hospital: safe, responsive, well-led (22 September 2015)
- Eastbourne District General Hospital: safe, well-led (22 September 2015)
- West Hertfordshire Hospitals NHS Trust: safe, well-led (10 September 2015)
- St Alban’s City Hospital: safe, well-led (10 September 2015)
- Watford General Hospital: safe, well-led (10 September 2015)
- Waterloo Manor Independent Hospital (safe, effective, caring, responsive, well-led) (17 August 2015)
- Barts Health NHS Trust: safe, effective, well-led (22 May 2015)
- Newham General Hospital: safe, well-led (22 May 2015)
- The Royal London Hospital: safe, well-led (22 May 2015)
- Hinchingbrooke Healthcare NHS Trust: well-led (22 April 2015)
- Colchester Hospital University NHS Foundation Trust: safe, responsive, well-led (2 April 2015)
- Whipps Cross University Hospital: safe, effective, responsive, well-led (17 March 2015)
- Norfolk and Suffolk NHS Foundation Trust: safe, well-led (3 February 2015)
- Wye Valley NHS Trust: safe, responsive, well-led (14 October 2014)
- Hereford Hospital: safe, responsive (14 October 2014)
- Heatherwood and Wexham Park Hospitals NHS Foundation Trust: safe, responsive, well-led (6 October 2014)
- East Kent Hospitals University NHS Foundation Trust: safe, well-led (13 August 2014)
- William Harvey Hospital: safe, responsive, well-led (13 August 2014)
- Kent and Canterbury Hospital: safe, well-led (13 August 2014)
- Medway NHS Foundation Trust: safe, responsive, well-led (10 July 2014)
- Medway Maritime Hospital: safe, responsive (10 July 2014)
- University Hospitals of Morecombe Bay NHS Foundation Trust: safe, well-led (26 June 2014)
- Wexham Park Hospital: safe, responsive, well-led (1 May 2014)