Newcastle upon Tyne Hospital NHS Trust 'requires improvement' following latest CQC investigation
I was concerned to read the latest report published by the Care Quality Commission (CQC) into the standard of services provided by Newcastle upon Tyne Hospitals NHS Trust, one of the largest teaching Trusts in the UK, which has seen its overall rating downgraded from ‘Outstanding’ in 2019, to ‘Requires Improvement’.
The health watchdog carried out unannounced inspections at the Trust between June 2023 and September 2023 across six acute services: surgery, services for children and young people, and medical care at the Freeman Hospital and the Royal Victoria Infirmary (RVI), as well as maternity services and urgent and emergency care at the RVI and an inspection of the Trust’s patient transport service, known as ‘NECTAR’.
Summary of findings
The CQC reported that the standard of services at the Trust as measured by safety, effectiveness and responsiveness all ‘require improvement’ and highlighted the following areas as being of particular concern:
- Some of the services did not always have enough staff to care for patients and keep them safe;
- Staff did not always assess, monitor or manage risks to patients, act on them or keep good care records, and they did not always store and manage medicines safely;
- Not all staff reported incidents in a consistent and standardised way, and services did not always define the correct levels of harm according to the NRLS (National Reporting and Learning System) definition;
- Care and treatment was not always delivered in accordance with national guidance or evidence-based practice;
- Managers did not always monitor the effectiveness of the service or always work well together for the benefit of patients;
- People could not always access the services when they needed it to receive the right care promptly, and waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards;
- Senior staff were not always visible and approachable in the services for patients and staff; they didn't always use systems to manage performance effectively or make decisions and improvements, and they didn't have clear oversight of the key risks and had not always mitigated immediate risks;
- Staff did not always feel respected, valued, and supported and the Trust didn't have a culture where staff could raise concerns without fear as they were not always managed appropriately.
The CQC did rate the Trust as ‘good’ under ‘caring’, with recognition that staff treated patients with compassion and kindness and emphasised instances of outstanding practice, though this too represented a downgrade from the previous rating of ‘outstanding’.
Perhaps most significantly, however, the report highlighted a deterioration in leadership at the Trust, which was rated as ‘inadequate’.
Troublingly, concerns were also raised about a culture of bullying, with some staff reporting that bullying by management and more senior clinical staff was ‘commonplace’ with employees being discouraged or threatened from reporting inappropriate behaviour from senior colleagues.
The CQC has used its enforcement powers and placed conditions on the Trust's registration which require the Trust to make specific improvements within a specified timescale and to submit monthly reports to CQC demonstrating progress.
Conclusion
The report makes for concerning reading and emphasises the importance of effective, open and collaborative leadership as a crucial means of promoting patient safety.
Unfortunately, as a medical negligence solicitor, I frequently come across examples where patients come to harm as a result of poor management and inadequate processes for recognising and managing risk, often with devastating consequences. I therefore hope that the Trust addresses the findings of the report as a matter of urgency.
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