Question and Answers
When did the CQC visit the Trust?
The CQC inspectors came to the Trust in April (24 & 25) and May (6 & 7) of this year.
What were their overall findings?
The overall rating for the Trust is ‘requires improvement’.
The Trust has three hospital sites and the inspection reports state:
Queen’s Hospital ‘Requires improvement’,
Sir Robert Peel Community Hospital ‘Requires Improvement’
and Samuel Johnson Community Hospital ‘Good’.
What is the Trust’s response to the report?
The Trust accepts that there is always scope for improvements and continuous learning. We
do not, however, accept or recognise all the facts presented in the report.
Why is the Trust appealing, and against what?
We are appealing against the facts contained in the report and will be asking Sir Mike
Richards to hear our appeal as he has agreed to do for other Trusts in our position.
Did they visit each of the three hospitals?
Some members of the CQC inspection team visited the Trust’s three hospital sites.
Unfortunately Sir Mike Richards was unable to visit any of our hospitals.
What are the possible ratings you could have received?
The CQC can award a hospital four ratings, codes until red, amber and green. They are:
Red - Inadequate; Amber - Requires Improvement; Green - Good and Green Star Outstanding.
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What does ‘requires improvement mean’?
It means the CQC has made a number of recommendations, for the Trust to follow.
BHFT has been issued with 19 recommendations. Of these recommendations, there were
14 actions which the Trust ‘must take’ and five actions that the Trust ‘should take’. Out of
the 19 actions we have completed 10 and the remaining eight will be completed by the
autumn. There is one action where we are awaiting clarification from the CQC.
How many of the 14 actions the Trust ‘must take’ have been completed?
Eight have been completed and five are work in progress, we have asked for clarification
from the CQC on one of the recommendations. Of the work in progress those actions will be
completed by the autumn.
How many of the actions the Trust ‘should take’ have been completed?
Two have been completed and three are a work in progress. The three will be completed by
the autumn.
What’s the delay on the other actions and when will they be completed?
There is no delay, we have put the recommendations into action, but some will take time to
complete, e.g. ‘Ensure that all relevant staff in the Trust are trained in paediatric life support
and staff in the neonatal until are confident in neonatal resuscitation’: we have a refresher
course in place, staff are attending it and by the end of September they will have all
completed it.
How do you compare with other Trusts?
The CQC has inspected 34 NHS Trusts under its new regime. Out of those seven were
found to be ‘good’, 22 were found ‘requiring improvement’ and five were found to be
‘inadequate’.
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Was there any good news in the report?
Yes. The report found several areas of outstanding practice, including:
Board visibility and improvements to staff engagement;
Maternity services;
The only Trust to use enhanced recovery for caesarean section patients;
The breast clinic’s bra fitting service for women post operatively;
The orthopaedic team’s introduction of enhanced recovery for hip and knee
replacements, reducing the amount of time a patient needs to be in hospital;
The development of a tool to assess the impact of certain medicines on patient falls;
And additional training for doctors jointly with the coroner on a range of issues,
including the correct completion of death certificates.
BHFT knows that improvements can always be made and we have already implemented a
number of the recommendations made by the CQC.
The Chief Executive, Chairman and board are very proud of the improvements that have
already been implemented and the hard work and dedication the staff are showing to
patients to deliver excellent standards of care.
The report found there to be ‘an overwhelming sense that this was a caring organisation.
People using the service spoke highly of the staff and said they had been well looked after.’
In particular women and their families spoke of how they were treated with compassion,
dignity and respect.
The report criticised the medical care, as ‘inadequate’, especially in relation to three
issues: patient moves, inconsistent approach to discharge and nursing levels on
wards. What is going wrong?
Patient moves
Part of our appeal is because we believe the CQC may have misinterpreted the data we
provided to them regarding patient moves. Only a small number of patients have been
moved more than three times and often these are appropriate, discussed with the patient
and their family and in the best interests of the patient.
We have sought to seek clarification on this issue and completed an independent review,
which highlights that patient moves were, in the main, following agreed planned patient care
plans and most importantly ensured that patient care was not being compromised.
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Discharge
Since the CQC inspection, the Trust has improved its discharge processes. Working
jointly with Staffordshire and Stoke on Trent Partnership Trust to make the discharge
process simpler for patients and staff; and we are currently implementing this work.
Nursing levels
The Trust always ensures there are enough nurses on each ward to cover each shift. If
we require ten nurses on a ward, there will be ten nurses – but some of them may not be
permanent members of staff with BHFT – therefore we are ‘below establishment figures’.
The Trust has worked very hard to recruit more members of staff for nursing, from Burton
and the surrounding area, as well as further afield in Portugal and Italy.
There was also mention that you do not have a consistent approach to dementia care.
We believe we do. We have dementia champions across the Trust. We do not recognise
the description of dementia care across the Trust, in the CQC report and we have asked the
CQC to provide us with more information and details on this, so we can improve in the areas
they identify.
How are you going to improve the learning from incident reporting?
We continue to improve and learn from our incident reporting. Our assessment and
management of patient falls and patients’ pressure ulcers has for example changed in
response to learning from these incidents, and we can continue to review our systems and
processes. We have also reviewed equipment used for treating patients in response to our
incident reporting, and have trialed new initiatives as part of this on-going improvement
process.
What about safeguarding?
We are currently reviewing the services we offer to vulnerable adults and children, and the
mechanisms we have in place to safeguard the best interests of our patients. Our Children’s
safeguarding policy and training is also under review, and we have appointed a further
Matron to lead on safeguarding children across our hospitals.
Is anyone going to resign?
No, the Board has full confidence in the staff at Burton hospitals and is looking forward to
working with porters, consultants, our admin and clerical teams, nursing assistants,
directors, junior doctors and our nurses and midwives to continue the improvement journey
at BHFT.
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