Trust given formal warning after investigation into Derriford Hospital standards

The healthcare watchdog, the Care Quality Commission (CQC), has issued a formal warning to Plymouth Hospitals NHS Trust after an investigation into eight serious patient safety incidents in the past year at Derriford Hospital.

A planned inspection by the CQC was brought forward following a series of 'never events' - serious patient incidents so called because they should never happen - some involving treatment or surgery to the wrong part of the body. The hospital had the second highest number of never events in England over the last four years.

During the unannounced inspection, a CQC team spent two weeks at the hospital in April. They have raised concerns about the scheduling of operations and subsequent raised risk levels, reporting that clinical staff had told them that the timetables were unrealistic and did not make allowance for any unexpected incidents that could cause delays. When the surgery list over-ran, staff might cut corners to save time and staff shortages meant specialist theatre staff were often not available.

The Trust has been told to "make urgent improvements to protect patients undergoing surgery" at Derriford Hospital. Of the nine national standards the CQC tested, only four were met. The other five were all assessed as requiring action. These are:

Respecting and involving people who use services
Care and welfare of people who use services
Staffing
Assessing and monitoring the quality of service provision
Patient records

With regards to staffing, the report said: “In order to safeguard the health, safety and welfare of service users, the registered provider had not taken appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff”.

In criticism of the care and welfare of people using services, the CQC said the hospital had “not taken proper steps to ensure that each service user was protected against the risks of receiving care or treatment that was inappropriate or unsafe”.

The report criticises the hospital's assessement and monitoring procedures as having "not protected service users, and others who may be at risk, against the risks of inappropriate or unsafe care and treatment, because there were no effective systems in place to regularly assess and monitor the quality of services provided”.

The report also states that patient records had not been stored securely.

The following standards have been met according to the report:

Cooperating with other providers
Management of medicines
Requirements relating to workers
Complaints ("there was an effective complaints system available.")

The CQC's report follows revelations last month that the Trust had failed to meet the four hour target on A&E waiting times overall last year and had also missed an annual government target for cancer care.

However, improvements had had an effect. Between April 2012 and January 2013 Plymouth Hospitals NHS Trust was in the top half of performing Trusts against the national A&E four hour targets.

The Trust's Chief Executive Ann James said in response to the report: “We are a caring hospital with compassionate, committed staff. Patients and visitors see this every day and so did the inspectors. I would like to publicly thank our staff for their incredible work, often in challenging circumstances.

“The warning notice follows never events which happened last year (2012/13). In line with our commitment to openness, the never events were discussed and reported publicly in Board meetings and were the subject of considerable media coverage back in March.

“Since then we have been working hard to ensure that our practices in theatres are as safe as can be and we have not had any further never events (since March 2013).

“Our priority is making sure our patients have the safest, best care available, just as we would want for our own loved ones."

Under considerable scrutiny over its patient care record and facing significant additional financial pressures, the Trust's board met back in June to review performance and launch its future clinical strategy.

In a statement responding to the CQC report, Plymouth Hospitals NHS Trust said: "We have taken these steps to improve safety in our theatres and beyond:

"A surgeon is now in charge of theatres, supported by a matron.
"Put in place a full theatre improvement plan led by our new Director of Nursing. This is already leading to changes in practice and culture.
"Sought an independent review to ensure we haven’t missed anything.
"Started investing millions of pounds in more nurses, midwives to ensure we get staffing levels right and ease the pressure on our existing staff.

"If you are coming into hospital for an operation here, you are in safe hands:

"Last year (2012/13) nearly 39,000 patients were operated on at Derriford Hospital. We reported eight never events in that year. This should also be put into context. Most hospitals have reported some never events. We are a bigger hospital treating more copmplex cases than many other hospitals.
"We are in the top decile nationally for incident reporting which is a good indicator of a positive safety culture.
"We have one of the best survival rates in the country - a mortality ratio which is approximately 10% better than expected, making Plymouth the best in the south west and among the best hospital trusts in the country.
"Our readmission rates are around 6% better than expected and access to day case surgery is amongst the best in the country."

Ann James added: “We are committed to doing everything we can to reduce the risk of never events happening."

The Trust faced similar scrutiny from the CQC in February 2011 after six reported never events led the body to warn of prosecution or closure of operating theatres if the hospital did not take urgent action.

The CQC report finds that despite the same issues having been identified, the necessary changes had not been made. The trust has been given a week to respond with a report detailing measures to be taken to address the issues.