Isle of Wight NHS Trust placed into special measures
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The report of the Care Quality Commission (CQC) into the standard and quality of care provided by Isle of Wight NHS Trust was formally published today.
The former Chief Executive of the Trust, Karen Baker, stood down at the end of March, having considered the draft report, acknowledging that the Trust had "not always provided the quality of care the public expects" and apologised for this fact. Earlier this month, it was reported that significant concerns had been raised and that the Trust was expected to be placed into Special Measures by the CQC, but the details of the report and extent of the Trust's failings have not been made openly available until today.
The CQC carried out short-notice visits to inspect the following services:
- Medical care
- End of life care
- Community health services for children and young people
- Community health services for adults
- In-patient community care
- Inpatient mental health service
- Community mental health services
- Drug and alcohol dependency service
- Emergency ambulance service and patient transport
I was pleased to see that the Trust received a "Good" rating for the caring attitude of its staff and many patients and their relatives reported favourably on their interactions with staff and their caring manner.
However, there were unfortunately many concerns raised and an overall impression that there had been a deterioration in the safety and quality of some services. Those services rated as inadequate were:
- Mental health
- Emergency ambulance
Those rated as requiring improvement were:
- Acute, emergency and urgent care
- End of life care
- Community services
Amongst the complaints highlighted in the report are the following:
- Serious safety hazards in the inpatient mental health wards including access to electrical cupboards, live broken electrical sockets, failing personal alarms and broken beds and ligature points that were either unidentified or not addressed with little understanding demonstrated of the risks this presented to mental health patients.
- A lack of understanding and implementation of Safeguarding requirements
- Staff shortages and reliance upon locums across many departments including A&E, Medical wards and Ambulance service, with a resulting impact on service delivery and patient safety
- The Trust employs just 1 part-time geriatrician for a population of 140,000 increasing to 230,000 in the summer months, 26% of whom are over age 65 and 12% over age 75, well above the national average.
- Deficiencies in record keeping with a corresponding failure to undertake and maintain appropriate risk assessments.
- Mental health services in particular not adhering to evidence based national guidelines for treatment pathways.
- Outcomes for stroke patients not as good as would be expected.
- Failure to facilitate rapid discharge for end of life care patients meaning that the majority of end of life care patients were not transferred to their preferred place of death.
- Ambulance response times were consistently behind target. They were working with an unreliable mobile data system which sometimes froze.
- Leadership and strategy for change was poor. There was evidence of a culture resistant to change, overly bureaucratic and hierarchical. A subtle culture of bullying was found, barriers to change and a lack of performance management.
In my capacity as a clinical negligence solicitor, my job is to help people who have been injured through medical treatment. Of particular concern to me therefore, was the failing of the Trust to deal with complaints and errors in a prompt and open manner. The CQC found that the Complaints process was delayed, often without explanation; the completion of internal investigations took longer than expected and there was a lack of understanding and implementation of the Duty of Candour obligation by middle and junior management and more importantly, by front-line staff.
Following the publication of their report, the CQC has imposed special measures by way of enforcement actions in relation to mental health services due to a risk of actual harm to patients. Urgent improvements must be made in order that the Trust can continue to provide mental health service. In addition a number of requirement notices to improve other failings identified have been served.
Whilst I do of course appreciate that all NHS services are facing difficult choices at the moment in relation to service provision, and are under increasing pressure to deliver more services to patients who are living longer without the desired increase in financial provision, it is disappointing that a local NHS provider has been found to be inadequate overall and in some cases, unsafe. This is particularly so given that some of the criticisms made are the same as concerns raised following a review by the CQC in 2014, which have not been properly addressed or acted upon. These reviews are undertaken to ensure that the services paid for by the taxpayer, are delivered to an acceptable standard and it is imperative that the points made are taken on board and acted upon as quickly as possible, so that healthcare for all on the Isle of Wight improves in the very near future.
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