CQC calls for improvements at Oxford University Hospitals NHS Foundation Trust
The Care Quality Commission has told Oxford University Hospitals NHS Foundation Trust that it must make immediate improvements following its latest inspection by the Care Quality Commission.
Inspectors visited the trust during November and December 2018 and January 2019 to check the quality of five core services: urgent and emergency care, medical care, surgery, maternity, and gynaecology. CQC also looked specifically at management and leadership to answer the key question: Is the trust well-led?
As a result of this inspection the trust has now been rated Requires Improvement overall. For caring effective and response the trust was rated as Good. For safety and well led it was rated as Requires Improvement. Previously it had been Good overall.
Following the inspection, CQC used its urgent enforcement powers to impose three conditions on the trust's registration within surgical services at the John Radcliffe Hospital:
- To ensure patients' privacy is always maintained, including when they are asleep, unconscious or lack capacity when in the main operating department. This included ensuring all windows in doors to theatres are obscured.
- To produce an action plan to assess and mitigate the risk of infection and the risk to the health and safety of service users receiving care and treatment and the risk to staff in the main operating department.
- Each week the trust must submit a report to the CQ C, which describes the action taken and sets out the evidence which demonstrate those actions are being taken in regard to the points above.
Full details of the ratings are given on the CQC website at: https://www.cqc.org.uk/provider/RTH
CQC has also published the trust's Use of Resources (UoR) report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Requires Improvement for using its resources productively. The combined rating for the trust, considering CQC's inspection for the quality of services and NHSI's assessment of Use of Resources, is Requires Improvement.
CQC's Deputy Chief Inspector of Hospitals, Dr Nigel Acheson, said:
"Since our last inspection, Oxford University Hospitals NHS Foundation Trust has not sustained the momentum and imbedded the improvements that were necessary. As a result, the trust's overall rating has moved from Good to Requires Improvement.
"We have made it clear to the trust where it must take action to improve and have placed urgent conditions on the trust's registration to ensure these improvements do take place. We will remove those conditions when we are satisfied that the trust has made sufficient progress to provide the quality of services that its patients are entitled to expect.
"However, I am pleased to note that the trust has a strong and engaged workforce who worked together for the benefit of patients, although it is concerning to find that some staff particularly those with protected characteristics under the Equality Act, did not always feel they were treated equitably."
Inspectors found that department managers had the right skills and abilities to run a service providing high-quality care. But, at board level there were some key areas where the team lacked expertise . There was a drive to develop future leaders, but there was no formal board development plan in place for this.
The trust did have systems in place for identifying and reducing risks - but these were not always effective. There were areas where poor practice presented a risk and had not been recognised as such.
In the emergency department at the John Radcliffe Hospital, demand for services frequently outstripped the availability of appropriate clinical spaces to care for patients. Emergency department waiting times from referral to treatment and discharge were not always meeting national standards.
However, staff cared for patients with compassion and kindness. Feedback from patients was consistently positive about the way staff treated them. Staff provided emotional support to patients to minimise their distress. Staff involved patients and those close to them in decisions about their care and treatment.