England’s Chief Inspector of Hospitals has told Wirral University Teaching Hospital NHS Trust that it must continue to make improvements following an inspection by the Care Quality Commission.

A team of CQC inspectors visited the trust in March and May to check the quality of care at their main hospital – Arrowe Park Hospital. Wirral University Teaching Hospital NHS Foundation Trust was last inspected in September 2015 and rated Requires Improvement overall

As a result of this inspection the trust has again been rated Requires Improvement overall. For caring the trust was rated as Good, for safety, effectiveness and responsiveness Requires Improvement and for well-led they were rated Inadequate.

CQC looked at medical care, surgery, end of life care, urgent and emergency services, maternity and the critical care unit. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?

The well-led category deteriorated from Requires Improvement to Inadequate. Inspectors noted that not all leaders had the necessary experience, knowledge and capacity to lead effectively – there were unstable leadership teams throughout the trust.

People did not always receive a timely apology when something went wrong in line with their duty of candour obligation, and the same national guidance was not followed when the organisation failed to ensure that all recruitment checks had been completed for senior leaders.

Leadership within the executive team had been affected by significant turnover of leaders including the chief executive and chairman; this had affected the capability and capacity within the senior leadership team to progress improvements.

There was a trust governance structure in place that did not always operate effectively. Some new systems had been put in place to monitor quality and safety but the improvement was difficult to assess.

There was not always a positive culture that supported and valued staff. Some staff said that they had witnessed or experienced bullying or harassment and inspectors found that when concerns had been raised, they had not always been dealt with in a timely manner.

The rating for safety remained the same at Requires Improvement. Safe systems of work and standard operating procedures were not always reliable or appropriate to keep people safe. The regularity and checks of major incident equipment had not been consistently followed and was not easily accessible in an emergency situation.

The rating for effectiveness went down to Requires Improvement from Good. There was little evidence of monitoring adherence to national guidelines; additionally not all staff had the right skills and experience to fulfil their roles.  There was limited leadership development in services and some services were not able to evidence staff competencies.

Caring remained at Good. People who used services and those close to them were positive about the way staff dealt with people – they were treated with respect and kindness during all interactions observed.

Responsiveness remained at Requires Improvement. Complaints were not always being responded to in a timely way and there was little evidence of the learning applied to practice within services. Not all services had been planned and provided that met the needs of the local people, for example the children’s department was not open 24 hours a day; meaning that children were sometimes assessed and treated in inappropriate areas of the department.

There were shortfalls in how the needs of different people were taken into account on the grounds of protected characteristics under the Equality Act.  There were also difficulties with access and flow throughout the hospital.

The Chief Inspector of Hospitals, Professor Ted Baker, said: 

“Since their last inspection in September 2015 Wirral University Teaching Hospital NHS Trust has not made the improvements required, in fact in two categories their rating has deteriorated. I am particularly concerned with the trust’s leadership deficiencies. It’s worrying to note that for well-led, the service was rated Inadequate.

“Inspectors noted that there had been significant change at board level; systems that had been put in place to monitor quality and safety were not working and there was evidence of bullying and harassment.

“We did identify some areas of good practice. In medical care services there were areas specifically designed for patients with dementia.

“We found areas for improvement including 34 breaches of legal requirements that the trust must put right, and I expect the trust to prioritise these as a matter of urgency. We will return in due course to monitor this trust carefully and will return in due course to check these significant improvements have been made.”

Full reports including the latest ratings are available at: https://www.cqc.org.uk/provider/RBL

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