West Suffolk Hospital

Updated 22 June 2021

West Suffolk NHS Foundation Trust (WSFT) provides hospital and community healthcare services and is an associate teaching hospital of the University of Cambridge. WSFT was awarded foundation trust status in December 2011.

WSFT serves a predominantly rural geographical area of roughly 600 square miles with a population of around 242,000. The main catchment area for the trust extends to Thetford in the north, Sudbury in the south, Newmarket to the west and Stowmarket to the east. Whilst mainly serving the population of Suffolk, WSFT also provides care for parts of the neighbouring counties of Essex, Cambridgeshire and Norfolk.

The maternity service at West Suffolk Hospital delivers approximately 2,500 babies per year and offers a choice of three birth settings: birth at home; the co-located low risk midwifery led birthing unit (MLBU); the consultant led labour suite.

The service is provided by a team of consultant obstetricians who provide consultant presence on labour suite, supported by training grade doctors and midwives who work across the inpatient areas. Community maternity services are provided by four teams of midwives, as well as three continuity of carer teams. The maternity service has a number of specialist midwives. A perinatal mental health midwife works in partnership with the perinatal team at the local mental health trust. The service has a midwife who leads on bereavement and offers ongoing support to women and partners who have suffered a pregnancy loss. The service also had two practice development midwifes to assist maternity staff with their mandatory training and competencies and a safeguarding midwife who staff can seek safeguarding advice from.

We last inspected the maternity service between 24 September 2019 and 30 October 2019. The report was published on 30 January 2020. The maternity service was rated requires improvement overall. Safe and effective were rated as requires improvement, caring and responsive were rated good and well led was rated inadequate. Due to the significant concerns within the maternity service we undertook enforcement to enable the improvement of safety within the service. We issued a warning notice under Section 29A of the Health and Social Care Act 2008 on the 14 November 2019 and told the trust it must improve.

We carried out this unannounced focused inspection to follow up on the issues we identified in our 2019 inspection. We have continued to monitor the trust closely and carried out this unannounced inspection to follow up on the actions taken by the trust to address the safety risks to patients. We found that the trust were now compliant with all aspects of the S29A warning notice.

Our rating of services stayed the same. We rated them as requires improvement because:

• The service was frequently short staffed and had to rely on calling in staff from other areas to cover the labour suite and maternity ward. Staff told us that the shortages impacted their welfare and at times they didn’t feel listened to.
• The service did not have a tool in place to triage women. Staff told us that they relied on their clinical decision making when triaging women and that this meant decisions could vary from clinician to clinician.
• The service had improved their governance arrangements, however we had concerns about continued lack of compliance with the Maternity Incentive Scheme. Arrangements were not in place for oversight of local audits, two audits we saw did not have action plans assigned to them. The service did not always minute meetings or produced minutes that lacked in detail.

How we carried out the inspection

As part of our inspection we visited the following areas within the maternity service: labour suite, midwifery led birthing unit, F11 ward (the combined antenatal and postnatal ward) and the maternity day assessment unit. We spoke with 21 members of staff including medical and midwifery staff, maternity care assistants and service leads. We observed care, handovers/meetings and reviewed 11 sets of maternity records. We also looked at a wide range of documents including policies, standard operating procedures, meeting minutes, action plans, prescription charts, risk assessments and audit results. Before our inspection, we reviewed performance information about this service.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 30 January 2020

Our rating of this service went down. We rated it as requires improvement because:

• The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Hazardous cleaning chemicals were not always stored securely.
• The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
• Leaders and teams had systems to manage performance. However, they did not always identify and escalate relevant risks and issues or identify actions to reduce their impact.
• There was no formalised local induction to the ward for bank and agency nursing staff.
• Not all leaders had the skills and abilities to run the service as some were new in post. However, a programme of support was in place to help them gain experience.
• The service did not always collect data and analyse it. Staff could not always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
• Team meetings were not held regularly to discuss and learn from the performance of the service. Not all staff were aware of the freedom to speak up guardian.
• Not all staff completed mandatory training in key skills and processes were not fully effective to ensure compliance targets were met. Compliance for medical staff with training specific for their role on how to recognise and report abuse fell below trust targets.

However:

• Staff used equipment and control measures to protect patients, themselves and others from infection.
• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• Leaders were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

Updated 4 August 2016

Services for children and young people at West Suffolk Hospital were good.

The children’s wards and treatment areas were visibly clean.

Management and storage of medicines was appropriate and safe.

Staff knew how to safeguard children and undertook relevant specialist paediatric training.

The services managed risk well and used a paediatric early warning system to identify if a child’s health was deteriorating. There had been no serious incidents in the services in 2015 and staff learned from minor incidents and shared their learning.

The services planned and delivered children’s and neonatal care in line with national, regional and local guidelines and carried out clinical audits. Nursing staff and doctors had high levels of skills and competencies and worked well with other teams in the hospital to find the best solutions for children.

There was seven-day access to diagnostics and fast tracking was available for children’s x-rays for the same morning/afternoon if needed.

Nursing staff and doctors were compassionate and dedicated to the welfare of children. Care was tailored to individual children. The services offered a high level of psychological and emotional support.

Consultants worked to provide access for patients. They set up outreach clinics in GP premises and held telephone clinics so that patients could stay in their own surroundings. Staff saw and treated children promptly in the hospital in most cases.

Nurses, doctors and managers had a vision for children and neonatal services which reflected the trust’s strategy of working with other providers in the community. There was clear leadership in the services and staff told us they enjoyed working for the services. Staff listened to children and their parents and had made improvements in response to feedback.

Updated 4 August 2016

Overall critical care was rated as ‘good’. Safe and caring were rated as good, effective and well led rated as outstanding and responsive rated as requires improvement.

This reflects consistently good staffing levels of doctors and nurses, which met the safe standards established by the Faculty of Intensive Care Medicine, the Royal College of Physicians and the Royal College of Nursing. Two dedicated professional development nurses managed mandatory training in the unit and provided substantial development support and opportunities to nursing staff.

There was consistent, seven-day input from a multidisciplinary team of specialists. The standard of medicine management was very high and the unit had a dedicated full time pharmacist. A follow-up nurse, audit nurse and technologist significantly extended the scope and effectiveness of the critical care service.

Staff practiced evidence-based care and treatment based on the best practice guidance of the National Institute for Health and Care Excellence and developed plans to improve the service by using the results of local and national audits.

There was a demonstrable focus on providing individualised care based on feedback from patients and their relatives and from the outcomes of pilot projects conducted by critical care staff. Additional support for critical care patients was provided by a follow-up nurse and a critical care outreach team, who also provided a cross-department education programme.

Staff were encouraged and supported to undertake novel research projects, which they were able to present at national conferences as a knowledge-sharing strategy. Senior staff had developed a robust five-year service plan in collaboration with unit staff, which was further evidence of the cohesive and supportive work culture we found.

Dedicated housekeeping staff maintained a very high level of cleanliness and hygiene and infection control evidence reflected this.

There were a number of areas within the service we judged to require improvement. For example, staff did not always understand or use incident-reporting processes and investigations did not always result in demonstrable learning. There was a lack of governance in relation to incidents.

The principles of infection control were not always evident in the unit for a patient who was potentially infectious. Staff did not always provide continuous and appropriate supervision for high dependency level two and level one patients when they were cared for in side rooms.

Updated 4 August 2016

End of life care at West Suffolk NHS Foundation Trust was rated good overall. Safe, responsive and well led were all rated as good and caring as outstanding, with effective rated as requires improvement.

Staff knew how to report incidents involving patients at the end of life and evidence of this was seen throughout the inspection.

Staff adhered to infection control practices, particularly within the mortuary. The specialist palliative care team (SPCT), mortuary, chaplaincy and bereavement staff had all completed 100% of their required mandatory training. Patient records were accurate and completed in a timely manner.

Patients were able to access food and drink when they required it, and were assisted to eat if needed. Pain relief was prescribed and administered in a timely manner and in accordance with trust policy. The trust scored well in the March 2016 National Care of the Dying Audit, meeting four out of the five clinical outcomes. The trust’s policies around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were ambiguous and left staff confused about how to interpret the MCA and when to apply for a DoLS. The completion of the trust Escalation Plan and Resuscitation Status (EPARS) was inconsistent and often did not reflect the patient’s medical notes.

Patients and their families were cared for with dignity, compassion and in a respectful way throughout the inspection. Staff gave examples of exceptional practice that enhanced patients’ physical and emotional wellbeing. Staff used their initiative in often difficult situations to ensure patients and their families received the care they required.

There was a mixture of patients with and without cancer referred to the SPCT. We saw care planning was documented and implemented across all clinical areas inspected.

The chaplaincy was able to contact religious leaders of other faiths; however this was limited and rarely used.

The trust had a clear strategy and vision for end of life care. Although no substantive medical leadership was in place, the SPCT practice development matron met weekly with the executive lead for end of life care for senior guidance and support. The trust demonstrated multiple initiatives to improve and ensure sustainability within the service. Formal staff and public engagement was lacking, however informal feedback was sought from staff on a regular basis through discussions within ward areas.

Updated 22 June 2021

Updated 30 January 2020

Our rating of this service went down. We rated it as requires improvement because:

• Leaders did not always understand and manage the priorities and issues the service faced.
• There was lack of local oversight in relation to some of the issues identified during our inspection. For example, there was lack of local oversight in relation to processes in place for monitoring patients requiring a follow up appointment or those on surveillance pathways. We found there were a large number of vascular patients affected by lost to follow up issues, with the potential for serious harm. The service were unaware of the number of patients who may have been lost to follow up.
• Not all risks and issues were identified, escalated or effectively acted upon to reduce their impact. The lack of robust systems to ensure patients on surveillance pathways, or requiring follow up, was known but actions had not been undertaken in a responsive manner. This had resulted in a potentially significant patient safety risk within the vascular service, and an extended period of time where potential risk across other specialties remained unknown.
• There was a lack of ownership by senior leaders within the service, despite systems to manage risk and performance being in place.
• People could not always access the service when they needed it and receive the right care promptly. Waiting times from referral to treatment varied, with some specialties better and some worse than national standards. The percentage of patients waiting more than 18 weeks from referral to treatment on non-admitted and incomplete pathways was below the England average.
• Delays in diagnostic test results meant that clinic appointments were often wasted.
• There was no process in place to monitor the average waiting times for a follow up appointment.
• The service took longer than the trust target to investigate and close complaints.

However:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided timely care and treatment. Patients received pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 30 January 2020

Our rating of this service stayed the same. We rated it as good because:

• Nursing staff did completed training in key skills. Staff protected patients from abuse in line with trust policy. Safety incidents were managed within set timeframes and staff reported incidents in line with trust policy. Staff assessed risks to patients and there were systems in place to identify deteriorating patients. Staff collected safety information and use it to improve services.
• The service had processes in place to ensure that care was evidence based. Managers monitored the effectiveness of the service and ensured action was taken in response to national audits. Managers ensured that staff were competent for their roles. Staff assessed and monitored patients regularly to see if they were in pain.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to complain. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders had the skills and abilities to effectively lead the service and operated effective governance processes throughout the service. Leaders and teams used systems to manage performance effectively.

However:

• Staff did not always complete training in key skills. Staff did not protect patients from abuse in line with trust policy.
• The service did not have effective systems and processes to safely prescribe, administer, record and store medicines.

• People could not always access the service when they needed it, and some had to wait too long for treatment. However, there were robust plans for dealing with delays.

Updated 30 January 2020

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s wider vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

• The service did not always control infection risk well, we identified staff not bare below the elbows, wearing jewellery and not following the services infection control policy.
• Staff recording checks on controlled medicines, refrigeration temperatures and equipment were not consistent.
• Staff did not consistently complete patient safety checklists and general risk assessments, for example falls risks. Recording emergency equipment checks were not consistent.
• The management of risk around non completion of patient risk assessment and safety check lists required significant improvement.
• Leaders did not always use systems to manage performance effectively.
• Audit systems for record keeping were not effective in improving compliance with patient safety check lists.