The Care Quality Commission
  • Hospital
  • NHS hospital

Archived: Stafford Hospital

Weston Road, Stafford, Staffordshire, ST16 3SA (01785) 257731

Provided and run by:
Mid Staffordshire NHS Foundation Trust

Important: This service is now managed by a different provider - see new profile

All Inspections

1-2 July 2014

During an inspection looking at part of the service

The key question we were asked to consider whether Mid Staffordshire Hospital NHS Foundation Trust (MSFT) is currently providing safe care and whether safety was likely to be sustainable in the future. We were aware that the planned date for the dissolution of MSFT and transfer of responsibility for services to University Hospital of North Staffordshire NHS Trust (UHNS) and Royal Wolverhampton NHS Trust (RWT) is 1 November 2014. We therefore considered whether safe provision of services was likely to be sustainable over the next four months and beyond that over winter 2014/15.

Our approach

To undertake this task within a very short timescale we modified our new approach to inspection of acute hospitals. We concentrated particularly on the first of CQC's five key questions i.e. Safety. Within this we looked very closely at staffing levels for nurses, doctors and allied health professionals in key clinical services and the approaches that Trust Special Administrators and Mid Staffordshire Hospital NHS Foundation Trust has made to recruit and retain staff. We also looked at the impact of any deficiencies in staffing levels on the quality of care being delivered by staff at MSFT. Finally we considered the leadership of services at MSFT.

During the pre-inspection phase we looked at the report from the Trust Special Administrators (TSAs) regarding future configuration of services currently provided at MSFT. These recommendations have been accepted by the Secretary of State for Health and we were not asked to reopen the debate on these recommendations. Rather, the report provided us with the agreed direction of travel for different clinical services. We are also aware that a further review into the configuration of maternity services is being commissioned. We reviewed the safety and sustainability of services at this trust in this context.

We were given access to the minutes of the Sustaining Services Board, chaired by the TSA representative, which brings together leaders of the local health economy around MSFT and to a copy of the due diligence report commissioned by the Board of UHNS. The Chief Executive of MSFT and her staff were extremely helpful in providing detailed information on current and projected staffing levels and other recent performance management information for the trust.

In this process, we are not providing ratings on the trust as we normally would do. This is deliberate and reflects both the bespoke nature of the remit and the planned disaggregation of the trust in November.

An overview of our findings

The commitment of staff at all levels to the delivery of high quality care at MSFT was evident throughout the hospital. However, it is important also to recognise the degree of fatigue reported by staff. This relates both to the relentless external scrutiny focused on MSFT and from uncertainty about the future.

The trust is facing major difficulties in recruiting and retaining medical and nursing staff both because of the continuing uncertainties about the future and because of the previous poor reputation of the trust outside the local area. These factors are creating a large destabilising influence across the organisation.

The senior managers at MSFT, including the Chief Executive, are spending inordinate amounts of time ensuring that individual nursing shifts are adequately filled and that sufficient numbers of medical staff will be available for different services. To date they have just been able to do this, but the emphasis here is on the word just. This has resulted in a significant reliance on temporary medical and nursing staff, which has a resultant impact on permanent staff working in the relevant clinical areas. In addition, there is an almost complete dearth of formal medical service level clinical leadership at MSFT. While additional staff have been supplied by UHNS in some clinical areas, in other areas the movement of staff has been from MSFT to UHNS.

Our inspection team members judged that safe care is currently being delivered in each of the clinical areas except for medical care which required some improvement. Staffing levels are only just adequate in some areas, particularly on the medical wards and of these, the winter escalation ward, (ward 11) was still open and gave the most cause for concern. Medical and nursing staffing pressures make this ward unsustainable.

The inspection team members were, however, much less assured about the sustainability of some services, even over the next four months. Should staffing levels fall by even one or two people in some key posts, services would become unsafe. The only option for handling such an eventuality identified to us either by the TSA or the trust management would be to reduce the bed base and almost certainly to restrict admissions to the hospital (unless flow through the hospital can be substantially improved). Indeed there have already been occasions when the West Midlands Ambulance Service has been asked to divert emergencies to UHNS or RWT. Undesirable as this is, this does indeed appear to be the only option available. The fragility of the provision of acute services cannot be overemphasised

The TSA and the trust management have proposed a reduction in the opening hours of A&E as a means of reducing the burden on acute services and thus maintaining safety. My inspection team had concerns about this approach. In particular they were concerned that it might not achieve the desired reduction in emergency admissions to the hospital and that it might render the junior doctor rotas unviable. This would at the very least need to be discussed with colleagues at Health Education England.

Looking beyond the planned date of transition in November 2014, inspection team members were unanimous in their view that services would be unsustainable should any degree of winter pressures arise. It is therefore imperative on safety grounds that the transition should not be delayed.

Transition

We were both surprised and very concerned that a clear transition plan has yet to be developed to ensure the safe transition of responsibility for clinical services to the agreed model of care over the next four months. This clearly requires full involvement of MSFT and other organisations in the wider health economy. Although the Sustaining Services Board has provided a useful forum for bringing together the relevant stakeholders it is not a decision making group and has no authority to take action. In addition the workforce at MSFT needs clarity as soon as possible about what is going to happen and when. The current uncertainty is contributing to the fatigue and fragility amongst staff. The transition plan should therefore include a commitment by the acquiring organisations to actively support medical and nursing staffing levels at Mid Staffs over the next four months so that services remain safe.

It is now imperative that a clear and timetabled transition plan should be developed and implemented without delay. This should set out the steps that will be taken to ensure services remain safe, effective, caring and responsive to patients’ needs. Leadership responsibilities and accountabilities need to be clearly defined. This will require high level input and commitment from TSA/MSFT, UHNS and RWT and from CCGs and WMAS. No single organisation can achieve this on its own. High level oversight from Monitor and TDA, as the organisations which oversee the various providers will be essential.

Yours sincerely

Professor Sir Mike Richards

Chief Inspector of Hospitals

26, 27 February 2014

During a routine inspection

A team of five CQC inspectors, one colleague from NHS England, one colleague from the local commissioning group, a specialist adviser in accident and emergency care and an expert by experience visited Stafford Hospital on 26 and 27 February 2014.

As part of this inspection we looked at the care provided to people who were elderly and may have dementia. We looked at care / treatment people received whilst in the accident and emergency department and then their care on severals wards in the hospital. We looked at how the hospital reviewed the quality of care and treatment provided to people. This included investigations into people's poor experiences of care and treatment within the hospital.

During our inspection we spoke with 41 patients, 12 relatives and 48 staff.

The majority of people we spoke with (38 of the 41 people) were positive about the care and treatment they received at the hospital. Three people told us about improvements that they thought were needed. One patient told us, 'I feel I have been well treated since I came into hospital. Staff have been kind and considerate. The nurses are really busy but stop and talk to me if I have any concerns. When the doctors talks to me I feel that he listens to what I say and respects my point of view'. Another person said: 'I feel treated with dignity and respect'.

People who were in-patients during our visit told us that they were informed about the treatment they needed and would receive. One person told us, 'Everyone has been great. The doctors explained all the treatment I would have'.

People we spoke with made positive comments about the staff. One person said, "I have heard so many bad things about this hospital and did not know what to expect, but I have not been able to fault the staff or the care I have received".

We had been told before we visited the hospital, that the trust which managed the hospital had been experiencing difficulties in recruiting and retaining nursing and medical staff. We were told that as a result of this the trust had needed to employ large numbers of bank and agency staff to ensure that there were sufficient staff available to care for people. The trust had also told us that they had reduced the total number of beds available in the hospital and had stopped elective surgery in the hospital. The trust's management team praised the commitment of the staff to ensure that wards and department were covered and risks to people were minimised.

Staff we spoke with were informed about the hospital's staffing difficulties and gave us examples of their commitment to people's care.

We found that the hospital had systems in place to check the quality of care and treatment that was provided. We found there was a need to ensure that complaints and serious incidents were dealt with more promptly. The trust could make improvements to these processes to ensure they always gained the most learning from them.

We found that care records were not always available or consistently completed. The lack of essential information meant there was an increased risk that people may not consistently receive the care they needed.

1, 4, 5 February 2013

During an inspection in response to concerns

A team of three CQC inspectors, three colleagues from the local commissioning team and a director of nursing from another hospital visited Stafford Hospital on 1 February 2013. We visited six wards. We completed further visits to the hospital on the 4 February and 5 February 2013 to review how the hospital managed patients’ complaints and to make sure that we also understood the views of patients not satisfied with the service they had received.

During our inspection we spoke with 52 patients and relatives and 44 staff. Patients we spoke with were positive about the care they received at the hospital. Patients said that they were treated with respect and their privacy was observed. One patient told us, “I would have no concerns about coming in again”. Another said, “I couldn’t fault the place, everyone is wonderful and treat me with respect".

Most patients told us that they were informed about the treatment they would receive. One person added, “The doctor’s communication could be improved but the nurses come back and explain things to me”.

Patients we spoke with made positive comments about staff. One person said, "I could not fault them". A teenager said, "All the staff have been brilliant and always listen to me”.

Staff told us that they received the training they needed and felt supported by senior staff.

We saw that appropriate systems were in place for patients and staff to raise concerns about poor practice.

19 June 2012

During a routine inspection

We visited Stafford Hospital on 19 and 20 June 2012 as part of our planned/scheduled review process and to review improvements. The inspection was unannounced which meant that the service did not know we were coming.

Four compliance inspectors and an expert by experience took part in this inspection. Our experts by experience are people of all ages, from diverse cultural backgrounds who have used a range of health and/or social care services. The expert by experience talked to the people who used the service and their visitors. They looked at what happened in the wards and what it was like to be a patient. They took some notes and wrote a report about what they found and details were included in this report.

During the two days we spoke to over one hundred people, including patients, visitors, staff and visiting health professionals and spent in excess of sixty 'person hours' in the hospital. We also met with the chief executive, the medical director and the director of nursing and midwifery and visited seven wards and departments

We contacted the Local Involvement Network group (LINk) and they sent us their most recent 'enter and view' report. The LINk gathers information and feedback from a broad range of community engagement events and activities to help identify themes and issues which are emerging with regard to health and adult social care services across Staffordshire. The co-ordinating group will refer issues to the Staffordshire County Council Overview and Scrutiny Committee after full consideration and when direct approaches to commissioners and providers have not secured a satisfactory outcome.

We saw evidence of good verbal and written communication regarding consent to treatment. We saw signed consent forms within some patient's notes. The staff were seen to interact well with patients and relatives; explaining the care they were going to receive and updating them with any progress.

One patient told us 'They told me they were going to do the procedure and I didn't object so they did it. I think they've done a good job'. His relative informed us that they gave consent to do the operation and were made aware of what would happen.

We saw evidence of care pathways being followed which were supported by updated risk assessments. A care pathway is "anticipated care within an appropriate time frame, written and agreed by the hospital's staff and the multidisciplinary team. The pathway plans the care to be received and records the action taken whilst the treatment is given.

The staff we spoke to had good knowledge of plans and was aware of the importance of reviewing the records. We identified one set of notes which was found to be lacking in important information and some evidence of ongoing monitoring was absent.

When asked about the standard of care received in the hospital, one patient told us 'You can't fault it'. They said that they felt safe in the ward and that staff came quickly when called. 'If I wanted help I am sure I would get it'. They said they were looking forward to going home but was not sure when that would happen. 'They are not always certain of what is happening themselves!'

There was strong evidence of improvement from previous inspections in staff training and knowledge regarding safeguarding of patients. There was written evidence on the wards regarding who to contact to discuss safeguarding issues.

There was evidence of improved distribution of the recent medicines management policy. The staff we asked confirmed seeing alerts relating to drugs. Improved attention was being paid to the management of drugs on discharge. We saw posters reminding staff about the message of the month.

We saw that mandatory training within the hospital was overseen and reviewed by the ward/department manager with the support of the Practice Development Team to ensure that staff were competent, skilled and experienced. A training matrix was evidenced in Accident and Emergency (A&E) where an exceptional amount of time had been spent ensuring that the newly recruited staff, supported by the existing experienced staff, were developed and deemed competent.

We saw that supervision was taking place regularly for most staff. There were good examples of staff being supported to participate in training at other trusts and then implementing their findings within the hospital on their return.

The provider may wish to consider reviewing the appraisal system as we found a variation in the understanding of the appraisal process throughout the trust regarding the review process.

We found obvious evidence of improvement in quality monitoring systems overall, with decisions being cascaded and followed up with staff to ensure implementation was achieved through the clinical quality dashboard reporting. The dashboard is a toolset of visual displays developed to provide clinicians with the relevant and timely information they need to inform daily decisions that improve quality of patient care.

We were informed that the complaints staff had received further training to give improved responses to complaints and to have a wider understanding of the management of them. We evidenced early resolution of complaints had increased.

2 November 2011

During an inspection looking at part of the service

We carried out this review to check whether Stafford Hospital had made improvements in relation to the management of medicines.

A patient on ward 12 said that " She had brought her medicines and a repeat prescription from home. A doctor had checked her medicines in the Accident and Emergency. She had been taking an oral antibiotic but this was changed to intra venous one and this was explained to her."

A patient of ward 12 said that " That the staff were very good at administering medicines because they tell her what medicines they are giving her and they give them around the time she used to have them at home. She said the staff had been very good and had explained to what her medicines were for over the time that she'd been in hospital."

The wife of a patient on ward 12 said she " Was very positive about her husband's care."

A patient on ward 1 said that " The nursing staff were good at giving him his medicines when he needed them. He said they were a good bunch of nurses."

A patient on the Acute Medical Unit said that " He was having some antibiotics through an intra venous line. He said the staff were prompt at removing the line when the antibiotics had finished. He said that he had been made fully aware of what antibiotics he was taking and what they were for."

12 October 2011

During an inspection looking at part of the service

We visited the accident and emergency department (A & E) in September 2011. At that inspection we identified a shortage of nurses and in particular we were concerned about the trust's contingency arrangements when staff were absent in an emergency. We were also concerned that some of the nurses working in the department didn't have the skills and experience needed to work in A & E. As a result of our concerns we had given the trust until 4 October 2011 to address our concerns and as such become compliant with the regulations.

We re- visited the A & E department on three occasions for this review, 17, 18 and 19 October 2011 to see what action had been taken and to make sure that the trust was now compliant .

We involve people who use services and family carers to help us improve the way we inspect and write our inspection reports. Because of their unique knowledge and experience of using health and care services, we have called them experts by experience.

Our experts by experience are people of all ages, from diverse cultural backgrounds who have used a range of health and/or social care services.

An expert by experience took part in this inspection and talked to the people who used the service and their relatives. They looked at what happened in the A & E waiting room and what it was like to be a patient. They took some notes and wrote a report about what they found and details were included in this report.

To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool at this review. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record the type of care they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences in A & E and this is included in the report.

We were supported at this review by the CQC nurse advisor who interviewed patients and staff and reviewed relevant information and documents.

Several patients and their relatives told us that their visit to A & E had been a good experience. They told us, 'The staff have been very attentive and kind. We haven't had to wait very long to be seen and we have been told the plan of care.' One person we spoke with was very anxious about their relative and unhappy about the care they had received. The senior staff in the department dealt with the situation, reassuring them and resolving the issue immediately.

One patient told us that they had been in the hospital a few times and each time felt that the care was very good. They told us, 'Even though the staff are very busy, they have told me what is happening, asked if I am in pain and got me a drink. They all seem very professional.'

All of the staff spoken with told us of the improvements made by the trust since our last visit. They now know that they can use agency staff to cover shifts and the bank of staff has been expanded. Work is being undertaken to ensure that the staff have the skills and competencies to work in the A & E department.

The trust is looking to implement permanent systems which will provide long'term solutions. This includes new ways of working and addressing staff absenteeism at its root cause.

15 September 2011

During an inspection in response to concerns

Some patients told us that they had been waiting for up to three hours and that no-one had communicated with them as to how long they would have to wait. One patient's relative told us they were informed about the treatment plan but they had been in the department a long time and felt that staff were very busy.

Other patients told us that they would not re-visit the hospital again by choice because of the long wait and lack of communication.

8 June 2011

During an inspection looking at part of the service

In the Accident and Emergency Department (A&E) patients were very pleased with the care and support they were receiving. They told us

'Oh the staff here are great. I have no complaints at all about the place.'

'I have been seen very quickly.'

'Staff are very attentive, they keep coming in and checking me.'

The family of one person told us that nurses had all been very helpful and considerate, and had explained to them what was happening and why it was happening. This alleviated their anxieties, and helped to settle their relative into the ward.

In the Special Care Baby Unit (SCBU) people told us

'I had plenty of information before I came into the labour ward, this information was given to me during ante natal classes and you are taken on a tour of the unit and told what to expect'

'You are told what your choices are and this is discussed with you by your midwife before you go into labour' 'This is good because you know what to expect'