West Suffolk NHS Foundation Trust

Updated 30 January 2020

West Suffolk NHS Foundation Trust (WSFT) provides hospital and community healthcare services to people mainly in the west of Suffolk 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 community services cover a range of adult community services, specialist community services for children, young people and families and community hospitals inpatients. Services are delivered in a variety of settings including people’s own homes, care homes, community hospital inpatient units and clinics, day centres, schools, GP surgeries and health centres.

Services provided by the trust are mostly commissioned by NHS West Suffolk Clinical Commissioning Group. The trust also has established working relationships with other providers of health and social care services across Suffolk and parts of Cambridgeshire. WSFT is a part of the Suffolk and North East Essex STP.

Acute core services provided by the trust include: urgent and emergency care, medical care (including older people’s care), surgery, critical care, maternity, services for children and young people, end of life care, outpatients, gynaecology and diagnostic imaging.

The last inspection of the trust was undertaken between 9 November and 1 December 2017. This inspection comprised of two core services, end of life care and outpatients’, and well led. At the 2017 inspection the trust was rated outstanding overall. Achieving outstanding ratings in effective, caring and trust wide well led. Safe, responsive and well led at service level were rated as good.

We inspected the trust between the 24 September and 30 October 2019. The core service inspection took place on the 24 and 25 September 2019, with three further unannounced inspections on the 8, 9 and 11 October 2019. A well led inspection at provider level took place between the 28 and 30 October 2019.

During this inspection we spoke with 237 staff of various grades including nurses, doctors, senior managers, allied health professionals, health care assistants, ward managers, ambulance staff, health visitors, occupational therapists, physiotherapists, audiologists, speech and language therapists, nursery nurses, locality leads, physiotherapy and occupational therapy staff, administrative staff and volunteers. We spoke with 70 patients and relatives and reviewed 135 patient records. 

We found significant concerns and risks to patients within the maternity service which we raised with the trust at the time of inspection. Following the well led inspection, we undertook enforcement in respect of the maternity and midwifery service 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 by 31 January 2020.

Updated 30 January 2020

Our rating of the trust went down. We rated it as requires improvement because:

• We rated safe, responsive and well led as requires improvement and effective and caring as good. Ratings for all five key questions, safe, effective, caring, responsive and well led had gone down. The rating for the well led question at trust level had gone down from outstanding to requires improvement.
• We rated three of the trust’s five acute core services as requires improvement (maternity, medical care and outpatients) and two as good (urgent and emergency care and surgery). Overall ratings for urgent and emergency care and surgery had remained the same, medical care and outpatients had gone down. We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. In rating the trust, we took into account the current ratings of the three services not inspected this time. We rated all three community services as good overall, with safe, effective, caring, responsive and well led rated good. Community health services had not been rated previously.
• Processes for identifying, recording, escalating and managing risks across the organisation were not always fully effective or undertaken in a timely manner . There were inconsistent approaches to managing safety. Not all services controlled infection risk well. Completion of patient risk assessments, documentation and record keeping varied. Medicines management, including security and storage of medicines was inconsistent. Staff training and compliance in key skills fell below trust target, specifically for medical staff. Clinical and internal audit processes were not always fully effective across all services.
• Services do not always meet people’s needs. People could not always access services for assessment, diagnosis or treatment when they needed to. The trust continued to underperform across a large range of national access standards, in particular those related to the national 18 week referral to treatment (RTT) standard, the six week diagnostic standard and access standards related to suspected and confirmed cancer management. Action to address this were not effective and at a global trust level, the number of patients on the RTT waiting list was substantially higher than 12 months previously, reflecting a lack of systemic waiting list control.
• Not all systems produced reliable information that supported staff to develop and improve performance. Ongoing issues with e-Care had impacted on the ability and accuracy to report service performance specifics, such as referral to treatment time and theatre utilisation.
• Not all staff felt respected, supported and valued or felt that they could raise concerns without fear. Communication and collaboration to seek solutions had not always been effectively undertaken. An open culture was not always demonstrated
• The style of executive leadership did not represent or demonstrate an open and empowering culture. There was an evident disconnect between the executive team and several consultant specialties. Whilst priorities and issues were known and understood these were not always managed in a consistent way.

However:

• Services had enough staff to care for patients. 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 and supported them to make decisions about their care. 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 trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them in their work.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – .

Updated 30 January 2020

Updated 30 January 2020

Updated 30 January 2020

We rated the service as good because:

• 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 assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff checked patients had enough to eat and drink. Managers monitored the effectiveness of the service. 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 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 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.

Updated 30 January 2020

We rated this service as good because:

• 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 assessed risks to patients, acted on them and kept good care records. They managed medicines 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.
• 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 and 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 well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Staff did not always complete the mandatory training required to ensure they maintained their knowledge and skills.
• Patient information systems were not integrated and made it difficult for staff to maintain contemporaneous records. Data was not always available to enable staff to manage performance effectively.
• Facilities for audiology assessments in the Ipswich child development centre did not meet national standards.

Updated 30 January 2020

We rated the service as good because:

Staff understood how to protect patients from abuse and assessed and managed patient risks well. The service controlled infection risk well and maintained a clean environment. Staff kept good care records and managed medicines well. The service managed safety incidents well, learned and shared lessons from them. Staff collected safety information and used it to improve the service. However, as no acuity tool was used it was difficult to assess to whether the were enough staff to keep patients safe and mandatory training compliance was inconsistent.

The service followed best practice based on national guidance and ensured staff were competent for their role. Staff ensured that patients had enough to eat and drink and provided pain relief to patients as needed. Staff worked well together for the benefit of patients, gave advise on how to lead healthier lives, and supported them to make decisions about their care. Managers monitored the effectiveness of the service.

Staff treated patients with compassion and kindness, respected their privacy and dignity and provided emotional support to patients and families. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

The service planned care to meet the needs of local people and coordinated care with other services and providers. The service ensured that patients and relatives could give feedback and treated concerns and complaints seriously. However, there was a lack of individualised care and needs.

The service was manged by leaders with the skills and abilities to run the service and who operated effective governance and risk management processes. Staff were clear about their roles and accountabilities and felt respected, supported and valued. Leaders managed services well using reliable information systems and supported staff to develop their skills. Staff were committed to improving services, however not all senior staff were aware how they could find the data they needed, to understand performance, make decisions and improvements.