Updated 22 December 2021
University Hospitals of North Midlands NHS Trust provides a general acute hospital services for 1.1 million people in Staffordshire, South Cheshire and Shropshire. The trust provides a full range of hospital services including urgent and emergency care, critical care, medical care, surgery, end of life care, maternity, gynaecology, and outpatients’ services. Services for children and young people are provided at the Royal Stoke University Hospital and County Hospital. In addition to these services, the trust is also a tertiary centre on the Royal Stoke University hospital site for trauma, cardiology and spinal care. The trust also provides specialised services for three million people across a wider area, including neighbouring counties and North Wales. These specialised services include cancer diagnosis and treatment, cardiothoracic surgery, complex orthopaedic surgery, laparoscopic surgery, the management of liver conditions, neurosurgery, neonatal intensive care, paediatric intensive care, renal and dialysis services, respiratory conditions, spinal surgery, trauma and upper gastrointestinal surgery.
The trust employs over 11,000 staff. Services are provided at:
- The Royal Stoke University Hospital – 1,100 current inpatient beds.
- The County Hospital – 197 current inpatient beds.
University Hospitals of North Midlands NHS Trust was formed in 2014, integrating the University Hospital of North Staffordshire with Stafford Hospital (Mid Staffordshire NHS Foundation Trust). The County Hospital, previously known as Stafford Hospital, was part of Mid Staffordshire NHS Foundation Trust. In 2013, the trust was put into administration by Monitor and Trust Special Administrators were appointed to run the trust and determine its future. The trust has had a history of financial challenges and was in financial special measures until autumn 2020.
The trust had experienced significant challenges over the past 18 months due to the Covid-19 pandemic. The trust had treated over 7,106 Covid-19 positive patients, of those 1,517 were Covid-19 related deaths. Staff were redeployed from substantive roles to care for the most acutely ill patients and support staff in critical areas across the trust. Services had to be redesigned and moved at short notice.
At the time of our inspection, the number of patients admitted to the trust with Covid-19 had significantly reduced.
We carried out a short notice-announced inspection of the following acute services provided by the trust and inspected two core services because we had concerns about the quality and safety of services. These were:
- Urgent and emergency care at the Royal Stoke University Hospital.
- Medicine at the Royal Stoke University Hospital.
We also carried out two focused inspections as part of our continual checks on the safety and quality of healthcare services. These were:
- Medicine at County Hospital. This was a focused inspection on the safe, effective and well-led key questions.
- Surgery at County Hospital. This was a focused inspection of safe and well-led key questions.
Following our inspection, we served a Warning Notice under Section 29A of the Health and Social Care Act 2008. This warning notice served to notify the trust that the Care Quality Commission had formed the view that the quality of health care provided in relation to medical staffing in urgent and emergency care at the Royal Stoke University Hospital and the risk management of patients with mental health needs medicine at County Hospital required significant improvement.
We also inspected the well-led key question for the trust overall.
We did not inspect some services previously rated requires improvement because this inspection was focused only on services where we had concerns or had not inspected for some time. We are monitoring the progress of improvements to the services and will re-inspect them as appropriate. Services previously rated as requires improvement and not inspected this time include:
- Urgent and emergency care at County Hospital.
- Outpatients at County Hospital and the Royal Stoke University hospital.
In rating the trust, we took into account the current ratings of the four services not inspected this time.
Our rating of services stayed the same. We rated them as requires improvement because:
The trust had made improvements since our last inspection but further work was needed to improve the rating.
We rated caring as outstanding, well led as good, safe, effective, and responsive as requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings. This was an improvement since the last inspection.
We rated medicine at the County Hospital as requires improvement.
We rated surgery at the County Hospital as good.
We rated urgent and emergency care at the Royal Stoke University Hospital as requires improvement.
We rated medicine at the Royal Stoke University Hospital as good.
The trust did not always have enough staff to care for patients and keep them safe.
The service attempted to control infection risk; however, staff did not always comply with recommended practice. Staff did not always assess all risks to patients and therefore could not act on them. Staff did not always maintain good care records.
There were significant handover delays for patients arriving by ambulance and for those who self-presented to the emergency department.
Further improvements were needed to ensure that patients with mental health needs had their risks assessed and managed across the trust.
When patients could not make decisions about their own care and treatment, mental capacity assessments and best interest decisions were not always made in a timely manner.
The service did not always manage safety incidents well and we were not assured that staff reported all patient safety incidents and near misses in line with trust policy.
However:
Staff provided care and treatment that was based upon national guidance and standards. Managers monitored compliance against these standards and took action to address any concerns. Patients received pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent.
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.
Most 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 managed services and all staff were committed to improving services continually.
Staff treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
The trust board was cohesive and had the appropriate range of skills, knowledge and experience to perform its role. Board members understood their roles and were able to challenge appropriately.
The trust collected reliable data and analysed it. Staff could find the data they needed to understand performance, make decisions and improvements.
While the trust has managed considerable challenges during the significant impact from the COVID-19 pandemic, the senior team had persevered with the roll out of the Improving Together programme with the aim to encourage teams to embrace change and drive improvement.
How we carried out the inspection
We carried out this inspection on 24 and 25 August and 5 and 6 October 2021. We visited areas relevant to each of the core services inspected and spoke with several patients and staff, as well as holding three focus groups. During the inspection, we visited the frail elderly assessment unit, acute medical unit, respiratory ward, the general medicine wards and all areas of the emergency department at the Royal Stoke University Hospital. At County Hospital, we visited ward one (general medical ward), ward 15 (care of older people) and the Acute Medical Unit (AMU). We also visited the theatre department, including the recovery areas, ward 8 (general surgery), and the elective orthopaedic unit at County Hospital.
We spoke with 179 staff members of various speciality and profession including, consultants, doctors, nurses, healthcare support workers, pharmacists, patient experience, domestic staff and administrators.
We spoke with 25 patients and reviewed 61 patient records in total across both sites.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.