The Care Quality Commission
  • Organisation
  • SERVICE PROVIDER

University Hospitals of North Midlands NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

All Inspections

24 August 2021, 25 August 2021, 5 October 2021, 6 October 2021

During a routine inspection

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.

05 Jun to 01 Aug 2019

During a routine inspection

Our rating of the trust stayed the same. We rated it as requires improvement because:

  • We found significant concerns regarding the care and treatment of patients in the emergency department at Royal Stoke Hospital.
  • We found serious issues in relation to the care and treatment of patients with mental health needs and patients who lacked mental capacity to make decisions. These concerns were mainly focussed within medical care and urgent care services. As a result of these concerns we took urgent enforcement actions to ensure patients were safe.
  • Governance systems although embedded were over complicated and unreliable. However, we found that the newly appointed chief executive was undertaking extensive work to improve these systems.
  • In rating the trust, we took into account the current ratings of services not inspected this time.

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 – www.cqc.org.uk/provider/reports.

3 October to 16 November

During a routine inspection

Our rating of the trust stayed the same. We rated it as requires improvement because:

  • We rated safe and responsive as requires improvement, effective and well-led as good, and caring as outstanding. All ratings improved, apart from safe which stayed the same. We rated both hospitals as requires improvement.
  • Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • We rated well-led at the trust level as good.
  • We saw the trust had taken steps to improve patient flow through both hospitals, including a range of initiatives in the Emergency Departments and in medicine.
  • Processes around the management of medicines had been improved.
  • Staff were very caring and compassionate, universally put the patient first despite facing huge pressure on capacity.
  • Staffing levels had improved and the trust had less reliance on temporary workers.
  • Services in critical care and end of life care had been transformed since our last inspection.

However;

  • We consistently observed that staff were not confident in relation to the Mental Capacity Act 2005 and were unsure of how to apply it.
  • Despite the trusts actions and initiatives to improve patient flow, the emergency department was consistently failing to achieve the 4-hour waiting time target and was well below the England average

April 2015

During a routine inspection

The University Hospitals of North Midlands NHS Trust was created on 1 November 2014, following the integration of University Hospital of North Staffordshire NHS Trust with Stafford Hospital from the Mid Staffordshire NHS Foundation Trust. The trust has strong links with Keele University and Stafford University and is a University teaching hospital. The trust continues to work towards foundation trust status, with a view to becoming a Foundation Trust by 2017-2019.

We recognise that the leadership of the new trust has had the significant task of bringing together two organisations at a challenging time. We have seen that progress has been made but there is still more to be achieved.

The trust provides general acute hospital services for approximately 700,000 people living in and around Staffordshire. The trust also provides specialised services, such as Trauma, for three million people in a wider area.

The trust has had a challenging winter managing its delivery of acute services, specifically in meeting the A&E targets. This has been the subject of a joint risk summit with stakeholders in January 2015.

We inspected this service in April 2015 as part of the comprehensive inspection programme. We inspected all core services provided by the trust at both hospital sites.

We visited the trust on 22, 23 and 24 April 2015 as part of our announced inspection. We also visited unannounced to the trust until Tuesday 5 May 2015. Our unannounced visit included A&E, Medical Care Services and Critical Care.

Overall we have rated this trust as requires improvement. We saw that services were caring and compassionate. We saw a number of areas that required improvement for them to be assessed as safe and effective. We saw that leadership of services at the trust also required improvement at both a local and an executive level. The responsiveness of services was assessed as inadequate.

Our key findings were as follows:

  • Staff were caring and compassionate towards patients and their relatives, we saw a number of outstanding examples of good care right across the trust.
  • There was a strong culture of incident reporting and staff were encouraged and supported by their managers to engage in this. This made staff feel empowered.
  • Achieving safe staffing levels was a constant challenge for the organisation and there was a heavy reliance on agency and locum staff to support this.
  • Systems and processes did not support patients flow through the organisation.

We saw several areas of outstanding practice including:

  • Outstanding work being done on the Specialised Neurological Unit at the County Hospital to improve the outcomes for patients.
  • A range of initiatives in services for children and young people to enhance their patient experience.
  • Diagnostic imaging services had received accreditation from the Royal College of Radiologists through the imaging services accreditation scheme (ISAS).

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Review systems and processes to ensure patients flow through the organisation in a timely manner.
  • Address high waiting times in the emergency department.
  • Review the capacity and adequacy of the critical care services.
  • Review the sustained use of recovery to accommodate critically ill patients.
  • Implement the individualised care plan as soon as possible so that patients who are actively dying are supported holistically. This would also support the nursing staff to meet all the needs of the patients.
  • Review systems and processes to ensure staff are engaged with the plans for service integration and communication networks between senior management and front line staff are improved.
  • Review pathways between County Hospital and Royal Stoke to ensure patients transferred from the emergency department are kept safe and patients who transferred for treatments and procedures are done so efficiently and effectively.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.