Archived: Burton Hospitals NHS Foundation Trust

Updated 22 October 2015

Burton Hospitals NHS Foundation Trust gained trust status in 2008 and is the principle provider of acute hospital services for the residents of Burton Upon Trent, and surrounding areas. The trust provides services from three locations; Queen’s Hospital, Sir Robert Peel Community Hospital and Samuel Johnson Community Hospital. The trust also has a treatment centre which provides day case ophthalmology, outreach and community-based clinics to the population.

The trust serves a population of more than 360,000 people in Burton upon Trent and surrounding areas, including South Staffordshire, South Derbyshire and North West Leicestershire. A full range of services are provided at the Queen’s Hospital site, including critical care. At the two community hospitals services include minor injuries, medical care, outpatients with day surgery services at Sir Robert Peel and a midwife led maternity unit at Samuel Johnson.

The trust employs around 2,700 staff and has 544 inpatient beds across the three locations. There were 41,147 total inpatients between April 2014 and March 2015 and 226,595 outpatient attendances across all three sites in the same period. There were 114,390 attendances at the accident and emergency and minor injuries units.

The trust was included in Professor Sir Bruce Keogh’s review of trusts in 2013 with higher than expected mortality rates. The overview report ‘Review into the Quality of Care and Treatment provided by 14 Hospital Trusts in England’ is available on the NHS Choices website. A number of areas of good practice were identified as part of the review; the report also identified a number of areas of concern. The trust was inspected by CQC in April 2014, where it was found that progress against some of the key action from the Keogh review had been slow.

This inspection follows up the recommended actions from the Keogh review and also considers the findings from our inspection in April 2015.

Updated 22 October 2015

Burton Hospitals NHS Foundation Trust was formed in 1993 and achieved foundation status in 2008. The trust consists of three sites Queen’s Hospital in Burton, Sir Robert Peel Community Hospital in Tamworth and Samuel Johnson Community Hospital in Lichfield.

In July 2013 the trust was one of 11 placed in special measures by Sir Bruce Keogh following a review into hospitals with higher than average mortality rates. CQC inspected the trust in April 2014 and although some progress had been made against the Keogh action plan, the trust was rated as ‘requires improvement’ with medical care and the well-led domain rated as ‘inadequate’; the trust remained in special measures.

We visited the hospital sites on 7, 8 and 9 July 2015 as part of our announced inspection. We also visited unannounced to Queen’s Hospital on Friday 24 July 2015.

Overall we have rated this trust as requires improvement, but we acknowledge that the trust has made significant improvements in the last twelve months. We saw that services were caring and compassionate. We also saw that people have good outcomes because they receive effective care and treatment that met their needs. We saw a number of areas that required improvement for them to be assessed as safe and responsive. We also saw that leadership of services in some areas also required improvement.

Our key findings were as follows:

• The hospital had made significant progress since our last inspection in April 2014. Improvements in safety and leadership were evident, but there was still more work to be done.
• Staff were caring and compassionate towards patients and their relatives. Patient’s dignity and privacy was ensured and we saw many examples of good care right across the trust for staff at all levels.
• There was a strong open culture and staff were encouraged and supported to report incidents. There were clear systems in place to ensure lessons were learnt and services developed as a result
• Nurse staffing was a challenge in a number of areas for the trust. There was heavy reliance on agency staff to ensure staffing levels were kept safe. The trust was working hard to address this.
• The five steps to safer surgery (part of the World Health Organisation (WHO) surgical safety checklist) was embedded and the latest audit report showed high levels of compliance.
• Dementia care had been further embedded within the trust. Nurses, nursing assistants and volunteers had been trained as dementia champions; they encouraged others to make a positive difference to people living with dementia.
• The numbers of patients using the day-case unit at the Sir Robert Peel Community Hospital had declined and there were concerns regarding the long term sustainability. A decision to close the unit was postponed until 2016, following consultation with staff and the local community.

We saw several areas of outstanding practice

• Critical care had developed an organ donation group to improve and promote organ donation within the hospital and the local community.
• The maternity service was awarded the Excellence in Maternity Care award by CHKS in 2014. The quality of care at Burton Hospitals NHS Foundation Trust was judged to be the best out of 148 NHS maternity providers in England, Wales and Northern Ireland.
• Innovative practice to increase hand hygiene, using the latest technology monitoring the use of alcohol sanitising gel.

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

Importantly the trust must:

• The trust must ensure that ward assurance targets, such as hand hygiene practice and recording of patient observations, is achieved at a consistent level in the emergency department.
• The trust must review the use of agency staff on surgical wards to ensure staffing levels and skills mix are maintain and all staff have access to the relevant records.
• The trust must develop a clear vision and strategy for critical care services which is shared with staff and clinical leaders and demonstrates how the service will develop in the medium and long term.
• The trust must ensure that all identified learning points from the investigations into recent Never Events are fully implemented and signed off to ensure that learning and changes to practice have been put in place.
• The trust must develop a strategy and long term vision for gynaecology services at the trust to ensure that patient services can improve and develop.
• The trust must ensure that a rapid discharge pathway for end of life patients is formalised to ensure that people can leave hospital in an effective way that meets their wishes.
• The trust must review policies and procedures for planning and booking outpatient clinics to ensure that waiting times for appointments are minimise and patients are not subject to long delays in waiting for appointments. Waiting times in outpatient clinics should be re routinely monitored.
• The trust must review arrangements for access to x-ray imaging after 5pm weekdays and on Saturday afternoons and Sundays for minor injury unit patients at the two community hospitals.
• The trust must support the two minor injury units to audit its performance in order to assess the effectiveness of their own practice and to identify and manage risks.

Professor Sir Mike Richards

Chief Inspector of Hospitals