The Care Quality Commission
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The Dudley Group NHS Foundation Trust

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

Overall: Requires improvement read more about inspection ratings

All Inspections

15 Jan to 16 Feb 2019

During a routine inspection

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

  • Corbett Hospital was rated as inadequate overall, and in one service safe and well-led were rated as inadequate.
  • Russells Hall Hospital was rated requires improvement overall, in two services, safe was rated as inadequate and one service as inadequate for well led.
  • Community services were rated good as overall.

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/RNA/reports.

15 Jan to 16 Feb 2019

During an inspection of Community end of life care

Our rating of this service stayed the same. We rated it as good because:

  • The leadership team had planned for enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • Staff were provided with mandatory training in key skills. Compliance was good, and education, training, learning, reflection and learning was promoted, supported and embedded.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care. An improved electronic recording system with a view to becoming paperless meant that there were ongoing improvements in record accessibility.

  • The team provided care and treatment based on national guidance and evidence of its effectiveness. Managers monitored and checked practice to make sure staff followed guidance. Staff consulted and adhered to NICE guidelines which meant patients received evidence-based care.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • Staff of different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care. Joint working and collaboration with external stakeholders was fully embedded in the work carried out to support patients and their families.

  • The team consistently cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress. There were are a range of supportive services available to patients and their families while using services and following bereavement.

  • The team involved patients and those close to them in decisions about their care and treatment.

  • The team took account of patients’ individual needs. Interpreters were accessible for patients who did not speak English. There were champions who had received additional training to ensure good quality care across the board. Patients, the carers and staff could access mental health teams and a psychologist for support.

  • People could access the service when they needed it. Staff responded to referrals to treatment promptly and in line with good practice. There were 7-day a week, 24 hour a day services available and accessible specialist support out of hours.

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.

  • The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However, we also found:

  • Despite support to recruit a locum consultant, the service did not have enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

5 December 2017

During a routine inspection

  • We rated safe, effective, responsive and well led as requires improvement and caring as good. We rated two of the trusts core services as good, two as requires improvement and one as inadequate. We rated community services including sexual health as good.
  • In rating the trust, we took into account the current ratings of the four core services and community end of life services that were not inspected this time.
  • 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 requires improvement.

 

5 December 2017

During an inspection of Community health services for adults

We rated it as good because:

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • We saw excellent innovative multidisciplinary team working. Staff of different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust planned and provided services in a way that met the needs of local people.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However

  • Community staff were not fully compliant with mandatory training or appraisal rates.
  • Whilst we were confident patients were receiving person centred care, we found patient care plans were generic and not person centred.
  • People could not always access services when they needed it. Waiting times for treatment were not always in line with good practice.

26 and 27 March 2014

During a routine inspection

We carried out this comprehensive inspection as part of the new hospital inspection programme and as a follow up to the Keogh review which took place in 2013. Of the 14 trusts inspected under the Keogh review for the quality and safety of their services, The Dudley Group NHS Foundation Trust was one of only three trusts that were not put into special measures. That review identified concerns regarding:

  • governance arrangements
  • the need to embed a culture of learning from incidents
  • how the trust uses and reviews mortality data
  • the system for bed management and patient flows
  • embedding patient experience in the organisation’s learning and strategy
  • staffing levels and skills mix
  • safety and equipment checks
  • pressure ulcer care.

Before the inspection conducted in March 2014, the Trust was identified in CQC’s intelligent monitoring system as a priority band 4 Trust. There are six bands within the monitoring system so this Trust had a relatively lower risk.

We noted that the trust’s action plan to address the concerns following the Keogh review had been put into place and signed off.

Our inspection of The Dudley Group NHS Foundation Trust included Russells Hall Hospital, Corbett Outpatient Centre and Dudley Guest Outpatient Centre.

The announced inspection took place between 26 and 27 March 2014, and unannounced inspection visits took place in the two weeks following this visit.

Overall, this trust was found to require improvement, although we rated it good in terms of having caring staff, and effective services.

We saw much support for the trust, both from the public and from the local health economy.

We saw a trust that was a considerable way along its improvement journey and saw many areas of strong development. Whilst some of the core service areas within the trust required improvements in leadership, we found the executive team and the trust board had a clear focus on improvement and as such we rated this trust as good for its overall leadership.

The improvements required by the trust were within the grasp of the trust and its leaders. We were confident that these could be achieved quickly.Key findings related to the following:

  • The trust’s staff are seen as highly caring by many of the patients we spoke to and praised the staff for ‘going the extra mile’.
  • The trust’s leadership team is seen as highly effective by the staff; and is recognised to be clearly in touch with the experience of patients and the work of the staff.
  • Staff value the Dudley Group as a place to work and a team spirit is clearly evident.
  • The trust has responded well to the Keogh review in 2013.
  • There are a number of areas of good practice in the trust, which should be encouraged. Staff feel able to develop their own ideas and have confidence that the trust will support them.
  • The emergency department (A&E) is busy and overstretched. There remain challenges in the flow of patients, but much of this relates to flow across the rest of the hospital. Only a small proportion relates to the emergency department itself.
  • The trust does not always follow its own policy in relation to DNACPR (do not attempt resuscitation) notices.
  • The ophthalmology clinics require review to ensure that all patients are followed up as required and that there is capacity for these clinics.
  • The trust must review its capacity in phlebotomy clinics as this is seen as insufficient.

Professor Sir Mike Richards

Chief Inspector of Hospitals

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.

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.