Archived: Hinchingbrooke Health Care NHS Trust

Updated 11 August 2016

Hinchingbrooke Hospital is an established 289 bed general hospital, which provides healthcare services to North Cambridge and Peterborough. The trust provides a comprehensive range of acute and obstetrics services, but does not provide inpatient paediatric care, as this is provided within the location by a different trust. The trust has the traditional system of governance in NHS. The trust had previously been managed by a private provider. The ethos of empowerment of staff remained at the hospital and the “stop the line” initiative was still in use. This allowed anyone to raise issues immediately with the senior team. We found that this system was now working well within the hospital.

The average proportion of Black, Asian and minority ethnic (BAME) residents in Cambridgeshire (5.2%) is lower than that of England (14.6%). The deprivation index is lower than the national average, implying that this is not a deprived area. However, Peterborough has a higher BAME population and a higher deprivation index.

Updated 11 August 2016

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 15 and 18 September 2014 at which the trust was rated as inadequate and placed into special measures. The CQC undertook a review of the areas rated as inadequate in January 2015 to ensure the safety of patients. At this inspection we rated most elements as requiring improvement although the urgent and emergency services were rated as inadequate. We undertook a focused inspection to review all areas identified as requiring improvement or inadequate in October 2015 to monitor the trusts progress. We returned on 10 May 2016 to monitor whether the improvements seen at the previous inspection were sustained.

Since 1 April 2015 the trust has a traditional management structure of an NHS trust. The trust has a trust board and with non-executive directors. The chief executive has now been in post for nearly 10 months. The changes that had been put in place were beginning to embed and staff were aware of the process for escalating issues to the senior team. The trust were aware of challenges and had plans in place to address these. We were aware of ongoing talks with a neighbouring trusts about efficient use of resources across the county.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating. The inspection found that overall the trust has a rating of ‘Good’.

Our key findings were as follows:

• Most new systems and process were in place and these were embedded. Senior managers could articulate risks both internal and external to the organisation.
• Some new systems in processes in the emergency department such as triaging patients arriving by ambulance were yet to be embedded.
• There was an increased emphasis on incident reporting and disseminating learning to all areas of the trust though there were some delays in reporting incidents in surgery.
• Medicines were well managed across the trust with consistent processes to investigate concerns.
• Staff were caring and compassionate in their care of patients.
• Organisational development work had significantly impacted on the trusts development into a learning organisation.
• The emergency department continued to be under pressure through increasing volumes of attending patients and small numbers of emergency care consultants.
• The care of patients with a mental health condition was improved in the emergency department.
• There was an increased programme of audit including stroke audit though performance against some audits in the emergency department was below the England average.
• Referral to treatment times (RTT) were met for medical and surgical patients.
• There were clear visions for the services and visible leadership within the divisions.
• The trust and individual divisions were working with other providers and stakeholders on sustainability and transformation plans. Staff and managers had plans for improving care pathways though there was some anxiety amongst staff about collaborative working with other providers.
• There was a detailed end of life strategy in place which had received additional resourcing to meet the needs of patient and their relatives.

We saw several areas of outstanding practice including:

• The trust employed an Admiral Nurse to support people living with dementia, their relatives and carers as well as staff. This was one of only five Admiral Nurses in acute trusts in England.
• Staff worked with a local prison where consultants review patients that are at the end of their lives and work with prison and hospital staff to ensure that patients were safely admitted to the hospital or referred to the local hospice.

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

Importantly, the trust must:

• Ensure that there are sufficient numbers of suitably qualified, skilled and experienced medical staff on duty in the emergency department. Also ensuring that there are robust contingency plans and which forecast shortages and ensure that sufficient cover is provided.

• Ensure that the time to treatment from a clinician in the emergency department is reviewed and times to treatment are improved.
• Ensure that the triage process for ambulance arrivals is received to ensure that the pathway for patients is safely and times of assessment accurately recorded.
• Ensure that infection control practices within the emergency department are improved.
• Ensure that the processes for the checking of equipment, particularly blood glucose and anaphylaxis boxes, in the emergency department is improved and safe for patients.

In addition, the trust should:

• Review the observation and seating arrangements for the children’s area to ensure parents and children only sit in this areas.
• Should ensure that fridge temperatures are routinely checked.
• Should allow staff to attend and receive updated mandatory training.
• Review the need to monitor the culture of staff within the emergency department.
• Review the environment and provision of children’s services and where children are treated.
• Ensure that records are used in a consistent way across wards, that they are contemporaneous; reflect patient needs and appropriate actions taken following risk assessment.
• Review the relative risk of readmission for surgery patients as data shows this to be significantly above the England average.
• Review the complaints process and the time taken to provide people who complain with a full response.

• Should ensure that audits are undertaken locally within the emergency department to improve quality measurement and assurance.
• Should ensure a consistent monitoring of preferred place of death for patients receiving end of life care.
• Should ensure that there is a clear target for fast track discharge of patients requiring end of life care and ensure consistent monitoring of the timeliness of these discharges.

Based on the findings of this inspection I would recommend the trust be removed from special measures. However I would recommend that ongoing support continue during this period of transition.

Professor Sir Mike RichardsChief Inspector of Hospitals