Updated 3 November 2023
The East and North Hertfordshire NHS Trust provides a wide range of acute and tertiary care services from four hospitals, namely the: Lister in Stevenage; New Queen Elizabeth II (QEII) in Welwyn Garden City; Hertford County Hospital in Hertford; and the Mount Vernon Cancer Centre (MVCC) in Northwood, Middlesex.
The area served by the trust for acute hospital care covers a population of around 600,000 people and includes east and north Hertfordshire, as well as central Bedfordshire. The MVCC provides specialist cancer services to some two million people from across Hertfordshire, Bedfordshire, north-west London and parts of the Thames Valley.
Since October 2014, the Lister has been the trust’s main hospital for specialist inpatient and emergency care.
The New QEII hospital opened in June 2015 and provides outpatient, diagnostic and antenatal services, along with a 24/7 urgent treatment centre. Hertford County provides outpatient and diagnostic services. The MVCC provides tertiary radiotherapy and local chemotherapy services. Through the Lister, New QEII and Hertford County hospitals, the trust provides a wide range of acute inpatient, outpatient, diagnostic and minor treatment services – including emergency department and maternity care. The trust offers regional and sub-regional services in renal medicine, urology and plastic surgery. The trust is also a provider of children’s community services.
The trust has four clinical divisions – Planned Care, Unplanned Care, Women’s and Children’s and Cancer, each led by Divisional triumvirate, of Divisional Director, Divisional Medical Directors and Divisional Nursing Director. These are supported by a corporate infrastructure.
We carried out this unannounced inspection of the Lister Hospital location inspecting 4 of the acute services provided:
- Urgent and Emergency Services because we had concerns about the quality of services.
- Medical Care (including older peoples care) because we had concerns about the quality of services.
- Surgery because at our last inspection the safe domain was rated inadequate and the service was rated requires improvement.
We also carried out an unannounced focused inspection of Maternity Services because at our last inspection carried out as part of the national maternity inspection programme, the safe and well led domains were rated inadequate. We also issued a Section 29A Warning Notice. At this inspection we found that the Trust had met the requirements of the Section 29A Warning Notice.
We also inspected the well-led key question for the trust overall.
Our rating of services stayed the same. We rated them as requires improvement because:
- We rated safe, responsive and well-led as requires improvement, and effective and caring as good.
- We rated 4 of the trust’s services we inspected as requires improvement. In rating the trust, we took into account the current ratings of the 4 services not inspected this time.
- Staff did not always complete mandatory training and there were not always enough staff to meet the needs of patients.
- People could not always access the care and treatment they needed in a timely manner. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards. The trust had recently agreed a Full Capacity plan describing actions to be taken when there were excessive patient delays. However, this was yet to be embedded.
- The service did not always manage safety incidents well and did not always ensure that lessons were learnt from them.
- Leaders identified and escalated relevant risks and issues but they did not identify actions to reduce their impact. There was no evidence the outcomes recorded, what mitigation actions had been completed or if the risk had reduced or increased.
However:
- The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well.
- Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
- Staff treated patients with compassion and kindness, respected their privacy and dignity and provided emotional support to patients, families and carers.
- 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 manage services and all staff were committed to improving services continually.
How we carried out the inspection
We carried out the core service inspections on 20 and 21 June 2023, and the well-led inspection on 2 and 3 August 2023.
We visited areas relevant to each of the core services inspected and spoke with a number of patients, staff and patient representatives.
We spoke with 87 members of staff at all levels of the organisation across various specialities and including healthcare assistants, nurses, midwives, junior doctors, pharmacy staff, consultants and administrative staff.
We also spoke with 10 patients and 4 relatives. We observed care and reviewed 50 sets of care records. We also looked at a wide range of documents including policies, standard operating procedures, meeting minutes, action plans, risk assessments, training records and audit results. We attended staff handovers and daily safety huddles.
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.