A warning notice issued to NGH over the quality of monitoring in A&E has been lifted, a new inspection report reveals, but the hospital overall is rated as ‘requires improvement’.
The Care Quality Commission (CQC) report, based on an inspection in September, rates the quality of care at NGH as ‘good’.
However in all other categories (safety, effectiveness, responsiveness and leadership) inspectors gave the hospital a rating of ‘requires improvement’.
Professor Sir Mike Richards, England’s Chief Inspector of Hospitals, managers and staff had taken significant actions to meet the concerns contained in the warning notice issued in March 2014 over its A&E and medical care departments.
He said: “Our inspectors found a number of improvements were needed at Northampton General Hospital NHS Trust and, while the warning notice requirements had been met and there were some areas of good practice, it was clear that work was still needed to improve services so that they meet the standards people have a right to expect.
“The trust should ensure that patient assessments in the emergency department are carried out within four hours and it must continue to embed effective training and staff appraisals systems to ensure targets are met.
“The trust should also continue to review all areas of patient risk and ensure all areas of risk highlighted on the corporate risk register are reviewed within the prescribed timescales.
“Our inspectors will return to check on what progress has been made with regard to the necessary improvements.”
Deborah Needham, deputy chief executive, said: “The report highlights the improvements noted by inspectors; we had already recognised the need for improvements in many of these areas and had put actions in place to address them.
“Internal structures were revised to support the organisation to be assured that these actions were monitored and progressed in a timely manner and we are delighted the CQC recognised and formally acknowledged the improvements in their follow up visit of September 2014, including lifting the formal warning notice.
“We continue to work on outstanding areas requiring improvement, some of which are in keeping with challenges that many other NHS Trusts currently face.”
Some of the recommendations from the original inspection in January 2014, which were part of the warning notice, were quickly resolved at the time.
For instance, within hours of the CQC inspection and initial feedback NGH immediately stopped sending out medicines by taxi, revised its ‘do not resuscitate’ forms and training, and ensured that all medical equipment was tested and properly labelled.
In the intervening nine months major developments have included:
-a new resuscitation unit which doubles NGH’s capacity to care for critically ill patients. It now provides dedicated paediatric care facilities in the A&E department, with 24 hour access to a Registered Sick Children’s Nurse
-daily clinical safety ‘huddles’ to identify potential delays and safety issues earlier and taking immediate action.
-identify and mitigate risks to patients and learn from experiences such as complaints, ‘near-misses’ and serious incidents.
-more mandatory staff training by improving the range of options for staff to access training (for example by e-learning)
- better end of life care with new personalised care plans and having a designated consultant to be NGH’s lead for end of life care
Mrs Needham said: “We have seen improvement in our performance against the four-hour standard during May and June. We are working hard both within the hospital and with our partners to minimise the length of time patients stay in hospital.
“With sustained and increased pressure on the whole urgent care system, we ensure that during periods of intense pressure, we continue at all times to prioritise the safe care of our patients.
“Going forward, we are committed to building on the improvements and sustaining the required performance by prioritising a multi-agency response to addressing the county’s urgent care problem.”