CQC report orders Kettering General Hospital to improve as overcrowded A&E patients put at safety risk and 'quality of leadership' declines

An unannounced inspection was carried out after concerns were highlighted to the commission about the safety and quality of medical care and surgery services.

Inspectors also checked to see if improvements had been made at urgent and emergency care and children and young people’s services.

Staff were judged as ‘caring’ in three out of four of the areas but A&E was judged to be ‘requiring improvement’ after inspectors found deteriorating patients were left unseen in overcrowded waiting areas and children witnessed traumatic events.

Charlotte Rudge, CQC deputy director of operations in the Midlands, said: “When we inspected Kettering General Hospital NHS Foundation Trust, we saw that the quality of leadership had declined which was having an impact on the quality of services. Although we saw some improvement in children and young people’s services, there is still much more to do there and across medical, surgery and urgent and emergency services.

“We saw several issues with the urgent and emergency service environment which could be a potential risk to people’s safety. It was clear the demand on the service had outgrown the size of the department and we saw people sitting on floors or standing due to insufficient space. Sometimes, relatives had to alert staff to people’s conditions deteriorating due to nurses not being able to see everyone in the waiting area which was placing people at the risk of harm.

“In addition, the children’s waiting area wasn’t always separated from the adults. We heard examples where children had witnessed high risk patients being treated which could have been traumatic for them.

“However, it was positive that some improvements had been made at children and young people’s services. Staff were better at identifying sepsis and there was clear evidence of timely escalation to the medical team once someone had shown symptoms.

“Staff had access to rapid assessment with child and adolescent mental health services (CAMHS) when needed and Skylark, the children’s ward worked closely with them. We saw examples of positive and regular communication with the service to support young people as quickly as possible when needed.

“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can receive safe and appropriate care.”

The overall rating for the trust remains as requires improvement but for individual services were rated:

- Children and young people’s services: the overall rating has gone up from inadequate to requires improvement. ‘Safe and well-led’ have gone up from inadequate to requires improvement, ‘effective and responsive’ are rated requires improvement again and ‘caring’ is rated good again.

- Urgent and emergency care: this has been rated requires improvement overall again. ‘Safe’ is rated inadequate again, ‘effective and responsive’ and ‘well led’ are rated as requires improvement again and ‘caring’ has gone down from good to requires improvement.

- Medical care: this has been rated requires improvement overall again. ‘Safe’, ‘effective’ and ‘well led’ are rated requires improvement again, ‘responsive’ has gone down from good to requires improvement and ‘caring’ is rated good again.

- Surgery: this has been rated requires improvement overall again. ‘Safe’ and ‘responsive’ are rated requires improvement again, ‘effective’ and ‘well-led’ have gone down from good to requires improvement and ‘caring’ is rated good again.

Kettering General Hospital’s chief executive Deborah Needham said: “We welcome the inspection report by the CQC. Since the inspection took place, we have continued to see improvements across both medicine and surgery, having reduced our maximum waiting time for treatment and improving our four-hour performance in the emergency department. Our new safer staffing tool, introduced last year, is helping us to also ensure we maintain safe levels of staffing and address any gaps across our hospital.

“We were pleased that inspectors recognised that our staff are caring, compassionate, and kind to patients and their families, and that our overall rating for caring remains good. We are especially pleased that our significant efforts to improve children’s and young people’s services have been recognised with an improved rating. We clearly still have a lot of work to do in this area but I was proud to see that the CQC described our staff as working well as a team, and that we treat children, young people and their families with compassion and kindness.

“We will be working hard to address the issues raised, however, we recognise that the ratings are indicative of the immense operational pressures our hospital, like many others up and down the country, continue to face and that our teams continue to do an incredible job to provide safe and effective care to our patients.

“We’re inviting CQC to visit us again to look at the well-led domain as it was re-rated without a specific inspection and we feel we have a wealth of positive evidence to share with them on this.”

In urgent and emergency services inspectors found:

– People presenting with acute mental health concerns didn’t have access to a dedicated room which met national guidance relating to the provision of a safe environment.

- There wasn’t a consistent process for staff to follow to assess people being brought in by ambulance.

- Staff described a culture of learning from incidents in the department while others described a culture of blame where staff didn’t acknowledge or talk about their mistakes for fear of ridicule.

In children and young people’s services:

- Staff knew how to identify adults and children at risk of significant harm and worked with other agencies to protect them.

- Skylark ward had a play area and sensory room to help distract children and meet their sensory needs.

- Managers accurately calculated and reviewed the number and grade of nurses, nursing assistants and healthcare assistants needed for each shift.

In medical care:

- The service didn’t always have enough nursing and support staff to keep patients safe.

- Staff didn’t always make sure the needs of people with a learning disability or autistic people were assessed to ensure they were provided with person centred care. However, staff were able to demonstrate a good knowledge of the needs of people living with dementia and the support needed for their family.

In surgery:

- Staff were concerned that people weren’t always assessed by senior medical staff when they were showing signs of deterioration.

- Staff said they felt the staffing levels weren’t sufficient and this added extra pressure to ensuring safe care.

- Staff gave examples of when they had raised safeguarding concerns and how they had actioned them.