Care Quality Commission tells trust that runs Scarborough Hospital improvements are needed

During inspections at Scarborough Hospital and York Hospital in October last year, the CQC initially inspected medical care, maternity services and urgent and emergency care.

Due to concerns found in relation to maternity services at both hospitals, , as well as in urgent and emergency care at York Hospital, CQC issued a letter of intent asking the trust to make rapid improvements in maternity services at both hospitals, relating to managing people whose health was deteriorating, people who were waiting for care, as well as medicines management issues.

When CQC returned to reinspect the above services during the well-led inspection in November, there had been some improvement in urgent and emergency care.

However, improvements had not been made in maternity services, so urgent conditions were placed on the trust in these areas to ensure people’s safety by driving rapid improvement.

This related to having effective systems in place to monitor and manage risks to people’s safety.

Following the November inspection, CQC received information of concern and extended the well-led inspection, which continued until March.

Since the inspection, the overall rating for the trust as well as for how safe it is, remains rated as requires improvement.

How effective and responsive the trust are, have dropped from good to requires improvement, and how well-led the trust is has declined from requires improvement to inadequate, and caring remains rated as good.

The ratings for these services at Scarborough Hospital following this inspection are:

Medical care – remains rated requires improvement

Maternity services – has dropped from good to inadequate

Urgent and emergency care – improved from inadequate to requires improvement

Sarah Dronsfield, CQC deputy director of operations in the north, said: “When we inspected York and Scarborough NHS Foundation Trust, we didn’t find well-led services.

“We were concerned to find leaders didn’t always understand or effectively manage all the priorities and issues the trust faced.

“Although improvements had been made in medical care since we issued a warning notice in March last year, at our visit in October we found further serious concerns around maternity services and urgent and emergency care.

“In some areas we found there wasn’t always an open culture where staff could raise concerns without fear.

“This lack of poor leadership was having an impact across all of the services we visited. We saw people using services being put at risk of harm from a lack of good processes, such as staff not completing risk assessments or keeping people’s care plans up to date.

“We also saw infection control processes weren’t effective in urgent and emergency care, with dirty equipment and premises, and clinical waste not being managed appropriately.

“The trust wasn’t always providing maternity care in a way that was planned to meet the needs of local women and people using services. It was concerning people couldn’t access services when they needed to.

“However, most staff treated people with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

“Following the inspection, we fed back our serious concerns to the trust leadership team and we expect to see rapid and widespread improvements.”

Inspectors found during this inspection that there weren’t enough staff with the right qualifications, skills, training or experience to keep people safe from avoidable harm and to provide the right care and treatment.

They also found that staff didn’t always meet the trust target for mandatory, role specific and safeguarding training.

Maternity services and urgent and emergency care at both hospitals, and medical care at York Hospital, didn’t manage medicines well.

Managers didn’t always investigate incidents and share lessons learnt promptly.

In maternity services, staff didn’t always monitor the effectiveness of care and treatment so they could learn from it and make improvements in order to achieve good outcomes for women and people using the service.

Urgent and emergency care at York Hospital and maternity services at both hospitals didn’t always plan and provide care in a way that met the needs of local people.

People couldn’t access some services when they needed it to receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge people weren’t in line with national standards.

Senior leaders weren’t always visible and didn’t always support staff to develop their skills. The vision and strategy had not yet been embedded. They didn’t always use systems to manage performance effectively or make decisions and improvements.

Staff didn’t always feel respected, valued, and supported. They weren’t always clear about their roles, responsibilities, and accountabilities.

Leaders and staff didn’t always engage with people, staff, equality groups, the public and local organisations to plan and manage services.

However, Inspectors did find during this inspection that most staff helped people understand their conditions and provide emotional support to people, families, and carers.

Across the trust, staff advised people on how to lead healthier lives, supported them to make decisions about their care, and had access to good information, and key services were available seven days a week.

The full report is available to read on the CQC website now.