West Hertfordshire Hospitals NHS Trust 'requires improvement' says CQC

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Inspectors visited core services at the trust earlier this year

West Hertfordshire Hospitals NHS Trust (WHHT) has been rated overall as 'requires improvement' following an inspection by the Care Quality Commission.

The Trust - which manages hospitals in Hemel Hempstead, St Albans and Watford - has seen a number of improvements, with some ratings jumping two places from 'inadequate' to 'good'.

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A partial inspection by the CQC in February and March looked at urgent and emergency services, medical care and surgery as well as a review of the leadership team and ‘use of resources’ – a measure to assess financial management.

West Hertfordshire Hospitals NHS TrustWest Hertfordshire Hospitals NHS Trust
West Hertfordshire Hospitals NHS Trust

The trust was rated 'good' for being effective, caring and well-led and rated 'requires improvement' for being safe and responsive, overall, the trust has a higher number of ‘good’ ratings than ratings for ‘requires improvement’.

When the trust was previously inspected, in 2018, it was rated as Requires Improvement overall.

All the trust's services at Watford General Hospital and St Albans City Hospital are now rated overall as ‘good’ (eight and three services respectively) and two out of three services at Hemel Hempstead are rated overall as ‘good’.

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Assessment of the trust has gone up in three domains - safe, effective and well led - and remained the same in two - caring and responsive. Ratings did not decrease in any domain.

The trust has no ‘inadequate’ ratings and did not receive any enforcement notices, which mean that services must be halted or changed immediately.

Urgent and emergency care services on all three hospital sites are now rated ‘good’.

Inspectors noted: “Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients.”

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Inspectors also saw “examples of excellent seamless care for patients”, through multidisciplinary working.

The overall rating for caring remains good, with inspectors mentioning that they “...saw staff engaged with patients and their loved ones...listening and being caring.”

The report also says: “We observed consultants being respectful and compassionate with distressed family members and we observed warm and caring engagement between staff and patients.

“Patients said staff treated them well and with kindness. They told us nursing staff went above and beyond to care and support them with an attentive bedside manner.”

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They also commented: “We saw staff comfort parents who were struggling to manage their emotions because their children were emotional.”

Inspectors highlighted staff engagement and leadership: “Our interviews with leaders at all levels confirmed that they had a shared vision which was based on the trust’s priority for ensuring patients received the best care every day.”

They also said: “Staff we spoke with felt positive and proud to work for the organisation.”

Summary of services at Hemel Hempstead Hospital, the report said: "Our rating of services stayed the same. We rated it them as requires improvement because patients assessments were not always completed in a timely manner, and records were not always kept up to date; there remained some confusion within the inpatient team as to the long term plans for the service. However, urgent and emergency care services improved and were rated good overall.

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"There had been improvements in the governance arrangements of the department and there was clear oversight from clinical leads based at Watford General Hospital. The team were fully engaged and were starting to look at quality and service improvements. Medical services improved and were rated as requires improvement. There had been changes to the functionality of the inpatient area and the leadership which had impacted positively."

CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said: “Although the trust’s rating remains the same, we saw improvements in several areas, especially within urgent and emergency services, which is now rated as Good overall.

"Staff should be proud of the improvements that have been made since our last inspection.

“We have reported our findings to the trust leadership, which knows what it must do to bring about further improvements and ensure it maintains any already made.

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“CQC’s immediate focus will be on supporting the trust to keep people safe during the Covid-19 pandemic, working with NHS England and NHS Improvement to ensure additional support is in place where needed.”

Staff satisfaction, improved morale and involvement in making changes to services were evident to inspectors, who also praised the trust for its focus on staff development and succession planning.

Effective partnership was noted in the CQC report which described how staff work with other organisations to ensure that all aspects of patients’ care is joined up; including mental health support, housing and safeguarding for vulnerable children and adults.

The trust was also commended for the care it took to make sure its services meet the needs of patients with dementia and learning disabilities.

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Continued good performance against financial targets was praised, with an acknowledgement that clinical staff were closely involved to ensure that patient care is not compromised when costs are cut.

In terms of community engagement, the inspectors noted two ‘so you want to be a doctor?’ study days for local schools and colleges.

Visits made by members of the trust board and executives to clinical and non-clinical areas out of hours were mentioned by staff to inspectors.

Feedback was that leaders were “visible and approachable.”

Learning from complaints and incidents was cited as being very much part of the culture across all the areas inspected.

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Inspectors noted areas for further focus; some patient records were missing details such as patient’s weight; cleaning products were not always stored correctly and there were longer than national average waiting times for some surgery. Improvements in emergency care waiting times were noted.

These factors, as well as evidence that all staff were aware of the trust’s vision and recently launched five year strategy, contributed to an improved rating of good for ‘well-led’.

Chief executive Christine Allen said: “I am really pleased that inspectors saw how much we are achieving in terms of staff engagement, learning from incidents and always pushing ourselves to find new and better ways of delivering the best care for every patient, every day.

“We recognise that there are further improvements to be made. Waiting times for urgent care had been steadily improving despite increased demand.

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"We had also made progress in reducing waiting times for some surgical procedures, but this was before the COVID-19 pandemic impacted on our services.

"The improvements shown in this report demonstrate clearly the hard work and commitment shown by all of our staff.”

WHHT’s chairman Phil Townsend said: “I’m enormously proud of our staff and their dedication to improving services.

"These inspection results show how determined staff are to provide the very best care for patients and their commitment shines through every day; never more so than during our

response to the pandemic. I am proud to be their chairman.”

To view the full report visit: www.cqc.org.uk/provider/RWG.

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