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CQC Report Published: UHP rated Outstanding for Caring again but urgent and emergency care challenges recognised by inspectors

Chief Executive Ann James said:

Today sees the publication of our CQC report. The CQC came to inspect our services  in the autumn of 2021, carrying out an unannounced inspection of urgent and emergency care and medical care services and rating us for well-led as a trust overall.  These are the headlines from the report:

  • University Hospitals Plymouth NHS Trust remains rated as Requires Improvement  overall
  • Our #1BigTeam has once again been rated as Outstanding for Caringthis is testament to how compassionate our staff and volunteers are, even when facing significant pressure, as we have done for the last two years in particular.

We have improved our rating for Well-Led. We are now rated s Good for Well-Led. I am really pleased about this because this rating recognises the commitment, hard work and compassion of leaders right across the organisation to support patients and colleagues.
 

  • We are rated  Good for Effective and Requires Improvement  for the domains of Safe and Responsive
  • The CQC inspectors recognised the challenges we have in providing timely urgent and emergency care. These challenges are well-known and have been covered in the public domain. They result in long waits for patients, particularly in ambulances and we are doing everything we can to reduce these. The CQC are sufficiently concerned to have placed conditions on our registration. The conditions acknowledge the wider system challenges within which we will continue to drive our internal improvements. We will provide the required data and work with others across our local health and social care system to give an updated position on actions taken to avoid people having to come to the Emergency Department.
  • We have made significant improvements both in flow across the hospital and within the Emergency Department. We have more Same Day Emergency Care services and in 2020 an independent external review was externally commissioned by our Chief Executive and NHSE/I Southwest to consider the cultural and relationship challenges that may be impacting on the delivery of high quality safe care within the Emergency Department at Derriford Hospital. We have just received the independent reviewer’s updated report which details progress made and you can view this via this link.
  • We are delighted that the hard work undertaken in Medical Care and across the Trust in relation to Well-Led has been acknowledged by the Care Quality Commission.  This is a significant accolade given current pressures. It is important however to put on record that the efforts have been no less significant in Urgent and Emergency Care, but the challenges are so much greater and we have less direct control over how some are improved.

 

We are obviously disappointed by this last point but I want to share with you what the inspectors wrote:

Our inspection found significant concerns and challenges in urgent and emergency care and medical care, largely impacted by challenges within the wider health and social care system. Because of our concerns, we placed conditions on the trust’s registration requiring them to take action with the health and social care system to improve patient safety and experience.

The inspectors’ report acknowledges that despite all we are doing in our trust, we cannot solve the challenge of meeting urgent and emergency care need alone. We will continue to work hard with all our local partners to improve this and we appreciate their support. This is why working as an Integrated Care System is so important.

Quotes from CQC inspectors: Staff, while under immense pressure, worked hard to provide compassionate care to patients and to involve patients and those close to them in care and treatment decisions.

 

Our next steps
We were already addressing the ‘must do’ areas for improvement highlighted by the CQC and we are working on the should-dos.  Work already underway includes, for example:

  • To improve information sharing a new incident dashboard is now in place showing the number of patients in the ED, Ambulance handover delays, patients awaiting admission
  • Emergency Services nursing recruitment day held in September 2021 with 28 appointments made across band 2 – 5 nursing staff , leading to over recruitment to band 2s
  • Nursing development programme in place for Emergency Services to support junior band 6 staff

We are on a journey of improvement using a standard approach to team-driven improvement: our People First programme. The CQC noted that quality improvement activity was taking place in all care groups and we will continue to rollout the spread of People First.

We are investing more than £5m in recruiting more nurses and £4.7m in pharmacy staff to further improve the quality of our clinical pharmacy service. These staff will help ensure patients get their medicines in a timely and safe way across all of our hospitals, so they can go home as soon as they are well enough to leave.

We have plans to develop a new Urgent and Emergency Care Centre which will provide more space in which to care, as Stuart Windsor explains in this video.  We are moving forward with our Digital Strategy and we’re working closer than ever with GPs and colleagues in the community to join up care for patients and their families. This should all make it easier for patients to access care and through better communication and information sharing, we avoid duplication and give people a better experience.

We are extremely proud of how our #1BigTeam has responded to the pandemic and continues to respond to the ongoing demand for healthcare at a difficult time. We will continue to make improvements to provide the best care possible to our patients and their families.

End

 

Quotes from CQC inspectors: Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

NHS Devon Clinical Commissioning Group’s Chief Nurse Darryn Allcorn.said: 

Devon’s wider health and care system has been working closely together to support University Hospitals Plymouth NHS Trust to help reduce the number of people being admitted to hospital and to minimise delays in discharging patients.

Actions taken to reduce pressure on hospital beds include:

  • Awarding University Hospitals Plymouth a contract for providing community and adult social care services with Livewell SouthWest as an integrated care partnership, so that services can work more cohesively to keep people out of hospital and help them to get home.
  • Commissioning care hotel beds to enable people who are ready to go home, but are waiting for extra care to be provided, to leave hospital.
  • Creating Personal Health Budgets to allow people to pay for family or friends childcare or travel costs so that they can provide them with support or to pay for one off items that can’t be purchased through existing systems; such as a microwave if they can’t cook for themselves.
  • In partnership with Local Authorities we have provided additional investment on top of the national Workforce Support Grant  to provide incentives to care workers
  • Launching a significant recruitment campaign, along with the Department for Work and Pensions and Skills Launchpad, to attract more people to become carers.
  • Forming the Plymouth Local Care Partnership which strengthens relationships and gives local authorities, healthcare organisations and the voluntary and community organisations sector power to identify and focus efforts on local needs.  Priorities include integrating care to deliver the right care, at the right time, in the right place.  One example of this working in practice is Livewell Southwest and University Hospitals Plymouth working together to vaccinate housebound people against Covid-19

However Covid-19 continues to have an impact across the wider health and care system with more staff absent due to Covid-19 and some care homes closed to admissions due to Covid-19 outbreaks.

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