Medical care and surgical services at the Royal Devon & Exeter Hospital (RD&E) and North Devon District Hospital (NDDH) have been rated as ‘requires improvement’ following an unannounced inspection instigated by 16 ‘never events’ being reported at the sites between March 2021 and November 2022.
Anita Merritt www.devonlive.com
Never events are serious, largely preventable patient safety incidents that should not occur if healthcare providers have implemented existing national guidance or safety recommendations. It promoted independent health and social care regulator Care Quality Commissions to inspect the hospitals at the end of 2022.
Areas of concern found included a ‘high number’ of staffing shortages, long increasing waiting lists, surgical outcomes not always meeting national standards, action not always being taken quick enough for patients at risk of deterioration and significant challenges with the new integrated electronic patient record system.
The results of the inspection of diagnostic services, published today, May 26, state the RD&E has declined from a rating of ‘good’ to ‘requires improvement’ overall for medical care. It was rated as requires improvement for being safe and well-led. Effective, caring and responsive categories were inspected but not rated.
Surgery at both locations, dropped from good to requires improvement overall as did the ratings for safe and well-led. How responsive, caring and effective the service is was inspected but not rated. Medical care at North Devon District Hospital remains requires improvement overall. It was rated as requires improvement in safe and well-led. Effective, caring and responsive were inspected but not rated.
Diagnostic imaging at both locations was rated as good overall. It was also rated as good for being caring, responsive and well led, and requires improvement for safe. As per all CQC inspections, diagnostic services were inspected but not given a rating for how effective they are as it is not usually used for treatment.
This is the first inspection of the trust since the Royal Devon and Exeter NHS Foundation Trust and Northern Devon Healthcare NHS Trust merged to form the Royal Devon University Healthcare NHS Foundation Trust in April 2022. The aim of the merger was to combine resources and expertise to provide acute, community and specialist services across North Devon, Mid Devon East Devon and Exeter.
Corporate and clinical services are in the process of being merged. The inspection was one of a number of CQC visits that will form the Royal Devon’s overall trust rating.
The trust had a separate well-led inspection earlier in May which looked at the leadership and governance of the organisation. A further report and an overall trust rating is expected in the coming weeks.
Cath Campbell, CQC deputy director of operations in the south, said: “Our inspection of Royal Devon University Healthcare NHS Foundation Trust was prompted by concerns about the number of never events that had taken place. Although we understand the pressures that healthcare providers have faced, and continue to face, never events are precisely that – they should never occur.
“If they do, it’s important they are thoroughly investigated to ensure they don’t happen again. Once an investigation has taken place learning should be shared with all staff and that wasn’t always happening.
“The trust had mitigated risks by putting in place a never event investigation report. While individual investigations into each never event had taken place, the trust also recognised the need to join up the learning and communicate this between all trust locations as it wasn’t currently happening.
“Inspectors found staff knew how to safeguard people. They also treated people with kindness and compassion, considering their individual needs and preferences.
“Following the inspections, we reported our findings to the trust. Its leaders know what they need to do to improve services, and where there’s good practice on which they can build on.”
The inspection report does not reveal details of the 16 never events that were reported by the trust. The concerns highlighted by inspectors include:
- The service had a high number of vacancy rates at all levels. There was a high reliance on a locum workforce. Due to the shortages on most shifts, some people had to wait longer to receive help with food and personal care.
- In medical care, people’s documentation and risk assessments were not always completed. This meant staff did not always identify or act quickly enough for patients at risk of deterioration.
- In medical care staff did not always know if people had enough food and drink to meet their needs and improve their health as it was not recorded.
- In surgery, outcomes for people did not always meet expectations based on national standards. The surgical division was under pressure with long waiting lists which were increasing.
- In surgery and medical care, there were challenges with the new integrated electronic patient record system as a complete oversight of the service provided was difficult. Some audits that were required had been postponed during the pandemic and the results were currently unavailable due to the introduction of a new integrated electronic patient record system. This did not give sufficient oversight of performance and how to improve.
- Staff were not always competent in using the new integrated electronic patient record system.
- At the safety and risk meeting in October 2022, the trust acknowledged they were not completely assured that all the steps identified to minimise the amount of never events, were being taken. While individual investigations were completed, the trust did recognise the need to join up the learning and communicate this between all trust locations.
However, inspectors also praised the hospital in a number of areas. Inspectors note people didn’t stay in hospital longer than they needed to as managers and staff started planning each person’s discharge as early as possible.
Staff were said to be open and honest and understood the duty of candour. They gave patients and families a full explanation if and when things went wrong.
If staff were concerned about people’s mental health, it was noted the service had 24-hour access to mental health liaison and specialist mental health support provided onsite by the local mental health trust.
In diagnostic imaging services, inspectors found staff were discreet and responsive when caring for people. They took the time to interact with people and those close to them in a professional, respectful, and considerate way – to ensure people understood every issue.
Chris Tidman, the trust’s Deputy Chief Executive Officer, said: “We are pleased that our diagnostic imaging services have been rated good. We are of course disappointed by the results in our medical and surgical services, however, we feel it is a fair reflection of the challenges the trust and our teams were under at the time of the inspection.
“We are a learning organisation and we welcome feedback from the CQC and their response to our never events, which will help us to continuously improve our services for our patients and communities. We are reassured that the majority of the areas for improvement were already known to us, and work is underway to raise standards and performance.”
The report describes the challenges caused by the rollout of the trust’s electronic patient record.
Chris said: “Epic brings us huge opportunities to modernise the care we provide to our patients, but with a new system of this size we always expected it to take time to become embedded, so we were not surprised to see this reflected in the report.”
Inspectors also highlighted how patients were treated with compassion and kindness, and examples of positive-team working, staff feeling empowered to raise concerns and treating patients according to their individual needs.
Chris added: “As a leadership team, we are extremely proud of our staff and we encourage them to be proud too, of everything they do every day for our patients.”
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