Dudley's hospital trust told to improve by inspectors

The Dudley Group NHS Foundation Trust has been rated overall as 'requires improvement' by the Chief Inspector of Hospitals following an inspection earlier this year.

In the report published today (July 12), inspectors said sepsis treatment was not always carried out in a timely manner and concerns were raised about the Trust's diagnostic imaging.

The report also said there was a 'lack of awareness' surrounding ionising radiation regulations.

The Trust, which previously also received an overall 'requires improvement' rating in 2017, was rated as 'inadequate' for whether services are safe in today's report.

Whether services are effective and caring were rated as 'good', while the responsiveness and leadership of services were told to improve.

The Trust said it was making 'steady progress' across all of its services, but was 'disappointed' with the inadequate rating for safety and diagnostic imaging.

Professor Ted Baker, CQC Chief Inspector of Hospitals, said: “Inspectors found good practice at The Dudley Group NHS Foundation Trust, but they also identified areas where significant improvement was needed.

“The safety of urgent and emergency care fell short of our expectations. Inconsistent and poor practice meant that not all patients received sepsis treatment in a timely manner. Not all patients were monitored and observed sufficiently to identify deterioration, and we were not assured that all patients allocated to wait on corridors were safe.

“There were also issues with the trust’s diagnostic imaging – a service which includes provision of X-rays, ultrasound and MRI scans. Facilities at Russells Hall Hospital were too small to meet demand. People were at risk of avoidable harm because staff had not completed all required training, and there were insufficient plans to manage deteriorating patients. There was also a lack of awareness of ionising radiation regulations, meaning people could have been exposed to radiation levels that may not have been as low as practicable. Underpinning these issues was insufficient oversight from the trust’s leadership and a shortage of managers with the right skills and experience."

However he did praise staff for their 'kindness and respect' towards patients.

He added: “However, staff treated people with kindness and respect. The trust’s care of older people and those approaching the end of their lives was compassionate and effective, and community palliative care staff worked well with external health and social care professionals to put patients at the centre of everything they did.

A statement from the Trust said they 'welcomed' the report.

It said: "We welcome the publication of the report of our latest inspection by the CQC which took place between 15 January and 31 January 2019.

"Our overall rating remains the same at requires improvement and we are pleased that the hard work of our teams is paying off in our urgent and emergency services whose overall rating has improved to requires improvement.

"We are pleased the CQC recognised the outstanding aspects of our community end of life service which was rated good overall and received outstanding for caring. Community health services for adults received a good overall rating. This is great recognition of the dedication and commitment to excellent patient care these team deliver to their patients.

"We are thrilled that our surgical services received an outstanding rating for being a caring service and are rated good overall.

"Our critical care service improved to a good rating, in recognition of the improvements made by the teams in delivering safe patient care.

"One of our key areas of focus over the last two years has been the care of the deteriorating patient across the Trust with many improvements made in our Emergency Department (ED). This work means our patients are seen more quickly and effectively to ensure their safety. The CQC said 'we saw that the Trust, emergency department leaders and staff had worked hard on their sepsis recognition and treatment throughout the year'.

"This is backed up by the Trust in hospital Summary Hospital-level Mortality Indicator (SHMI) figure which shows that sepsis mortality is now below the national average and below what was expected for the Trust. We have seen a steady improvement in this figure since 2016/17.

"From a sample audit reported on 5th July 2019, 92.8 per cent of patients in our ED who had suspected sepsis received IV antibiotics within an hour. Meantime to administer IV antibiotics is now 38 minutes in our ED.

"We are confident emergency patients are seen in timely manner with 83.7 of patients being seen within 15 minutes (4th – 10th July 2019).

"We are making steady progress across all of our services but we are, of course, disappointed that our diagnostic imaging services has been rated inadequate overall, and overall the Trust was inadequate for safe domain.

"Our diagnostic team responded immediately to the concerns and put actions in place at the time of the inspection and are confident of our improvements. We introduced a matron to oversee quality and safety and have increased monitoring 24/7 of our inpatients waiting for imaging.

"We have also conducted a comprehensive staffing review to ensure any additional posts are in the right places to support patient care and safety. We have had an external expert’s view on our staffing review and skill mix within the department. We have been successful in recruiting specialist MI and CT radiographers who are now in post and additional radiographers will be in post by September.. We are continuing to invest in radiology staffing."

The Dudley Group NHS Foundation Trust also operates the Guest Outpatient Centre in Dudley and the Corbett Outpatient Centre in Stourbridge.