Running at nearly full capacity is having a major impact on patients at Cornwall’s main hospital, according to a new report.
The problem, which is “not of their making”, has been instrumental in the denial of a top grading after its toughest ever inspection.
The Royal Cornwall Hospital Trust (RCHT) was subjected to a rigorous assessment of key services and according to a report published today overall requires improvement.
In the sweeping four day inspection, Treliske, the main site at Truro, was said to be in need of improvement while West Cornwall Hospital in Penzance and St Michael’s at Hayle were both judged as good.
Inspectors for the Care Quality Commission (CQC) said the fact that the trust’s two main sites in Truro and Penzance were running at near full capacity all the time was having a major impact on patients.
They said the subsequent delays, bed pressures in some units which meant women were giving birth on the wrong ward and high levels of cancelled operations were unacceptable and ordered the RCHT to produce an action plan.
Dr Sheila Shribman, who chaired the CQC team visiting the trust, said they had not found anything to be inadequate, which is the lowest in the league of four ratings topped by ‘outstanding,’ with ‘good’ in second place and ‘requires improvement’ in third.
“This is a very busy, acute hospital,” she said.
“It has clearly been through some troubled times in the past, but it is also clear to me that this is an improving organisation with ambition to deliver high quality patient care.”
The CQC team said capacity and patient flow issues must be tackled.
In their report, inspectors said: “At Treliske Hospital, the high occupancy level, particularly in medical and surgical beds, was having an impact on he quality of care and on the trust’s ability to be responsive to patients needs.”
The report said a lack of free beds meant the critical care unit was not discharging patients onto ordinary wards quickly enough, which had led to operations being cancelled.
Medical patients were sometimes cared for on surgical wards, adding to the problem meanwhile patients' discharge into community care was sometimes delayed, known as bed blocking, because “this was not being arranged in good time with, or by, other providers.”
RCHT has had long standing issues over bed blocking, with delays in transfer of care reaching their highest level in a year one day last month.
Dr Shribman said it was not unusual, adding “I don’t think it is a problem of the trust’s own making.”
The inspection team also highlighted issues over patient records, which were found sometimes to be incomplete or missing.
However, the CQC praised a number of areas, including oncology services, the newly extended casualty unit, low mortality rates in the critical care unit, the team spirit in the trust and strong leadership.
Moreover, many staff were said to be “experienced, caring, compassionate, and champions for their patients.”
Chief executive Lezli Boswell said there were “no surprises, no major revelations” in the report and that she delighted the efforts of staff had been recognised.
She said work was ongoing with partners such as Cornwall Council and Peninsula Community Health, who run the county’s cottage hospitals, to deal with capacity issues.
Mrs Boswell said CQC chief inspector Professor Sir Mike Richards had said RCHT was “knocking on the door” of being rated ‘good.’
Sir Mike confirmed said that the trust had been “on a journey of improvement over recent years.”
He added: “But they're not there yet. At Treliske Hospital the high occupancy level, particularly in medical and surgical beds, has been having an impact on the quality of care, and on the trust’s ability to be responsive to people’s needs.
“If they are going to meet those pressures, the trust will need to work in partnership with commissioners and all the other providers, who share responsibility for the effectiveness of health and social care services in Cornwall.
“It was encouraging that the staff we met held such a positive view of recent improvements and were proud to work for the trust. I am confident that the executive team, with the support of the staff, can deliver the improvements we require on behalf of their patients.”
WHAT THE INSPECTORS SAID ABOUT WEST CORNWALL HOSPITAL IN PENZANCE
A hospital whose future hung in the balance a few years ago has emerged with a clean bill of health from its toughest ever inspection.
West Cornwall Hospital in Penzance has been judged as ‘good’ by a team from the Care Quality Commission who put its services under the spotlight.
The wards were said to be sufficiently staffed, clean and well led, with staff speaking highly of the matron and divisional manager.
Medical, surgical, out patients and emergency care services were uniformly said to be of good quality and won praise from patients.
The only blot on the report published today was across the RCHT, with the safety of medical services said to need improvement over record keeping which was found to be sometimes not up to date.
Inspectors listed this area as the only action the hospital must take to improve.
They also highlighted issues which could be taken, such as improving the layout of the outpatients department.
WHAT THE INSPECTORS SAID ABOUT ST MICHAEL'S HOSPITAL IN HAYLE
Inspectors who examined the two key services at St Michael’s Hospital in Hayle have delivered the verdict that they are both of good quality.
The hospital provides breast surgery and planned orthopaedic surgery for adults, as well as a range of out-patient clinics, all of which won praise from inspectors.
It was said to be a well run establishment, although staff raised concerns that they were often moved to help bridge gaps at the main site in Truro and this had a demoralising effect.
Inspectors were told that when nurses were moved to Truro it could lead the site short of staff, patients were largely full of praise for the treatment at Hayle.
WHAT THE INSPECTORS SAID ABOUT TRELISKE, THE RCHT MAIN SITE IN TRURO
Services at Cornwall’s main hospital site were judged to be in need of improvement by inspectors from the Care Quality Commission.
The team who conducted the in-depth analysis said that the many of the services were delivered “to a good standard” by staff who clearly cared about their patients.
However, the hospital was ordered to make urgent improvements over its safety standards relating to patient records, which were sometimes found to contain conflicting or missing information.
This was said to place patients at risk of not receiving the care they required.
Records were also found to be stored in some insecure areas which were not attended by staff.
The hospital was also ordered to improve patient flow issues which meant that too many operations were cancelled, not enough beds were available on the appropriate wards and sometimes medical equipment was in the wrong place.