“Urgent changes” are needed at the troubled Shrewsbury and Telford NHS Hospitals Trust (SaTH) after health inspectors highlighted “failing leadership” and normalisation of “poor patient care”.
The Care Quality Commission (CQC) said the trust’s new alliance with England’s biggest health NHS trust, University Hospitals Birmingham, signed last week and due to start on September 1, was a welcome “first step” on the road to making much-needed improvements.
SaTH has been in special measures since November 8, 2018, with a damning report into failings at the trust published later that month by the CQC.
But despite repeat follow-up visits, the health watchdog’s most recent inspection to each of the trust’s two hospitals in June uncovered issues “previously identified” which “had not been addressed”.
There were also “new areas for concern” where the trust had previously been meeting standards.
The highly critical hospitals’ reports concluded: “Risks were not well managed and patient records did not consistently reflect people’s needs and wishes.
“Some staff did not have the right competencies for their roles, and the trust’s policies and procedures were not always based on the most recent national guidance.”
Inspectors added: “The trust’s issues have been perpetuated by its leaders’ collective failure to demonstrate that they had the skills and abilities to meet the challenges the trust has faced.
“They were not always visible or successful in embedding their priorities, feeding a culture that did not identify or respond to problems.”
In one report, focusing on the Royal Shrewsbury Hospital, inspectors found basic patient documents like risk assessments were incomplete, and governance lacking.
In one case a patient discharged from hospital only four days previously, who the trust had documented as having a history of falls, incorrectly stated on their new admission paperwork the person had “no history of falls”.
In another case, a ward nurse was asked by inspectors why a patient identified at high-risk of getting pressure sores had no specialised mattress, but “they could not answer the question”.
Care plans “contradicted each other”, and the hospital leaders “did not demonstrate they had the skills and abilities” to run its services.
The report “found that there was a normalisation of poor care” and staff “did not challenge one another when they witnessed poor care”.
The second report published following an inspection at the trust’s other site, the Princess Royal Hospital in Telford, echoed the concerns found at Shrewsbury.
A ward nurse told inspectors of a fall-risk patient who required “continuous one-to-one supervision”, but when this was queried with the nurse on the ward looking after that patient “they were not aware” of that requirement.
Another patient was injured after falling from their bed because a “significant” risk factor in use of bed rails had been overlooked.
One member of staff, asked why a risk assessment had not been completed for one of their ward patients, told inspectors it “should have been completed” by another nurse on a different unit
“They did not acknowledge their role in assessing and managing this risk as the patient was now their patient on their ward,” the inspectors said.
The trust retained its overall inadequate rating, the lowest possible.
It was also rated inadequate in the key individual fields of being safe, effective, responsive and well-led – ratings which have persisted since last being published in April 2020.
The CQC’s chief inspector of hospitals, Professor Ted Baker, said: “We have repeatedly called for intervention to support improvement at Shrewsbury and Telford Hospitals NHS Trust.
“Despite this the trust has not resolved long-standing known issues, and poor patient care has been normalised. This situation must not continue.
“The trust has not responded satisfactorily to previous enforcement action.
“So I welcome their improvement alliance with University Hospitals Birmingham NHS Foundation Trust, which has been prompted following further intervention and enforcement action from CQC.”
He added: “This is the first step towards implementing the urgent changes that are required.
“We will continue to carefully monitor the trust to determine whether this drives the required change and will take further action if there is no progress.
“The trust’s board is fully aware of the essential improvements it must deliver.
“We continue to monitor the trust, including through further inspections.”
Following the latest inspection, the CQC issued the trust a warning notice to improve in key areas by no later than September 30.
SaTH’s chief executive Louise Barnett said: ““We welcome the Care Quality Commission’s (CQC) report and accept all the findings following their inspection in June.
“I am determined we now take immediate action to ensure a significant improvement in performance and delivery of care at SaTH.”
On the link up with UHB, she added: “This new Alliance will enable us to prioritise the development and delivery of a rapid improvement plan that will support clinically safe and sustainable patient services at SaTH.”
The latest report follows Prof Baker’s letter to NHS chief operating officer Amanda Pritchard, in July, outlining concerns about the trust.
He said consideration of recommending for “trust special administration” could not be ruled out, if other intervention actions could not be agreed.
The measure was previously used on the scandal-hit Mid Staffordshire NHS Foundation Trust, where an inquiry concluded hundreds of patients suffered poor care, eventually leading to the trust being dissolved.
In July, NHS Improvement announced a support package for SaTH.
A separate inquiry, led by Donna Ockenden, into failures at SaTH’s maternity services is also under way and has expanded to look at more than 1,800 cases, with a parallel police investigation running to see if any criminal action should be taken.