Portsmouth Hospitals NHS Trust ‘has failed to protect safety of patients’

The Care Quality Commission (CQC) has told Portsmouth Hospitals NHS Trust that it must make significant improvements to protect the safety of patients using medical care services at Queen Alexandra Hospital.

CQC has issued a ‘warning notice’ requiring the trust to improve safety, patient consent, dignity and respect, safeguarding and overall leadership, whilst also placing six conditions on the trust’s registration requiring specific action until the trust can demonstrate that patients are safe.

The action comes after two separate inspections this year in which inspectors identified a series of concerns about services for people requiring emergency medical care, particularly those affecting frail older people or those living with dementia.

During the inspections in February and May, teams of inspectors visited the acute medical unit, 10 medical wards and five outlier and escalation areas including the discharge lounge, and day units for cardiac and renal patients.

The hospital’s medical care has been rated as ‘inadequate’; urgent and emergency care has been rated as ‘requires improvement’, and safety is rated ‘inadequate’ in both departments.

CQC has placed six conditions on the trust’s registration: the trust must deploy enough suitably qualified and competent staff in the emergency decision unit in the emergency department; the trust must ensure all patients presenting to the emergency department with mental health problems receive a full assessment of all risks assessment and corresponding risk management plan; the trust must identify, monitor and observe detained or high risk patients with mental health concerns or vulnerable safeguarding issues across the hospital; the trust must ensure there are clearly identified leads for mental health provision within the emergency department and acute medical unit at all management levels; the trust must ensure that Deprivation of Liberty Safeguards are applied as per the requirement of the Mental Capability Act 2005; and the trust must immediately take action to ensure patients are safe.

Ted Baker, Chief Inspector of Hospitals, said: “At previous inspections we have found some very good services at this trust, but during our inspection in February 2017 - we found that the quality of care on the medical wards was poor - especially for the most vulnerable patients, whose needs were not being dealt with properly, and who were at risk of avoidable harm.

“Such was the level of our concern that we took enforcement action instructing the trust to implement improvements. We undertook a follow up inspection in May to look further into the wider culture, governance and leadership within the trust.

“It is a matter of concern that on this return inspection we found the trust had still not effectively got to grips with these issues. There was a distinct lack of management oversight. The board appeared to have no real understanding of what was happening on the wards: we concluded that the trust leaders were not giving sufficient attention to many of the concerns we identified or the concerns of their own staff.

“Portsmouth Hospitals has been under pressure for some time – too many beds are taken up by patients who are medically fit for discharge but unable to leave hospital until social care becomes available. This in turn creates further pressure on the wider healthcare system. All local system leaders must help resolve this issue.

“We have taken further action by placing specific conditions on the trust that demand clear progress over the coming months. The trust is required to send us weekly reports, and we have been working closely with NHS Improvement to ensure that the trust gets the support it obviously needs at the highest level.

“If the trust fails to meet these conditions, or if there is a continuing failure to provide services that are of sufficient quality, we will take further enforcement action to protect patients who depend on these services.”