By Julia Penhaligon
The Royal Cornwall Hospital at Truro should be taken out of “special measures” according to the Care Quality Commission.
The Trust which runs the hospital remains labelled as “requires improvement overall.” The CQC recommendation is to be considered by NHS Improvement's Provider Oversight Committee.
The CQC’s professor Ted Baker said inspectors found enough progress to make the recommendation to NHS Improvement.
CQC inspectors visited the trust during November and December 2019 to check the quality of six core services: urgent and emergency care, medical care, surgery, maternity, outpatients and end of life care. CQC also looked specifically at management and leadership to answer the key question: “Is the trust well-led? “
As a result of this inspection the trust is now rated as Good for being “effective and caring.”
“Well-led” progressed from “Inadequate” to “Good.” But the trust remains “Requires Improvement” for being “safe and responsive.”
Dr Nigel Acheson, CQC’s Deputy Chief Inspector of Hospitals for the south, said: "Royal Cornwall Hospitals NHS Trust has continued to make progress since our last inspection in September 2018. The trust has embedded a lot of the improvements needed.
“In July 2017, we rated the trust as Inadequate overall because of concerns relating to patient safety, the organisational culture and governance. Since that time, we have returned to inspect while continuing to monitor the trust closely.
“The leadership of the trust has worked hard to tackle the issues we reported on and they have jumped from Inadequate to Good in the well-led aspect of the inspection.
“The credit must go to the hard work and commitment of the staff and the current leadership team. I congratulate them on their achievements. While the overall rating of Requires Improvement remains the same, we have identified a number of significant improvements in the quality of services. I am happy to recommend that the trust is removed from special measures."
Inspectors found the board understood the priorities and managed the issues the trust faced. Board members were visible and approachable in the trust for patients and staff. They supported staff to develop their skills and take on more senior roles.
In urgent and emergency care staff worked together as a team for the benefit of patients. They supported each other to provide good care. However, there were instances where staff did not assess and monitor patients regularly to see if they were in pain or give pain relief in a timely way.
Medical care had enough nursing staff to care for patients and keep them safe and they understood how to protect patients from abuse. Staff assessed most risks to patients, acted on them and kept good care records. However, the service did not have enough medical staff in all areas and staff mandatory training was not fully completed.
In surgical services, staff knew how to protect patients from abuse and treated patients with compassion and kindness.
They worked well together for the benefit of patients and staff were supported to develop their skills. However, premises were not always suitable.
On Trauma 1 ward, many items were stored in a patient waiting area, because of a lack of storage. There was not enough space in one lounge, where three patients were waiting. Some surgical nurses were not trained to look after the acutely unwell medical patients on the surgical admissions lounge.
Staff in maternity worked well together to provide good care and treatment and gave patients pain relief when they needed it. They felt supported, respected and valued. Managers monitored the effectiveness of the service and made sure staff were competent.
Staff advised people how to lead healthier lives, supported them to make decisions about their care, and provided them with access to good information. A team of midwives supported the travelling community.
The trust’s end of life service had significantly improved from our previous inspection. The end of life team was working with other organisations across Cornwall to improve services for patients.
This joint working was in its early stages but there had been positive responses to an education passport. N ursing staff were providing education sessions and were monitoring work competencies to support an increase in understanding for all community staff and volunteers. Staff treated patients with compassion and kindness.
In outpatients, the specialist nurse for teenagers and young people with cancer provided exceptional levels of support to patients. Every six weeks, the nurse arranged a peer support evening at a local restaurant for young people to meet others who were being treated for a cancer diagnosis.
There were enough staff to care for patients and keep them safe and they understood how to protect patients from abuse. Staff worked well together for the benefit of patients and treated patients with compassion and kindness.