Patients on trolleys, risk of infection - is the Norfolk and Norwich really an unsafe hospital?
PUBLISHED: 09:52 30 June 2018 | UPDATED: 16:26 30 June 2018
Our flagship hospital has a huge task ahead to get out of special measures. In day two of our special report, we ask how worried patients should be that it has been rated "inadequate" for safety? Tom Bristow reports.
Patients waiting on trolleys, A&E “not fit for purpose” - and it is getting worse.
The Care Quality Commission (CQC) report, which placed the region’s biggest hospital into special measures last week, makes disturbing reading.
But the majority of patients experience excellent care at the Norfolk and Norwich University Hospital (NNUH), according to a survey for this newspaper.
The number of staff recommending the hospital as a place to be cared for in a staff survey is above the national average at 76pc. Its mortality rate is also falling.
A key reason the CQC gave the hospital its lowest possible rating of “inadequate” for safety was because of what it found in the emergency department and surgery.
They said the layout of A&E was “not fit for purpose”, healthcare records of patients were not always accurate and there was also a lack of a safe place for those with mental health problems.
More demand meant staff were also reporting a rise in serious incidents and there were long waits to offload patients from ambulances.
Worryingly, inspectors uncovered “manipulation” of delays by admitting patients who were approaching the 12-hour waiting target rather than those who had already breached the target.
The hospital has admitted it is not big enough to cope with demand, but its plans to expand need money which it does not currently have.
The emergency department was built for 82,000 patients a year, but it is getting around 130,000.
In its busiest month of December last year the NNUH was expecting 4,550 emergency admissions. It got 5,067.
And it has not hit the national target of treating 95pc of people who arrive at A&E within four hours since May 2015.
It sunk to a record low in February of 65pc putting it among the worst in the country.
In May it was up to 86pc, which is better than the Queen Elizabeth in King’s Lynn (QEH), but behind the James Paget University Hospital in Gorleston. The problems at the hospital are long-running, if other key targets are looked at.
It last hit a target to treat 92pc of patients within 18 weeks of them being referred for in September 2014. In April it managed 84pc, again better than the QEH but not as high as the James Paget.
A third crucial target is to begin treatment for 85pc of cancer patients within 62 days of an urgent GP referral. It reached that target in December 2017 and managed 80pc in April, again out performing the QEH but not the James Paget.
In surgery, the CQC inspectors were concerned about patients with infections not being isolated and the “unsuitable” day procedure unit being used as an escalation area for surgery.
They also found “significant quantities” of out of date items such as bandages.
Inspectors were also worried about staff training and infection prevention.
There were four so-called “never events” from June to November last year in surgery.
A high number of procedures were also cancelled at short notice and staff in surgery felt ignored and unsupported when raising concerns, the inspectors said.
But despite the problems many patients still rate their care as excellent.
In a survey of 750 people on this newspaper’s website last week 38pc rated their most recent visit as five out of five.
But the next most popular answer was the worst score of one out of five with 24pc.
We also asked in our survey what action patients would like to see the hospital take to improve.
The most popular answers were leadership changes, more funding for staff, listening to staff and expanding hospital.
But others dismissed the inspectors’ findings.
One said: “Nothing about the findings concern me. I’ve had A star treatment for cancer and they saved my brothers life the day this story broke.”
There was also huge praise for the front-line staff in the survey.
They were described as “caring”, motivated” and “excellent”.
And one of the positive points from the CQC findings was rating the hospital as “good” for caring.
“Staff took the time to interact with patients, act in a caring manner and be exceptionally kind to patients and those close to them,” they said.
The CQC also said it found “examples of outstanding practice” in urgent and emergency care.
The CQC has come up with 60 areas the hospital must improve on to comply with the law.
Timeline of challenges
• April 2015: Heath regulator, Monitor, says it is taking action to improve the NNUH after investigating missed waiting times.
• June 2015: Chief executive Anna Dugdale resigns after CQC report finds allegations of a “bullying culture”.
• July 2015: Mark Davies appointed as interim chief executive and then is given the job permanently
• November 2015: The CQC visits again and rates the hospital as “requires improvement”. A&E was rated as “good”, as was critical care.
• July 2016: The hospital is placed in financial special measures after forecasting a deficit of £30m in 2016/17.
• February 2017: The hospital comes out of financial special measures.
• April 2017: CQC inspectors visit again to make sure improvements are being made
• January 2018: The CQC tells the hospital it must make “significant improvements”.
• June 2018: CQC says hospital has got worse, rates it inadequate
What is the hospital doing to improve?
A spokesman said the hospital was working on an improvement plan to tackle all of the points raised by the CQC.
“There have been many improvements since the initial inspection visit in October 2017,” they said.
“We have built and developed the first dedicated Older People’s Emergency Department in the country.
“The Children’s Emergency Department has moved to a new unit, three times the size of the unit inspected last year and it opened its doors to patients in December 2017.
“The Mental Health Liaison Service, based at NNUH, has also increased its staffing from 13 to almost 30 to provide a 24/7 on site service.
“A new chief of service, service director, as well as a new deputy service director have been appointed to drive improvements in the Emergency Department.
“Unfortunately, in the past, operational pressures have often got in the way of staff training, appraisal and personal development. We agree that we need to get better at this, and we have a series of actions planned.”
Is more cash the answer?
The hospital had to save £25m in 2016/17 to come out of financial special measures.
But it is again predicting a deficit this year of £27m.
In its latest board papers, the hospital said the main cause of this was “clinical activity/income” not being at planned levels.
Nationally, NHS spending has increased by just over 1pc a year since 2013 in real terms.
But the budget of the NNUH has risen far more rapidly than that.
It rose from £480m in 2013/14 to £588m this year.
But no matter how much the funding increases it can not keep up with demand.
It is having to make savings of £30m this year and it also needs to find money to expand.
An NNUH spokesman said although it had increased the size of the emergency department, it needed extra funding to meet growing demand.
It is now bidding for money to expand radiology facilities.