The Queen Elizabeth Hospital (QEH) in King's Lynn 'fell short of what people should be able to expect' in an 'extremely concerning' inspection report released today.
The chief inspector of hospitals for the Care Quality Commission (CQC), Professor Ted Baker, panned the west Norfolk trust as he found "little evidence of improvement" when inspectors visited in March and April.
Previously the QEH was rated as inadequate and put into special measures last year, and this rating has been upheld.
Prof Baker said: "It was extremely concerning to find little evidence of improvement on our return. Improvements that needed to be made had not been made and the service fell short of what people should be able to expect.
"We found significant concerns and risks to patients within the urgent and emergency service, medicine, end of life care and gynaecology which were raised with the trust immediately. Many of these concerns had previously been identified at our inspection in 2018, yet necessary improvements had not been made."
Professor Steve Barnett, chairman at QEH, said: "We are absolutely determined to get this right for our patients. There are some success stories, lots of work in progress and also some very real challenges that we have begun tackling. What the trust needs now is stability, which changes to our leadership at board level will soon bring."
Throughout the report were themes of a reliance on agency and locum staff, staff not having the right skills to look after patients, and not learning from patient safety incidents.
Inspectors found in urgent and emergency services patients with mental ill health were not always kept safe, and pain levels were not always identified and monitored.
There had been an 83pc increase in complaints in the department since the last inspection, and patients who were deteriorating were not always spotted.
Non-clinical staff were making decisions over the escalation of patients, and on the first day of the inspection the on-duty consultants were not working in the department.
In medical care inspectors found patient records were not clear, were missing pieces of information, and were not stored securely.
And staff did not always care for patients with compassion. Inspectors said: "We saw numerous instances of neutral care interactions and occasions when a small number of staff appeared indifferent to their caring role. Three people complained about long call bell waits and we observed a number of occasions when call bells were slow to be answered."
They added: "We saw and heard examples of the service failing to meet the needs of patients."
Inspectors also saw poor infection control, and medicines stored incorrectly.
In surgery, safety incidents were handled well. The report said: "Staff recognised incidents and reported them appropriately.
"Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support."
But there were not always enough nurses to keep people safe and provide the right care.
In gynaecology, inspectors said the early pregnancy antenatal unit "had no emergency call bells or oxygen and portable suction equipment", although staff could get equipment and help from the maternity outpatient clinic next door.
But nurses in the department "did not hold a recognised post qualification gynaecological course" - and even the assessor did not have their own competencies.
Long waiting times meant 165 patients had not received follow up appointments. However it was found that "staff of different kinds worked together as a team to benefit patients".
The inadequate rating means the QEH is one of 12 failing trusts in England in special measures.
QEH chief executive Caroline Shaw, said: "We welcome the CQC's feedback and are using this to put in place the right foundations to make the sustainable changes that are necessary to ensure the consistent delivery of safe and quality care that our patients deserve.
"I know how hard our staff are working and how passionate they are about what they do and the care they provide. Our staff told CQC inspectors that as a senior leadership team there is more we must do to better support, value and recognise their contributions; feedback which we are acting on."
Darren Barber, staff side committee chair at QEH said: "I accept the CQC report in full. It is disheartening to read. I believe the pressure we are receiving from our regulators and our financial issues are not supporting staff in doing their jobs, nor providing them with the training or resources they need to do their jobs.
"I would, therefore, call on the local MPs to work with me in challenging the Department of Health and Social Care to develop a long-term solution for our patients and staff, here in West Norfolk.
"I recognise that our chief executive Caroline Shaw had only been with us a few short weeks before the latest inspection. Staff and the unions are committed to working alongside her to change the fortunes of The Queen Elizabeth Hospital King's Lynn. I urge the community and our stakeholders to give us time to do that."
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