Third critical report for James Paget Hospital in Gorleston

The Care Quality Commission (CQC) says the Gorleston hospital needs to improve standards of care or face further action, after it found major concerns around the way the hospital was monitoring and assessing its own care.

The hospital says the majority of the failings were found on only one ward and, given that it was deemed to be compliant in this area six weeks previously, it is a matter of improving consistency.

But the findings will heap more pressure on bosses at the 544-bed hospital - pressure which saw its chairman John Hemming resign earlier this month.

Interim chairman Peter Franzen last night vowed: 'When we come out of this, this will be a better hospital because of the CQC visit, however it has been a very painful journey.'

The third report comes as last-minute crisis talks appear to have averted industrial action by radiographers at the hospital, in a row over out-of-hours working.

A previous CQC warning was issued to the trust in September when it was found the nutritional needs of patients were still not being met, despite earlier concerns raised in a report as part of CQC's dignity and nutrition review.

On October 14, inspectors visited the hospital for the third time to check on what progress had been made.

Inspectors found improvements in relation to meeting the nutritional needs of patients and new systems had been introduced by the trust, meaning it was now compliant with this particular standard.

However, inspectors observed the new systems were not being properly monitored and were not always effective. This meant that standards were still falling short of what people should be able to expect.

It found major concerns with assessing and monitoring the quality of service, moderate concerns over care and welfare and inconsistencies in the keeping of patients' records.

Frances Carey, CQC regional director for the East of England, said: 'We were pleased to see the trust had taken action regarding our previous warning and put measures in place to help patients receive the food and drink they required. 'However we were once again disappointed because we observed that these new systems were not being consistently carried out. This meant that patients were still not always receiving the help they needed when eating and drinking.

'It is a basic requirement that vulnerable people who are trying to recover in hospitals receive the assistance they need to get the correct nutrition.

'Systems may be in place to achieve this at James Paget Hospital, but these can fail if they are not being effectively monitored or assessed to ensure they work. This is why we have issued a warning notice to the trust.

'This is not about paperwork for paperwork's sake, but the trust must assure itself that all patients requiring its support can get the care they deserve.

'The trust has to make sure it is checking its own systems and processes are working effectively.'

One person with dementia and identified, via a red tray system, as needing help was seen to have a hot meal, uncovered, in front of them for up to 90 minutes without receiving any assistance. By this time the meal would have gone cold.

A list of patients to tell staff who needed different coloured trays and jugs, so they could be assisted at meal times, was found to be inaccurate.

Inspectors saw people who did not need help with their meals were listed while there were others whose names were not listed that clearly required help.

Nutritional risk assessments and dietary intake records for patients were incomplete or inaccurate.

Frances Carey added: 'The law says that these are the standards that everyone should be able to expect. Providers have a duty to ensure they are compliant.

'We will be returning to the hospital to follow up on progress and, when we do, we will expect the trust to be able to demonstrate it has made further improvements.

'CQC has a range of legal powers it can use if it is found the required progress has not been made. Where necessary we will use these powers to protect the people who use this service.

'This warning sends a clear message that James Paget University Hospitals NHS Foundation Trust needs to address this issue or face serious consequences.'

James Paget chief executive Wendy Slaney said: 'We are pleased the work we have done around nutrition has been recognised by the inspectors and that we have improved. It has been a team effort in getting us to this position and I am grateful to all our staff for their support through what has been a difficult period.

'We fully recognise the importance of accurate documentation and robust monitoring systems and where there are failings we are committed to learning lessons and addressing areas for improvement. All of us at the James Paget are determined that we will work together to continue to improve the care we provide our patients.'

She said audits of wards were still ongoing in a bid to continue to monitor and improve standards, and the trust was reviewing its documentation to see if it could be made any simpler and easier for staff.

She added: 'There is no doubt it's a difficult situation, inevitably, for staff. We are now starting to see some of the changes in areas like nutrition and staff are now starting to see and agree that there are benefits for the patients out of this.

'What has been quite distressing for them is the way it has been played out in the media.'

She added: 'We have done a lot of work with staff, meeting with staff and talking with staff out on the wards, telling them to try not to worry about the critical aspect but to think about the things we are doing for the patients' benefit, and to focus on doing things not for CQC standards but for the patients' benefit.

'One way in which staff have benefited from this has been the incredible support they have had from the public since the reports came out.'

Patrick Thompson, chairman of patients' group the Norfolk Local Involvement Network (LINk), and MPs Brandon Lewis and Peter Aldous all backed the hospital in its bid to address the CQC's concerns and said they were positive it would be able to do so.

Mr Lewis, MP for Great Yarmouth, said: 'The CQC has raised a major concern, which management and the governors must deal with urgently. However, the priority for all of us must be the quality of the care offered to the patients. I have every faith in the determination of the interim chairman, governors and staff that the JPUH will be able to move forward and resolve the problems identified in the report and we all want to support them in that work.'