Under-fire James Paget Hospital announces action plan after third warning notice issued

A Norfolk hospital has pledged to implement a raft of new measures after being issued with a third formal warning notice by health watchdog the Care Quality Commission (CQC).

MPs spoke of their disappointment that the turbulent year for the James Paget University Hospital (JPH) at Gorleston was continuing.

New interim chief executive David Hill said he was swiftly getting to grips with the challenges posed in last night's damning CQC report and had devised a new action plan. He accepted that the hospital had been too slow in tackling problems raised by previous reports.

Great Yarmouth MP Brandon Lewis said he was confident Mr Hill, who started in his role this week, had what it takes to lift the hospital into compliance with national care standards.

The hospital has been assessed nearly half a dozen times since an initial failed inspection in April 2011. Inspectors visited the JPH on March 1 and found improvements were needed in relation to the care and welfare of people who use services.

The CQC's main findings were:

Some medical and nursing records were not up to date and some contained anomalies.

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Care plans did not always cater for the individual needs of the patient.

Records on cardio-pulmonary resuscitation (CPR) and 'do not attempt resuscitation' (DNAR) orders were not always completed with appropriate information and were recorded in several different places.

Patients were not always protected from the risks of receiving inappropriate or unsafe care or treatment.

If the hospital does not make improvements by May 31 it could be prosecuted by the CQC, with services restricted or, in the most serious cases, see services suspended or cancelled, or receive financial penalty notices and cautions.

Mr Hill, who was previously chief executive of the JPH before leaving in 2006 to work for the Bermuda Hospital Board, said: 'We completely support the work of the CQC locally and nationally, and they have done a great deal to raise the quality of care at the bedside.

'The JPH accepts that it has not made rapid enough improvements to previous inspection reports.'

And he outlined an action plan designed to lift the hospital into meeting nationally-defined care standards:

New standardised documentation to reduce duplication and the amount of paperwork. This aims to make it easier to plan patient care.

A �1m fund – freed up from a budget which stood at �159m in 2011-12 – to pay for new staff. Active recruitment is under way to employ a pharmacist for each ward.

Ongoing audits with instant feedback to highlight areas of good practice and to make improvements where necessary.

Better communication with, and education of, nursing and medical staff.

Reviewing 'do not attempt resuscitation' forms to ensure decisions are clearly documented.

Mr Hill explained that real improvement was likely to be seen in a matter of months, as documentation was completely revised and staff were trained to use new systems.

Coastal MPs are to meet hospital management today to ensure the trust's action plan is robust.

Therese Coffey, Suffolk Coastal MP, said: 'It's another setback for the hospital, even though there's record some improvement has been made.

'We will be looking for some very clear steps from the new chief executive and want to see what he's going to do to turn this around.

'Everyone wants this to be sorted out, but we want it to be done properly.'

Mr Lewis said the latest warning notice was a disappointment but he was cautiously optimistic about the hospital's future.

'We're getting on for over a year now and they just keep having problems,' he said. 'The previous senior management team just weren't getting to grips with the problems.

'But the new interim chief executive and chairman are very aware of what the issues are and how to deal with them.

'I've confidence and hope that we will move forward and see a very different hospital at the end of this year.'

Mr Hill said that there would be more changes to management roles, and he would be holding managers to account.

The need for improvement falls against a background of financial pressure, with the trust needing to find �19.5m of savings by 2014.

A total of 64 administration and support posts are at risk – with a review ongoing – and e-records have been introduced to make further savings.

But there could be more pain in the near future, as Mr Hill confirmed he was looking at cuts in 'other areas' but was still 'finalising initial discussions'.

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