Nottingham University Hospitals Trust’s rating has been downgraded from “good” to “requires improvement” following a Care Quality Commission inspection of its urgent and emergency and surgical services, and of its leadership, in June and July.
At the same time NHS England and Improvement announced the trust would effectively be placed in ‘special measures’. It has been moved to the lowest segment of the NHSE/I system oversight framework, and given ”intensive mandated support”.
NHSE/I said this was due to “concerns with quality of care, governance and leadership”, but also “concerns that improvements, particularly in maternity services, are not being made quickly enough and that the existing leadership cannot make the necessary changes without further support”. The trust has been subject to ongoing high-profile concerns in maternity services.
The CQC also handed the trust a warning notice urging it to make improvements around leadership, risk management, governance and culture.
The trust has been told “measurable action” must be taken across the organisation to address bullying after concerns were raised that staff were “afraid to speak up” and “are being treated differently due to race”.
The trust has also been rated “inadequate” for the well-led domain, “requires improvement” for safe, effective and responsive, but “outstanding” for caring.
The report, published today, stated: “In the 12 months to March 2021, there were 79 contacts made to the [Freedom to Speak Up Guardian], compared to the 51 contacts in the previous year.
“Themes of concerns raised through [The Freedom to Speak Up Guardian] included; bullying, lack of civility, staff not listened to, poor behaviours, some staff too frightened to speak up and staff being treated differently due to race. During an interview with a member of the executive team we were told the board were not aware of bullying concerns.”
Inspectors also raised concerns about the leadership, citing a “disconnect” between the board and wider organisation. The trust has also been urged to review safety and safeguarding incidents and to learn lessons when things go wrong.
The trust confirmed last month that its substantive chief executive, Tracy Taylor, has been off sick having had covid-19 since early July. Chief finance officer Rupert Egginton is acting as CEO in her absence.
The CQC said the trust must make improvements to urgent and emergency services, particularly in the time it takes for patients to receive an initial assessment.
The report stated a lack of space in the emergency department and high demand meant there were delays in patients receiving an initial assessment and “there was an inherent risk” serious symptoms may not be recognised.
The regulator has told the trust enough competent staff must be on shift to meet patients’ needs, risks must be identified and patients who require admission must be transferred without delay.
However, inspectors identified “some examples of good practices” at the trust, as surgery services are managed effectively and staff were “caring, supportive and respectful”.
The trust has faced problems in its maternity services, with the CQC raising concerns at the end of last year, and reports by The Independent and Channel 4 News covering cases where dozens of babies were stillborn or suffered serious injuries over the last decade.
Mr Egginton said in a statement: ”We would like to assure patients and colleagues that we are working hard to address the serious concerns highlighted in the recent CQC report, focussing on standards of leadership within the trust.
“It’s important to note that the report does not criticise clinical services and recognises the care, dignity, compassion and kindness that our staff provide for our patients; but it’s our job as the leaders of the trust to ensure that the foundations of our organisation - our processes, governance, and learning from incidents - improve to allow our teams to provide safe, high quality care within a positive, open and supportive culture.”