Cambridge’s Addenbrooke’s and the Rosie hospitals out of special measures and rated ‘good’

Cambridge University Hospitals NHS Trust has been rated ‘good’ by the Care Quality Commission (CQC) – just 16 months after it was placed in special measures.

The trust, which runs Addenbrooke’s and the Rosie hospitals, was rated ‘inadequate’ in September 2015, after the CQC identified specific concerns in surgery, maternity and gynaecology, outpatients and diagnostic imaging during its inspection.

A subsequent smaller, focused inspection in May last year found it had progressed and led to an amended rating of ‘requires improvement’. When inspectors returned in September, they found the trust had made further and significant improvements.

Today, the CQC is confirming that the trust is now rated as ‘good’ overall.

Trust chief executive Roland Sinker, pictured, told the Cambridge Independent: “It’s a huge testament to the hard work of our staff, support from patients and our partners around the hospital.

“It has been a whole hospital response but I think in particular the work of our partners around the hospital in social care, community services and general practice. They have been a very big part of the journey. And also the support of the regulators, the care quality commissioner, has been key.”

The inspectors identified significant improvements across most of the areas inspected compared to the previous inspection in 2015, including an increase in permanent staffing levels resulting in very low levels of agency nurse usage and improvement in the quality and safety of services.

Mr Sinker explained: “We’ve worked very hard on working out how many nurses, doctors and other professionals we need to provide great care to our patients, and then recruiting those posts and then really thinking about how we retain those members of staff by offering training and development opportunities.”

The CQC identified a few areas as ‘outstanding’, such as care and staff engagement, and highlighted areas for further focus, such as capacity and responsiveness, and appointment waiting lists.

Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “Senior staff at the trust described being placed in special measures as ‘a wake-up call’ which prompted an increased focus on relationships and communication between hospital staff and the senior team. The resulting improvements were evident in our inspection and in conversations we had with staff, who reported a more positive culture within the trust.”

The NHS trust is part of Cambridge University Health Partners which aims to develop Cambridge into the world’s leading life science centre through collaboration between clinicians, researchers and health-related industries.

Malcolm Lowe-Lauri, executive director of Cambridge University Health Partners, said: “It is very good news that the Care Quality Commission has given Cambridge University Hospitals (CUH) a ‘good’ rating. It reflects months of hard work within the Trust as new systems, ideas and procedures were introduced while supporting the outstanding treatment and care given by hospital staff.

“It is vital as core members of Cambridge University Health Partners, that CUH along with the two other NHS Trusts, Cambridge and Peterborough and Papworth Hospital, are recognised for their clinical excellence. If we are to drive research into new treatments, we need strong and confident health partners. We can then make the most of the data, experience and talent which lie at our disposal in Cambridge.

“The challenge now is to foster greater levels of collaboration between industry, the NHS and the university if we are to drive forward the local and national economy and lead the world in life sciences.”

Health Secretary Jeremy Hunt sent a video to Cambridge University Hospitals NHS Trust congratulating them on the improvement and saying they had “responded magnificently” to the challenge.

The inspectors identified significant improvements across most of the areas inspected compared to the previous inspection in April 2015, including:

• There was improvement in the quality and safety of all services with the exception of children and young people’s services which found the demand on the service challenging. This improvement was in line with the trust’s improvement plan.

• There was improved learning from incidents across the divisions and most staff had a good understanding of the duty of candour.

• There was an open culture, staff reported incidents and there was increased evidence of learning from incidents.

• Staff spoke positively of local (divisional) management. Managers in all areas were well sighted on risks as well as developing new pathways and delivering care.

• There had been an increase in permanent staffing levels resulting in very low levels of agency nurse usage across the trust.

• Significant improvement had been made into reducing the numbers of patients waiting for outpatient appointments.

• The Trust had developed a system of monitoring patient acuity on several occasions each day, allowing senior managers and clinical staff to flex staffing levels to meet patient need.

• The revised governance systems were sufficient to ensure that the senior team had robust information on which to make decisions.

• The electronic patient record (Epic) had now been in place for some 2 years. Many of the concerns identified at previous inspections had been addressed and staff were more familiar with the system.

The inspectors also identified a number of areas of outstanding practice, including:

• Weekly ‘music and movement’ classes in ward J2 to help meet the holistic needs of patients during their long-term recovery. A volunteer specialising in music and movement ran the classes and staff encouraged patients and their relatives to attend. This had received excellent feedback from patients and relatives.

• The teenage cancer unit provided outstanding facilities for young people diagnosed with cancer and receiving treatment for cancer. The teenage cancer unit provided a welcoming, age appropriate environment for young people to receive treatment, but also meet other young people and relax and socialise.

• The ED team had developed a mobile phone application called “Choose Well.” The application offered guidance on waiting times and hospital services across Cambridge in order to improve the patient experience and offer choices in health care.

• The emergency department had secured £100,000 of funding from the Small Business Research Initiative (SBRI) to support the development of a crowd prediction modelling tool to enable the trust to understand and map patient flow through the department.

• The charitable trust was in the process of setting up a trauma ICU centre in Burma in which a number of the ICU/NCCU staff were involved, as well as the Burma nurse specialist visiting later on in the year.

• The initiative for ‘Family Facetime’ proposed the purchase of two technology tablets to enable mums on the Obstetric Close Observation Area (OCOA) who are too unwell to visit their baby on the neonatal intensive care unit to receive a video link via Facetime with their baby.

• The bereavement follow up scheme saw a reduction in complaints of approximately 50%.

In addition, the report outlines actions the trust must and should carry out:

The trust must:

• Ensure medicines including controlled medicines are securely stored at all times.

• Ensure that end of life care is properly audited (such as preferred place of death and DNACPR) and actions taken in response to those audits.

• Ensure that complaints are responded to in a timely way wherever possible.

• Ensure resuscitation decisions are always documented legibly and completed fully in accordance with the trusts own policy and the legal framework of the Mental Capacity Act 2005.

The trust should:

• Ensure it improves the environment for children in the ED to ensure children’s safety at all times.

• Review staffing in the emergency department with respect to registered nurses (child branch) to ensure children’s needs and national guidance are met.

• Review staffing of the specialist palliative care team against national guidance.

• Ensure that all staff complete mandatory training and safeguarding training to ensure compliance with the 90% compliance target.

• Continue to work to improve delayed discharges and discharges that occur between the hours of 10pm and 7am in the critical care and intensive care units.

• Ensure the actions from the safeguarding review they have conducted for level three training for staff in adult areas caring for patients under the age of 18 years are implemented.

• Review the level of children’s safeguarding training healthcare assistants undertake to ensure it is in line with the Intercollegiate Role Framework for Looked After Children and the Trust’s own Safeguarding Children’s Policy.

• Review consultant hours in maternity in-line with national guidance.

• Continue to improve referral to treatment time performance including for cancer services and reduce the number of cancelled operations.

• Consider improvements to the response rate for the Friends and Family Test which are poor across the Trust.

• Ensure that systems are in place to reduce the risk of confidential information leaks.

• Work to reduce the number of diversions of high risk deliveries in maternity services.

• Continue to reduce the time for end of life patients to be discharged to their preferred place of care.

• Ensure that all equipment is appropriately checked and safety tested where required.