Care Quality Commission (CQC) publishes focused inspection reports of surgery and maternity

In its report, the CQC identifies a number of positive changes since its last inspection in April 2022 which also includes areas of outstanding practice in relation to patient safety and quality of care, alongside an acknowledgement of the pride and hard work shown by the teams.

In summary, the CQC concluded that the surgical department had met the requirements of its warning notice issued last year (the technical language is a Section 29A). Therefore, this no longer applies. However, they re-issued a warning notice to maternity services in relation to safeguarding training where, although significant improvements had been made, the required levels of compliance had not yet been achieved.

The report follows a focused inspection of surgical and maternity services in April 2023. Due to the nature of the inspection the ratings were not re-rated which means surgery remains as ‘Requires Improvement,’ Maternity remains as ‘Inadequate’ while overall the Trust remains rated as ‘Requires Improvement.’

Deborah Lee, Chief Executive Officer, said: “Overall this is a positive outcome which indicates some of the progress we have made over the last year or so.

“In particular it recognises the hard work of staff and colleagues who have put so much into patient care and I’d like to personally thank them for all their effort. It also demonstrates the journey we are on and the trajectory that the team have put us on. That’s particularly important given the context of health and care provision over the last few years.”

Surgery

Outstanding practice

Across surgery, the following practice was identified as outstanding:

• The Chedworth Surgical Unit has been designed specifically for day surgery purpose and has design features that make it difficult for it to be used for overnight stay
• The Trust has sustained zero never events (something that is avoidable if procedures and protocols are followed and are often attributable to human factors or a failure of systems) for its surgical division for 256* days. This has been achieved through a multi-disciplinary, multi stranded improvement project and the adoption of a culture of continuous quality improvement within the surgical division.

Other key findings

Other key findings across surgery included:

• Leaders were visible and approachable in the service for both patients and staff
• Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service
• Staff received support from twice weekly drop-in sessions from the risk lead to discuss incidents and lessons learnt
• We saw that there had been a significant improvement in the numbers of patients nursed in areas that were outside of their intended purpose
• An Acute Care Response Team Manager (ACRT) had been recruited to review workforce needs, attends the deteriorating patients committee and works on the draft governance framework

However, inspectors also found:

• There were instances of children undergoing non-specialist emergency surgery at Cheltenham General Hospital, this was not in line with national guidance.

Maternity

Key findings

Across maternity, key findings included:

• Staff had worked hard to make sure the majority of women experienced 1 to 1 care in labour which is crucial to safe care
• Staff assessed risks to women and acted on them
• Safety checks on emergency equipment was completed daily to make sure it was ready to use
• Staff had training in key skills for maternity and understood how to protect women from abuse
• Waiting time for women in triage to meet the 15-minute standard had improved to reduce any delays in care and treatment.

However, inspectors also found:

• Safeguarding training level 3 was not provided for all staff
• Incidents were not always investigated in a timely way which delayed the outcome and opportunity for learning to be shared.

Ms Margaret Coyle, Chief of Service for the Surgical Division and Consultant Oral and Maxillofacial Surgeon, said: “While we found some of the CQC findings last time round difficult, particularly given the context of the pandemic and the exceptional way we had responded, we are pleased to see the progress that’s been achieved since.

“Since the inspection team visited in April we’ve made good progress against the areas identified for improvement and continue to do so.

“We have always been confident about the level of care we’ve provided and it’s encouraging to see this reflected by the inspection team who’ve described some of our practice as outstanding. That’s testament to the hard work of the team.”

Lisa Stephens, interim Director of Midwifery, added: “The challenges across midwifery nationally are well documented and there is no doubt that these are difficult times across the profession. The areas identified by the regulators largely relate to training and processes and on occasions we’ve had to prioritise patient care over these.

“However, it’s important for expectant parents and those families accessing our services to hear about the good care we continue to deliver.

“In that regard we will continue to invest heavily in our service, to work closely with regulators and advisory teams, to ensure that we can continue to provide a service that we are all proud of.”

Deborah Lee, Chief Executive Officer, added: “Currently, our outcomes across surgery and maternity remain in line with other centres nationally and are better in some areas.

“We are determined that this report will provide further momentum and impetus to address the issues identified and are working harder than ever to engage and involve our frontline colleagues in finding solutions to our challenges.”

The Trust expects the CQC to re-inspect services once more in the near future and will be working with its colleagues and partners to obtain an improved overall rating.

* This is now more than 550 days.