Inspectors visited the trust in February to inspect the services provided by the trust’s two acute hospitals - Stoke Mandeville Hospital and Wycombe Hospital.
The CQC looked at how well led the trust was overall, and also inspected surgical services and medical services at both hospitals. Community health services were not inspected on this occasion.
Following the inspection, the overall rating for medical care (including older people’s care) at Stoke Mandeville Hospital remains as good. Safe, caring effective and well-led also remain as good.
But the hospital’s rating for being responsive to people’s needs has dropped from good to ‘requires improvement’.
The overall rating for surgery and how effective, caring, responsive and well-led services are at Stoke Mandeville Hospital all remain good. The safety rating remains as requires improvement.
At Wycombe Hospital, the overall rating for medical care, as well as how effective, caring, responsive and well-led the service is, remain good. But the rating for safe has moved down from good to requires improvement.
The overall rating for surgery at Wycombe Hospital went down from good to requires improvement. The rating for safe remains requires improvement. Effective, caring, responsive and well-led remain good.
How well-led the trust is overall has improved from requires improvement to good. The trust retains its outstanding rating for caring and its good ratings for being effective and responsive to people’s needs. But safety at the trust has dropped from good to requires improvement.
CQCs head of hospital inspection, Carolyn Jenkinson, said: ”During our inspection of Buckinghamshire Healthcare NHS Trust, our inspectors found a strong patient-centred culture with staff putting patients first and involving them in decisions affecting their treatment and care.
“We also found some notable examples of outstanding practice, which the trust deserves to be commended for.
“We do recognise and understand the pressures that all healthcare providers have been under during the Covid-19 pandemic, but the trust does now need to address the areas of concern we identified and make improvements.
“In particular, the trust needs to address the deterioration in safety we found at Wycombe Hospital.
"They need to ensure the environment is clean, damage free and fit for purpose and staff are following policies and procedures around infection prevention and control to keep people safe.
"They also need to improve the way they are managing medicines, as we saw some emergency medicine was missing from kits, and others like insulin were out of date.
“The senior leadership team knows what it must do to improve and have already told us what action they’re going to take.
"We continue to monitor the trust and will return to check on the progress of the improvements we’ve told them to make.”
Across both hospitals CQC saw:
In July 2020, the trust adopted the Brainomix e-Stroke Suite imaging platform at Wycombe and Stoke Mandeville Hospitals. The award-winning imaging platform uses cutting-edge Artificial Intelligence & Deep Learning methodology to help stroke physicians make life-saving decisions.
The trust staff worked hard to support patients and carers throughout the pandemic by introducing several initiatives such as the purchase of iPads and tablets which enabled patients to keep in touch with their families via video calls and a ‘Letter to a Loved One’ service which allowed friends and family to email letters and photos which were colour printed and hand delivered to patients.
A Same Day Emergency Care Service was launched in November 2020. Following a GP referral or triage in the emergency department reception, patients could be admitted to the new unit to be rapidly assessed, diagnosed and treated by a team of doctors, nurses and therapists without the need for a hospital admission or waiting to be seen in the emergency department.
Patients were treated with dignity, respect and kindness during all interactions with staff and relationships with staff were positive. Staff supported patients and their families and personal, cultural, social and religious needs were understood.
Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Services had enough staff to care for patients and they understood how to protect patients from abuse, and managed safety well.
The needs and preferences of different patients were considered when delivering and co-ordinating services with managers monitoring the effectiveness of services.
Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week
Ward staff did not always follow infection control principles in the use of personal protective equipment.
Training was inconsistent. Although inductions were good, Not all staff had completed all the trust’s mandatory training in key skills or received an appraisal of their work.
At Wycombe Hospital inspectors found:
Services did not always ensure products deemed as hazardous to health were stored securely.
Staff did not always maintain care records safely in accordance with trust policy. On one ward records were loose and not kept bound and secure.
Risks were not always clearly identified, recorded, escalated and action taken in a timely way. Staff were not always able to effectively contribute to improvements and guidelines were not kept current.
Staff gained consent and considered people’s capacity to make decisions. Where patients did not have the capacity to make decisions, staff followed best interest practices.
Patients knew how to give feedback about their experiences, including how to raise any concerns or issues.
Leaders were visible and approachable.
At Stoke Mandeville Hospital inspectors found:
They managed safety incidents well and learned lessons from them.
People could access the service when they needed it and did not have to wait too long for treatment.
Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care or plan their discharge. Staff had discussions about their patient’s holistic needs.
Ward staff used boxes holding sterile equipment to prop open fire and secure doors. This meant unauthorised people could access the building and potentially find unsafe equipment, for example scalpels and detergents.
Staff did not consistently complete ward-based risk assessments. For example, falls risk or nutritional assessments.
The environment and training of staff did not fully meet the needs of people living with dementia.
Capacity assessments were not conducted as required. Staff did not know who could carry out these assessments. Medical staff did not record capacity assessments in the patient record.
The report is published on the CQC website today, Friday July 1.