Airedale NHS Foundation Trust "Requires Improvement"

The Chief Inspector of Hospitals has rated Airedale NHS Foundation Trust (NHSFT) as Requires Improvement following an inspection by the Care Quality Commission.

A team of inspectors has found that the trust provided services that were caring, effective and responsive but needed improvement to be safe and well led.  

CQC inspected Airedale NHS Foundation Trust from 15 -18 March 2016 and undertook two further unannounced inspections on 31 March 2016 and 11 May 2016. Included in this inspection were Airedale General Hospital and Castleberg Hospital, near Settle and the trust’s community services including Coronation Hospital in Ilkley and Skipton Hospital.

Ellen Armistead, Deputy Chief Inspector of Hospitals at CQC said:

“We were impressed with the community-based collaborative care teams which were an outstanding example of multidisciplinary team working. The teams worked across acute and community services and in collaboration with other agencies to provide a responsive service for patients 24 hours a day, seven days a week providing a valued service help people to remain in their own homes and avoid unnecessary time in hospital.

“Inspectors found that nurse staffing levels in many clinical areas were regularly below the planned number. This was a particular concern in medical care, surgery, children’s services and in critical care.

“A new emergency department had been opened to meet the increase in patient numbers and new models of working, but there were not enough doctors to meet national guidance and there were too few specialist consultants in critical care.

Since the last inspection of Airedale NHS Foundation Trust in 2013, inspectors have found deterioration in the quality of some services – particularly in critical care and medicine.  While staff reported feeling proud to work at Airedale, some felt there was a less open and positive culture. Although the executive team had taken steps to address some of the issues raised by staff regarding support from managers and confidence to raise concerns, there remained concerns particularly in the critical care, medicine and surgery services.

Inspectors had concerns about the reporting and management of incidents, particularly within the critical care department. Although the critical care unit used telemetry equipment to monitor the heart rhythm of patients, staff were not always available to monitor the data and respond in a timely manner.

In contrast, in community services, the inspectors found a culture of continual service improvement and innovation. There were several examples of enhanced integration between health and social care within adults’ services.

The inspection has identified a number of areas for improvement that include:

• The trust must ensure that the remote telemetry monitoring of patients is safe and effective.
• The trust must review the governance arrangements and identification and management of risks within critical care to ensure that arrangements for assessing, monitoring and improving the quality and safety of the service are effective.
• The trust must improve engagement with staff and respond appropriately to concerns raised by staff.
• The trust must ensure the safe storage and administrations of medicines including the management of patient group directives and medicines reconciliation.
• The trust must ensure records are stored and completed in line with professional standards, including an individualised care plan.
• The trust must ensure the five steps for safer surgery including the World Health Organisation (WHO) safety checklist is consistently applied and practice audited.
• A multi-disciplinary clinical ward rounds within Intensive Care must take place every day to share information and carry out timely interventions.

The report also identifies a number of areas of outstanding practice including:

• Telemedicine services provide remote video consultations around the clock between Airedale staff and patients in their own homes, care homes and in prisons. Clinical staff in the hub received calls from staff in care homes and could speak to residents directly whilst viewing them on the screen. The community-based collaborative care teams  worked across acute and community services and with other agencies to provide a responsive service for patients  seven days a week.
• Within end of life care, there were innovative ways to ensure care was patient centred;  for example when patients with additional needs were admitted at the end of life, specialist staff were alerted and could respond in a timely way.

Bridget Fletcher, Chief Executive of Airedale NHS Foundation Trust said: “We are delighted that the CQC highlighted many examples of our good practice, as we pride ourselves on our compassion and standards of care. We know we have areas to improve on, and the breadth and depth of the CQC’s report has given us useful feedback on which we can build."

“We are addressing the issues around staffing and culture and had already put in place action plans to address areas that we felt required improvement. Our teams have risen to the challenge and have already made significant improvements in a number of key areas."

“We have over recent months strengthened our comprehensive nurse recruitment strategy, which includes initiatives such as developing our health care support workers, participating in the ‘Return to Practice’ programme and international recruitment. Earlier this year Airedale NHS Foundation Trust was named as one of the CHKS 40Top Hospitals 2016 and was also amongst the top five for the national patient safety award for the third year running which is a direct reflection of the high standards of care we provide to patients."

“We focus on promoting an open and transparent culture. In the 2015 national NHS Staff Survey Airedale scored above the national average for staff recommending the Trust as a place to work or receive treatment, which was also reflected in the recent Friends and Family Staff Test results. We are not complacent; we know there are areas we have to work on but we are encouraged by these results."

“I would like to pay particular tribute to our people. The first two inspections took place during our busiest winter month, and it is a testament to them that they coped with sustained demand, as well as a full CQC inspection. Whether they work in direct patient care or in a supporting role, all our teams care deeply about the community we serve, and it is right that this is recognised.”