COLCHESTER’S hospital trust has been given three months to improve.
The Care Quality Commission yesterday labelled Colchester Hospital University NHS Foundation Trust “inadequate” in its latest report.
It remains in special measures and must submit weekly updates for three months.
If there is no improvement, it will consider further steps.
The report praised staff as highly motivated but described some agency staff as "poor in quality of care" and said there was a lack of management oversight.
Professor Sir Mike Richards, Chief Inspector of Hospitals, said: “Once again, we have found a number of serious problems.
"I am concerned the trust has not taken sufficient action to address the requirements of our previous inspections and has shown only limited capacity to improve.
“While the staff have been working hard through many issues to drive improvements locally, their efforts have been affected by poor leadership and a high use of agency staff, some of who are unsuitable in terms of their skills and knowledge.
“We found there was a disconnect between what was happening on the front line and the senior management team.
"For example the trust board seemed unaware of significant backlogs and patient safety concerns across outpatient services.
“The multiple changes in leadership have made many people lose confidence in the trust.
"It is clear the trust cannot solve these important issues on its own, and will require continued support for the foreseeable future."
Sir Mike has written to the Health Secretary Jeremy Hunt recommending the trust remain in special measures for three months during which time they will have to submit a weekly improvement plan.
If it cannot prove it is heading in the right direction, the Care Quality Commission will consider further steps.
The inspection took place over four days in September last year.
Key findings:
- Significant and substantial shortfalls in the number of registered nursing staff;
- High use of agency staff. Five wards had between 80 and 100 per cent agency staff at weekends and night times; n 112 reported incidents of cancer patients waiting more than 100 days for treatment. The maximum wait should be 62 days.
- A lack of understanding and awareness of outpatient waiting lists, placing people at risk. 149,000 cases were considered to be high risk. The longest wait on the 18-week pathway was 116 weeks.
- Not enough staff on inpatient wards to meet the needs of patients. Agency staff brought in did not always have the required skills;
- Significant staffing shortfalls across many specialties from junior doctors to consultant grades, especially at night and during weekends;
- Pressure on surgical services meant routine operations were frequently cancelled;
- End of life care provision had deteriorated;
- Maintenance and repair of equipment was poorly undertaken in critical wards, including A&E and theatres. In some cases equipment was out of date.
- Multiple changes in leadership had created a feeling of instability. Of the non-executive directors, most had backgrounds unrelated to health.
- Major concerns over the emergency assessment unit; The trust had 14 "never events" , errors so serious they should never happen, over 18 months, more than any other acute hospital in England.
The report also found some areas where the Trust had improved. They included:
- A desire from staff to make changes needed to improve their departments to ultimately provide good care to patients;
- The core permanent staff working on the frontline were dedicated professionals;
- Good and innovative practice, especially in maternity and critical care.
"We're sorry." Colchester Hospital's head of nursing apologises
WE'RE sorry.
The director of nursing at Colchester Hospital University NHS Foundation Trust issued an apology to any patient who had received below standard care.
Barbara Stuttle was speaking at press conference called in the wake of the CQC report which found a catalogue of failings at the trust, which manages hospitals in Colchester, Halstead, Clacton and Harwich.
Ms Stuttle said: "All of us are mortified if we did not offer the care we should have done. It is not acceptable.
"On behalf of my nursing colleagues, I know they are disappointed."
She added: "I have never met such a dedicated group of staff.
"The commitment and support to the trust is phenomenal.
"I genuinely believe we will get this put right in a short period of time and ensure patients get the care they need."
Ms Stuttle answered questions alongside trust chief executive Frank Sims, Trust chairman Alan Rose, Dr Angela Tillett, the trust's medical director and Tom Nutt, chief executive of Healthcare Essex.
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Despite the concerns raised in the reports, Mr Sims said he was confident the failings could be fixed.
He said: "I took this job in October and knew at that point of the concerns the CQC had.
"I came here as a sort of secret shopper and met the staff and spoke to the patients.
"The people I met gave me confidence we could do the right thing.
"Everything in the report is fixable with the quality of staff we have.
"We have to accept and acknowledge the CQC report.
"I think we have to acknowledge we have not got it right for all patients. There has been inconsistency in the quality of care we have given but I welcome the report because it gives us a blueprint to go forward."
Mr Sims said four steps would enable the trust to move out of special measures:
* A substantive and sustainable senior leadership team for the first time in three years;
* An improvement plan which is already in progress;
* Frontline staff are to contribute to to the solutions through a series of Ask and Act workshops which will also broker a change in philosophy and culture at the hospital.
* Full transparency.
The trust has to produce a plan to demonstrate improvement by February 23.
Mr Rose said there had been examples of failing trusts being taken over by successful trust but he said he did not anticipate that would happen in Colchester.
Mr Sims said consistency of senior staff was crucial in achieving significant improvements.
He said the process had been long because of the length of time it took to recruit them.
Dr Tillett also apologised to cancer patients whose treatment had been delayed.
She said: "We have now made huge in-roads into that. If there are delays, we will follow that through and make sure patients get the care they need as soon as they can."
Carlo Guglielmi, 59, of Waldegrave Way, Lawford, gave his experience while battling bladder cancer 8/10, marked down because of a lack of communication.
“I cannot speak highly enough of the hospital and I am still under their care.
“I know staff and governors who get knock after knock after knock must be demoralised by what is happening. I know how hard they work.
“Nationally we have to look at the shortage of nurses.
“It is a catch 22 situation because once staff members are demoralised you do not get the best out of them.
“For medical and pastoral care I would give 10/10, the only thing I would fault is communication, that needs to get better.”
Mark Brown, 21, of Tulip Way, Clacton, received treatment at Colchester General Hospital last year for Hodgkin lymphoma, a former of cancer.
He rated the care he received as 10/10.
“My treatment was amazing and I could not compare it with anything else I have heard about elsewhere.
“The staff pulled out all the stops to make sure I felt human again and I had the best care possible, everything was very clean and everyone was very professional.
“I am quite surprised they have had a bad review.
“Sometimes there was a little bit of waiting but you expect that in a hospital where everything has to be so precise and you do not know what is happening with other patients.
“I would much rather have a professional and caring team and service rather than something which is more on time and less caring.”
Peter Lamb, 63, of Tudwick Road, Tolleshunt Major, was treated for bowel cancer in 2014.
He rated the care he received as 9/10.
“Right from the moment I walked into A&E I was seen within 20 minutes and had my operation the next morning.
“They looked after me very well and I was on the ward for a full seven days.
“Since I have come out I have had blood tests to check on the cancer markers and I just cannot fault them at all.
“I think maybe when I was on the ward the staffing level may have been a little low but they looked after the people who wanted to be looked after.”
Brian Bubear
Brian Bubear, 70, of Swan Street, Chappel, was attacked by a recovering alcoholic while he slept in a Colchester General Hospital ward last year.
Despite the horrifying experience he still rated the care he receives for a rare form of blood cancer to be 8/10.
“I spend a lot of time with the haematology department and I have nothing but praise for them. They work extremely hard and treat me well.
“Staff there have saved my life on more than once occasion.
“The problem I had was hopefully an isolated incident where the man was not responsible for his own actions.
“A sweeping statement which I would say is that sometimes there is too many chiefs and not enough Indians.
“It also seems that the number of agency staff coming and going all the time can create a bit of a problem.”
Freddie Jones, 71, of Rainsborowe Road, Colchester, praised the hospital after he was treated for cancer of the kidney and wife Carol suffered a heart attack.
His rating for the hospital was “getting close to a nine out of ten.”
“If it such a damning report then I am shocked.
“The treatment which both of us have had there is absolutely second to none.
“I was a very lucky man because I had no idea I had cancerous tumours of my kidneys.
“In the evening I noticed there were a number of agency staff but certainly not in the day time and I didn’t really have anything to complain about.
“I had no real axe to grind with anything.
“We have had to call an ambulance for my wife four times and on each occasion the care has been tremendous.”
John Mann, 69, of Fronks Road, Dovercourt, said the only problem during his stay at the hospital while suffering bladder cancer in 2014 was the food.
He gave the hospital 9/10.
“I simply cannot fault them – they were absolutely wonderful.
“On the medical side there is not a single thing I could suggest I think they needed doing.
“I was given exactly the amount of information regarding my treatment as I was comfortable with – they were just so caring.
“But there did seem to be a lot of agency staff around, but I was visited by a consultant at least once a day and sometimes twice.
“The only thing I had a problem with was the food.
“I was there six days and not given a single piece of fruit, but speaking to people I believe that has changed now.”
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SPECIAL MEASURES: A TIMELINE OF COLCHESTER HOSPITAL
COLCHESTER Hospital University NHS Foundation Trust was placed in special measures in November 2013.
The move came after the Care Quality Commission raised "serious concerns" about staff being pressurised into manipulating cancer waiting time figures to meet Government targets.
It prompted directors, including chief executive Gordon Coutts and finance director Mike Baker, to resign.
The hospital became the subject of successive investigations over the following two years and in February last year it was labelled “inadequate”.
Today, a Care Quality Commission report says the trust is still inadequate.
February 2012: Whistblowers claimed cancer patient records were being altered. A flawed internal investigation found no evidence.
Summer 2012: A whistleblower claimed she e-mailed then chief executive Dr Gordon Coutts over the lack of action, but did not receive a response.
February 2013: NHS England’s National Medical Director Sir Bruce Keogh launched a review into hospital trusts where unusually high death rates were discovered, including Colchester’s.
June 2013: NHS England found the trust was improving and did not need to be placed in special measures. However, whistleblowers told the review team about the cancer waiting times allegations which were passed to the Care Quality Commission for investigation.
August 2013: An inspection reviewed the records of 61 patients and found information relating to waiting times had been altered. Of the 61 patients, 22 were found to have been placed at risk of receiving unsafe or ineffective care because of delays. Six patients had had cancer treatment delayed by more than 100 days.
November 5, 2013: The Care Quality Commission published its findings and NHS England recommended the trust be placed in special measures.
November 19, 2013: Monitor placed Colchester Hospitals Trust in special measures.
December 2013: Dr Coutts resigned as chief executive and finance director Mike Baker stood down.
March 2014: Kim Hodgson was appointed temporary chief executive, replacing interim boss Sue Barnett, who had resigned.
February 2014: Monitor appointed the Royal Marsden, a leading specialist cancer trust, as Colchester’s partner to drive improvements.
May 2014: Dr Lucy Moore was appointed long-term interim chief executive.
May 2014: Lynn Lane, director of human resources, replaced Melanie Whitfield, who announced her resignation two months after joining the trust.
July 2014: Temporary finance boss Ian O’Connor left after five months.
July 17, 2014: The Care Quality Commission published its inspection review and found Colchester hospitals trust required improvement.
July 2014: Newly-appointed interim director of corporate affairs Helen Robinson's role is scrapped after she raised concerns about resources and how the trust was being run. She had been at the trust for a month.
August 2014: Colchester General Hospital was fined £130,000 after 130 ambulances were forced to wait for more than an hour outside over three months.
September 2014: Hospital bosses called an urgent summit after its accident and emergency unit almost came to a standstill. The hospital had missed its target of treating 95 per cent of A&E patients in four hours in four of the seven months previous months.
October 2014: The head of nursing at Colchester General Hospital Dee Hackett resigned amid concerns over staffing levels on wards - making her the seventh director to go in a year.
October 2014: Peter Wilson took over as temporary chairman of the hospital board from Sally Irvine.
November 2014: The trust plunged was forced to declare an internal major incident after the Care Quality Commission found the A&E department could not cope during an unannounced inspection.
December 2014: Investigators decided inaccuracies in the hospital's cancer waiting times figures were caused by managerial incompetence rather than bullying of staff. The ten-month review costing £500,000 was one of the biggest ever carried out by the NHS.
January 2015: Colchester General Hospital was rated as one of the worst in the country for hitting its accident and emergency waiting time targets with its performance dropping to the lowest level for a decade, with 83.4 per cent of patients seen in time.
January 2015: Cursty Pepper, associate director of operations, resigned after eight months.
January 2015: Anthony Marsh, chief executive of the East of England Ambulance Service, blamed delays in handing over patients at Colchester General Hospital for slow emergency response times.
January 2015: Alan Rose appointed the trust's new chairman.
February 2015: Colchester General Hospital was labelled as inadequate after a snap inspection by the Care Quality Commission. The A&E and emergency assessment units were inadequate. The hospital’s overall rating was downgraded from “requiring improvement” to “inadequate”.
May 2015: Colchester's hospital trust made strides to be taken out of special measures. The trust’s board was told for the first time in more than seven months, accident and emergency targets had been hit and there had been an improvement in filling nursing vacancies.
September 2015: The trust was ordered to take urgent action to protect patients. The Chief Inspector of Hospitals used the Care Quality Commission’s urgent enforcement powers, following an inspection in July, and told the trust to improve the quality of care provided to patients in surgery and medical care inpatient wards.
December 2015: Frank Sims, a former NHS accountant, takes over as chief executive of the trust - its fourth in two years.
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Hospital's £30million shortfall - MPs call for support
THE Government has acknowledged Colchester's struggling hospitals need more cash.
The hospital is facing a financial shortfall of £30 million by the end of March.
But Harwich and North Essex MP Bernard Jenkin said Health Secretary Jeremy Hunt acknowledged the trust, along with others in the Home Counties, needed more financial support.
Mr Jenkin said: "The problems facing the Home Counties health services are familiar.
"We feel less well funded than London and other parts of the country and yet we are supporting an ageing population which needs more clinical help.
"For the first time, the Government has recognised Essex has been underfunded and from April, the Colchester trust will receive a five per cent increase in funding."
Mr Jenkin, who has supported the trust throughout its crises, added: "This inspection looked absolutely everywhere, it was a warts and all report.
"There was no hiding place and I admit it makes pretty grim reading.
"However, since the previous CQC report, there has been a lot of change especially in the top team and for the first time there are now permanent board members and senior leaders which will provide stability."
Colchester MP Will Quince said: "There can be no hiding place for poor standards of care.
"The CQC report contains some bright spots on how the hospital’s services for children and young people are good but there are still areas which need rapid improvement.
"I am under no illusion as to the scale of the task ahead at Colchester Hospital.
“I have been working closely with hospital management and staff to help get the hospital out of special measures.
"I meet with the new chief executive, Frank Sims, and the chairman of the trust, Alan Rose, on a regular basis.
"Frank is a great leader and he’s already at the forefront of positive improvements.
"We need to give him and the leadership team time to get things right.”
In November, Mr Quince called for the Department of Health to step in directly to support the hospital.
He added: "It’s great to hear, since then, a service improvement director has been working longer at the hospital and there have been renewed negotiations with the Department of Health on funding issues.
“I strongly support calls for more capital investment in the hospital to create a new emergency department and a centre of excellence for complex surgery and cancer."
Witham MP Priti Patel said the leadership of the trust must turn its fortunes around.
She said: “Many of my constituents use the Trust’s services and have been concerned about its performance in recent years as successive CQC reports have highlighted problems.
"With a stable leadership team and a new chief executive now in place, the Trust must turn itself around to deliver the improvements we all want to see and high levels of care and service patients deserve.
“The improvements the CQC have noted have taken place since their inspection are welcome and the motivation and improvements being driven forward by many staff of the trust have been commended by the CQC."
“But the trust still has a long way to go to bring services up to an acceptable standard.
"The recruitment, training and retention of more permanent staff must be a priority as well as putting right the specific problems the CQC have identified."
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