11-13, 15 and 19-20 Feb 2014
During a routine inspection
Wexham Park Hospital is the main site of Heatherwood and Wexham Park Hospitals NHS Foundation Trust and provides services to a large and diverse population of more than 465,000. The area it covers includes Ascot, Bracknell, Maidenhead, Slough, South Buckinghamshire and Windsor. The trust has approximately 3,200 staff and a total of 650 beds, with 588 on the Wexham Park Hospital site. The trust has recently increased the bed capacity to meet increased demand following an increase in its catchment area in accident and emergency (A&E), paediatrics and wards and had plans to open more capacity later in 2014.
The trust’s catchment area population includes a significant proportion ethnic minority groups and 30 languages are spoken in the area covered by the trust. The most common (excluding English) include Hindi, Polish, Urdu, Somali, Romanian and Punjabi.
The trust became a foundation trust in 2007. At the time of the inspection, the executive team (based at Wexham Park Hospital) comprised members who were either interim appointments or relatively new in post, with only one member of the executive team in post for over three years. The chief executive had been in post for two years and four months (but had formally resigned, with a leaving date in March 2014).
At the time of the inspection, Wexham Park Hospital was in breach of a number of regulations and, in many instances, it has been providing care below the essential standards, as found during two previous CQC inspections in May and October 2013. In May 2013, there were particular concerns about the care provided to patients in (A&E and the impact this had on the ability of inpatient wards to provide the essential standards of care. At the inspection in October 2013, improvements in A&E were noted to have been made. However, we found that Wexham park Hospital was in breach of eight regulations. We served compliance actions for breaches of two regulations (15 and 16). We also served warning notices for breaches of six of the regulations (9, 10, 12, 17, 20 and 22).
We gained views from partner organisations who expressed their concerns about the care provided at Wexham Park Hospital and the future sustainability of the trust.
Wexham Park Hospital provides the following regulated activities, which formed part of our inspection: diagnostic and screening procedures, management of supply of blood and blood derived products, maternity and midwifery services, surgical procedures, termination of pregnancies and treatment of disease, disorder or injury.
We carried out an announced inspection visit on 12 and 13 February. We held focus groups and drop-in sessions. We talked with patients and staff from many areas of the hospital. We observed how people were being cared for, talked with carers and/or family members, and reviewed patients’ records of personal care and treatment. We held two listening events when patients and members of the public shared their views and experiences of Heatherwood and Wexham Park Hospitals NHS Foundation Trust. Patients who were unable to attend the listening events shared their experiences via email or telephone. We carried out three unannounced visits, when we looked at how the hospital ran at night, the levels and type of staff available, how they cared for patients, and patient flow through the hospital.
The trust had a long history of turbulence, which was felt by our inspection team at Wexham Park. Financial shortfall and high turnover of senior leadership had resulted in poor outcomes in recent CQC inspections and expressions of increasing concern from multiple stakeholders. We found the trust had significant legacy from a history of financial challenges and the hospital had a culture that was not open with learning at its heart. Although the financial challenges had been addressed and improvements trust-wide were beginning to be made with external support from agencies, the trust remained very challenged. The future sustainability of the trust and its hospitals remained a concern. Although efforts had recently been made in response to concerns raised by CQC about Wexham park Hospital, they were still very much in their infancy.
The culture was one of learned helplessness and accusations of bullying and harassment were seen throughout. Although the chief executive was reported to have high visibility and communicated regularly with the frontline, she had recently resigned and was due to leave in March 2014.
The lack of bed capacity in the hospital meant that many patients were moved from ward to ward during their stay, which impacted on their continuity of care and consultants being unaware of where their patients were in the hospital.
Staff stated they did not always report incidents or concerns because when they had done so previously, there had not always been any feedback and nothing had changed as a consequence. There was a consistent theme that learning was not implemented to improve patient care.
Cleanliness and infection control
Infection rates were in line with the national average. There were still concerns regarding infection control in some areas of the hospital but improvement been made since CQC raised concerns CQC during the inspection in October 2013. The trust had carried out a full deep clean of the whole hospital recently to good effect.
Staffing
There was high use of agency and locum staff, both in nursing and medical staffing. The trust recognised it had a high turnover of nursing staff and was considering approaches to retain and recruit nurses at the time of our inspection. During the inspection we noted agency staff were not consistently being appropriately checked or given an induction on arrival to the ward.
Staffing in radiology was a particular concern. There were 11.7 vacancies for radiographers, although the trust was in the process of recruiting. The radiology department consistently operated with agency radiographers every weekend and there were no plans in place to change this approach.
There were low levels of staff satisfaction and many reported concerns about a ‘bullying and harassment’ culture from senior managers and above. There was a significant level of conflict within the organisation among medical staff, which was impacting upon effective multidisciplinary working. Clinical engagement through the hospital was relatively low, with evident conflict and lack of belief in managers from many clinicians. The trust was aware of this and had gained external support to take steps to improve this.