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After routine inspection, GWH gets the regulator's verdict: 'requires improvement'


Following its routine inspection last autumn of all aspects of the Great Western Hospitals NHS Foundation Trust's services, the regulator - the Care Quality Commission (CQC) - has given its overall verdict that that the Trust 'requires improvement'.  And this judgment also applies to the main acute hospital in Swindon.

However, the report is a bit of a curate's egg.  The Trust was rated 'Good for caring'.  Its maternity and gynaecology services and its end of life care were all rated Good. All four GWH community services the CQC inspected were rated as 'Good on all key questions', with services for children and young people rated as Outstanding. 

This latter judgment is somewhat ironic as later this year Wiltshire's community services for children and young people, in which GWH play a part, will be handed over to Virgin Care after a tender process carried out by Wiltshire's Clinical Commissioning Group..

However, of the main hospital's eight service areas six merited the 'requires improvement' rating.  The list of issues covering "areas of poor practice" that the Trust has to address is long.  Though it does include: "Ensure the provision of single sex accommodation" - something GWH has not breached for a long time.

Some requirements do state obvious aims which the Trust's managers are always striving - within the constraints of NHS-wide recruiting difficulties and financial limits - to achieve: "Take steps to ensure there are consistently sufficient numbers of suitable qualified skilled staff and experienced staff employed to deliver safe, effective and responsive care."  

Professor Sir Mike Richards, the CQC's Chief Inspector of Hospitals commented on the findings: “The staff are caring, committed and compassionate, but I know that the trust has been under some financial pressure, and this may well have had an impact on patient care."

“We found a marked variation in the quality of the services between the acute hospital at Swindon and the services based in the community."

“There were particular concerns with staffing levels and how this compromised patient safety in the emergency department where people were queuing in corridors." 

Sir Mike Richards also highlighted the number of patients ready to leave hospital but for whom no care had been arranged - a problem that can be more accurately laid at the door of Council social services in Swindon and to a lesser extent in Wiltshire.

“Although these issues were recognised and known, we found that the necessary improvements had not been made or sustained. However, the trust leadership was open about the challenges they faced and listened to our concerns. They must now work hard to meet the demands required." 

GWH's Chief Executive, Nerissa Vaughan, responded to the report in a message on the Trust's website: "...we have been told [by the CQC] our patients receive kind and compassionate care, and I couldn't be more proud of our staff, who place treating patients with dignity and respect above all else."

"This culture of kindness and compassion is at the heart of everything we do and it's exactly the kind of care I would want for my friends and family."

"Some of the other areas we are focusing on are within our control and can be looked at directly, while other things, such as improving delays in patient discharges, require the support of the whole health and social care system, so we will be continuing our work with our local partners."

Ms Vaughan also mentioned the Trust's work on recruiting more nurses.   This is an issue for GWH that Marlborough News Online has reported on for several years - most recently earlier this month.

To put the CQC report in a wider context, we asked two experts in the field for their comments - though neither wished to be named.  They both thought the 'Requires improvement' rating is really a way of urging the Trust to keep up with the increasing complexity of conditions and available treatments and the increasing pressure of the numbers attending hospital - all on limited resources, hampered by previous reductions in the training of nurses and against the background of cuts to social care budgets.

And one said: "The CQC can count nurses, but it cannot help produce or pay for more of them."

Last week the CQC found Oxford Health NHS Foundation Trust 'requires improvement' in some of its services.  This Trust provides a wide range of health and social care, including mental health and other specialist services, over an area of southern England that stretches from Milton Keynes to Bath and includes the Cotswold House centre at Savernake Hospital.


Neil Goodwin, one of Marlborough News Online’s partners adds…..

I attended one of the ‘Tell us about your care’ pre-inspection meetings organised by the CQC and Healthwatch Wiltshire and Swindon, with the intention of sharing my generally positive experience of GWH having unexpectedly been confined to a two weeks stay a few months previously.

It was the Marlborough event at the Town Hall on 25 September last year, virtually unpublicised and I only found out about it through a colleague who was tipped off that it was taking place.

Unsurprisingly it was sparsely attended other than by a few health professionals, and one other acquaintance who had also found out about the event and whose motive was similar to mine.

The session appeared to be designed to cater for those invited, even though it was ostensibly pitched to the general public.  The presentation given was poor - laptop driving a projector and displaying on to a small screen — with the sound coming from the laptop itself.  In the main Assembly Room of the Town Hall…..

The overriding impression was that the CQC were going through the motions, and that they weren’t prepared for any positive views, rather expecting that if any members of the public did turn up it would be to share their bad experiences.  This may be a subjective view of the proceedings but it was certainly my take and also that of my acquaintance, who may well have been the only other member of the public present.

My experience as an in-patient at GWH had surprised me.  I’d expected something quite different and altogether much worse.  The level and standard of care couldn’t be faulted, the food was acceptable and the ward I was in was kept spotless with a rigorous daily cleaning schedule.  The only negatives were bed blocking - patients who weren’t able to be discharged due to lack of care facilities outside, and the high number of agency staff used which inevitably come at a high cost.  My view was that these two negatives could not have been laid at the door of the GWH, rather that the hospital had little other choice given the financial restraints to which they and the care services in general are subjected.

These positive comments surprised the CQC representatives present - not what they expected nor it appeared what they were looking for.  The eventual report doesn’t come as a surprise.





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