Bradford's hospitals must do better, according to new report

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by Bradford Teaching Hospitals NHS Foundation Trust, following Care Quality Commission inspections in October and November last year.

And while the report concluded that caring was 'Good', overall it said the Trust - which provides services at Bradford Royal Infirmary and St Luke's Hospital - requires improvement. Safety was rated as 'Inadequate', and effectiveness, responsiveness and leadership were rated as 'Requires Improvement'.

Inspectors found that the Trust was dealing with changes within the organisation, which had been introduced in the months prior to the inspection, including new leadership, and new organisational structures and governance arrangements.

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Professor Sir Mike Richards, CQC Chief Inspector of Hospitals said: "There have been some significant organisational changes introduced over the last few months, including changes in the leadership team with a new chairman and chief executive in post. New appointments had also taken place throughout the different clinical and managerial levels across divisions and departments.

“I do have concerns that many of the changes to systems and processes have yet to be embedded in practice and the lack of maturity of these arrangements meant that they were untried and tested with regard to robustness and effectiveness.

“I do commend the trust for the many areas where they have been able to demonstrate good and outstanding practice. The palliative care and elderly care teams have been doing some ground-breaking work.

“There had been a commitment by the executive team to consult and involve staff, particularly the clinical body. However, further work was needed to engage staff over improvements For example; a major challenge for the trust was the age of the buildings and some of the estate stock, particularly at Bradford Royal Infirmary. Improvements to the facilities were in progress with a new build on the Bradford Royal Infirmary site.

“They also need to address as a matter of some urgency the backlog of patients waiting for follow up appointments.

“While there are some signs that this trust is improving, a number of these improvements are new and need time to become fully embedded – the new executive team still need to engage more fully with staff. We will return in due course to check that the improvements we have identified have been made.”

During the inspection, the CQC saw a number of areas of outstanding practice including, at Bradford Royal Infirmary, 12 internships for people with learning disabilities being provided. A system of 'green bands' worn on patients' wrists displaying personal and procedure information was recognised as an effective safety measure by the World Health Organisation.

At St Luke’s Hospital there had been improvements to the wards to make them more user-friendly for people living with dementia, said the report.

At both hospitals, inspectors observed positive, kind and caring interactions on wards and between staff and patients.

However, the inspection team also found that the Trust must ensure that a significant backlog of outpatient appointments is promptly addressed; that governance and monitoring of outpatients' appointment bookings are operated effectively and are able to identify any potential system failures and take appropriate action; and that there is access to sufficient numbers of suitably skilled and experienced staff

At BRI, the report said priorities for the Trust included that the care and treatment of patients undergoing non-invasive ventilation meets the national guidance; that arrangements for stabilising children waiting for transfer to another hospital for paediatric intensive care were safe; that there are appropriate arrangements for the prevention and control of infection; that there is suitable access to hand wash sinks, particularly on the critical care unit and high dependency unit; and that the procedures for cleaning and disinfecting endoscopes are consistent with accepted practice.

The Trust responded: "Bradford Teaching Hospitals NHS Foundation Trust has shared with England’s Chief Inspector of Hospitals a progress update on how improvements are being carried out. Today, he published his report on services provided at Bradford Royal Infirmary, St Luke’s Hospital and four community hospitals following an inspection by the Care Quality Commission in October and November last year.

"Out of the 57 individual ratings awarded that were applicable, the Foundation Trust scored 'good' in no fewer than 32 areas; 'requires improvement' in 18; and 'inadequate' in seven. Together, these ratings translated into an overall score for the organisation as 'requiring improvement'.

"The report underlined that generally 'treatment and care followed best practice and national guidance and outcomes for patients were positive'; and patients had good experiences and were treated with kindness."

Trust chief executive Professor Clive Kay said: “One of the important findings that really shines through in this report is that our 5,000 staff and volunteers are judged to be very caring people. Throughout it, there are countless references to the caring, compassionate nature of everyone who works for us – something of which we should all be proud.

“Today’s report reflects back the successes we have achieved and challenges we are determined to overcome, showcasing many outstanding services and initiatives that are at the forefront of best practice and quality.

“These include the way we care for people with dementia and life-limiting illnesses, as well as the safety measures we have pioneered for patients undergoing surgery that are recognised by the World Health Organisation as exemplary.”

He added: “While we have made rapid and substantial progress in the six months since our inspection, the findings present a realistic picture of what further action we must take to accelerate our journey of improvement.

“There is a commitment from the new leadership team that there will be even further investment in our drive to improve the quality, safety and experience that our patients receive."

A spokesman for Healthwatch Bradford and District, the independent organisation that ensures patients and the public have a stronger voice on local health and social care services, said: "We played an important role in the Care Quality Commission’s inspection process, ensuring that experiences of patients and carers were shared with the inspection team.

"We routinely report back to the Trust about what we hear, both good and bad, to help them identify areas for improvement and take action.

"In common with the CQC inspection team, Healthwatch have often heard from patients and carers about hospital staff who are skilled, caring, and respectful. We know that there are areas of good practice which have been highlighted in the CQC’s report, but also that there are areas where services need to be improved."