FULL details of the extent of the problems confronting Worcestershire Royal Hospital have been laid bare for the first time.

Watchdog the Care Quality Commission (CQC) has today announced that the hospital, in Worcester, will remain in special measures until further review.

The announcement comes as a new report is published again labelling the site and Worcestershire Acute Trust, which runs it, "inadequate".

In the report the CQC says that rather than improving, the problems at the trust have been getting worse – something it calls "extremely concerning".

However, Michelle McKay, the new chief executive of Worcestershire Acute Trust, says she is "determined" to turn things around.

The trust, which also runs Redditch Alexandra and Kidderminster hospitals, was first placed into special measures in December 2015.

The new report puts the meat on the bones of a previous section 29A warning notice issued by the CQC in February when the trust was told it must get its house in order or face further action.

Mrs McKay, a former emergency nurse and emergency department manager, took over at the helm on March 27 and the CQC report refers to inspections in November and December last year, before she took over.

The CQC has recommended a three to six-month extension of special measures to allow the trust’s new executive team to drive the "urgent improvements" that are needed.

Professor Sir Mike Richards, the CQC's chief inspector of hospitals, said: “Rather than getting better, our latest inspection shows a noticeable decline in ratings.

“During our December inspection, we rated the trust inadequate for safety, responsiveness and being well-led. This is extremely concerning, both in terms of the quality of care that people can expect from the trust, and for what it says about the trust’s ability to improve.

"This situation must not be allowed to continue and we are considering, along with partner agencies, the best option available in order to improve services rapidly for the local population.

“Generally, staff were hard-working, passionate and caring and because of the quality of staff interactions with patients, we rated the trust as good for caring. Many staff, however, were clearly frustrated that they were not able to effect change due to poor communication between ward, divisional and executive levels."

The CQC's visit late last year included unannounced inspections at Worcestershire Royal Hospital, the Alexandra Hospital and Kidderminster Hospital, with all three rated inadequate.

One of the problems identified by the CQC was a lack of permanent leadership, an issue which Mrs McKay says has now been resolved.

"We are disappointed with the CQC's findings, but we fully accept them," she said.

"I am sorry to our patients, their families and carers have been let down "We all want our patients to get the best care possible and regret that this isn't currently happening, but we're determined to put things right.

"Whilst we have made improvements since the last inspection we recognise we still have some way to go.

"I am pleased that the reports acknowledge that we are a caring organisation, rating care at our hospitals as 'good', and our end of life care as 'good'."

She would be happy for one of her relatives to receive care at Worcester and said the report referred to the position of the trust 'quite a bit of time ago' and that 'things had changed since that time'.

Worcester's MP Robin Walker said the NHS was his 'top priority' after his re-election and that the CQC report highlights the importance of securing £29 million from the Government to improve capacity at Worcester.

He will be writing to health ministers about the importance of this extra investment which he said would help recruit and retain staff.

The CQC's main criticisms of the trust

  • Since May 2016 the trust has regularly breached the 12 hour target for patients remaining in the emergency department and many continued to be cared for in the corridor at Worcestershire Royal Hospital.
  • Staffing levels within the emergency department were not planned and reviewed in line with national guidance.
  • There were not enough consultants there to meet the Royal College of Emergency Medicine’s workforce recommendations.
  • There was no privacy and little confidentiality for patients being cared for on trolleys in the corridors of the emergency departments at Worcestershire Royal Hospital and the Alexandra Hospital.
  • Patients were sometimes waiting by external doors in cold conditions or out of staff view.
  • Patient risk assessments were not fully completed on admission and generally not reviewed at regular intervals throughout the patient’s stay in hospital and records were not always stored securely. This occurred in various hospital services including the emergency department, medicine, surgery and critical care.
  • Ageing and unsafe equipment was used in the radiology departments across the trust that was being inadequately risk rated.
  • Poor governance arrangements and over reliance on the assistance of others to highlight areas that require significant improvement.
  • Cultural and behavioural change is key to driving and sustaining the required improvements.

Areas that must improve at the trust

  • Patient documentation, including risk assessments, must always completed accurately and routinely to assess the health and safety of patients.
  • The trust must improve performance against the 18 week referral to treatment time, with the aim of meeting the trust target • Flow in the hospital must be maintained to prevent patients being treated in the emergency department corridors for extended periods of time • Patient privacy, dignity and confidentiality must be maintained at all times. For example, patients staying overnight in the gynaecology assessment unit.
  • The trust must improve performance against the national standard for cancer waiting times. This includes patients with suspected cancer being seen within two weeks and a two week wait for symptomatic breast patients.
  • There must be access to 24-hour interventional radiology services.
  • Patients under child and adolescent mental health services must receive care from appropriately trained staff at all times.
  • There must be an appropriate mental health room in the emergency department to care for patients presenting with mental health conditions that complies with national guidance.
  • There must be a robust system in place to ensure that all electrical equipment has safety checks as recommended by the manufacturer The trust must ensure that there is clear oversight of the deterioration of patients and that this is documented appropriately.