Hospital scraps inadequate rating as boss warns county is 'starved' of investment
PUBLISHED: 08:14 15 May 2019 | UPDATED: 11:01 15 May 2019
"We cannot fix this on our own."
That was the message from the chief executive of Norfolk's busiest hospital in an unprecedented plea to politicians to pump extra money into the health service.
Mark Davies, who has been at the head of the Norfolk and Norwich University Hospital (NNUH) since 2015, was speaking as a Care Quality Commission (CQC) report released today said there had been great improvements at the trust since March last year, scrapping its inadequate rating.
But even though NNUH was notched up a level to a rating of requires improvement, Mr Davies said there was still much to do at the trust, as the hospital performed the worst in the country for a major A&E target last month.
Mr Davies said: "First and foremost I would like to thank every one of our amazing staff who have been working so hard to deliver the trust's clear, comprehensive improvement programme. It is their dedication, commitment and hard work mainly through the winter months which has helped to improve our ratings in such a short period of time. We are now well on our way on our five year journey to outstanding."
But on issues such as staffing, waiting times, and hitting treatment targets - which are being seen nationwide as well - Mr Davies said: "We do need help. We cannot fix this on our own.
"We need to fix this across the county, with how we work with our colleagues at other hospitals, and from the system and the politicians what we need is investment. This county is starved of capital investment."
Mr Davies said the hospital needed new IT, around 200 more beds, and the equipment was on the whole still what was bought when the hospital was new in 2001.
The trust also struggles with paying £20m in private finance initiative (PFI) payments.
"It's a massive backlog, " he said. "It's something our MPs are aware of. So it's not just the PFI, the capital bill is significant. We cant borrow any more money, we don't have any savings in the bank.
"We're a bit stuck really and at the same time equipment is breaking down."
In today's report CQC inspectors found improvements in both culture and leadership - big concerns at their inspection last year.
And they also found examples of "outstanding practice" in surgery and critical care, and praised the use of robotics, QR codes, and electronic records.
But at the same visit, between January 22 and February 27 this year, there were also a number of troubling findings including:
- A lack of "respect and civility" between staff in some areas;
- Not enough nursing or medical staff to keep patients safe in some departments;
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- Staff being "close to burn out due to the higher demands on the service and the poor staffing numbers".
The report comes at the same time as official NHS data showed just 62.2pc of patients arriving at the NNUH A&E were seen within four hours - its worst performance since the measure was introduced. The target is 95pc, which just six trusts in the country are meeting, and it has not been hit nationally since July 2015, but the NNUH was at the bottom of the pile.
When inspectors visited nearly four months ago they said there was "no specific vision or plan for the emergency department".
But Mr Davies said the number of patients arriving at A&E was increasing by 10pc every year, while at Norwich's walk-in centre patient numbers were down by 9pc. He said: "We know we're not providing patients with the speed of the care we would want. We're doing everything we can.
Chief nurse Professor Nancy Fontaine said there were specific things the trust could do, such as improving their efficiency and processes, and added it was a top priority for the hospital's leadership.
Already some 425 extra members of staff had been hired, however Mr Davies said: "In 7,500 staff it goes back to demand, 400 people disappear into this hospital very quickly."
Both Mr Davies and Prof Fontaine praised staff - the hospital was rated as good for caring, and inspectors noted "staff cared for patients with compassion".
While Mr Davies, who is leaving the trust in the autumn, added: "Today's not about me, it's about the staff, but clearly I want to leave this place a better place than when I came. I'm delighted for the staff and for the patients."
The chief inspector of hospitals, Professor Ted Baker, said: "On our return to Norfolk and Norwich University Foundation Trust we found improvements at the trust, but it was clear there was still work to be done to ensure people can consistently receive the care they should be able to expect.
"While we found improvements in medical care, surgery and critical care, targets for mandatory training in medical care were not being met and governance process were not embedded. This meant there were inconsistences in how risks were reviewed. In urgent and emergency care there were issues regarding culture, leadership and the management of patient flow through the emergency department and staff recognising and responding to patient risks.
"We served a warning to the trust under section 29A of The Health and Social Care Act 2008 as a result of the ongoing concerns in urgent and emergency care."
What about the rest of the county?
Norfolk's other hospitals, the James Paget University Hospital (JPUH) in Gorleston, and the Queen Elizabeth Hospital (QEH) in King's Lynn, have also struggled to hit their A&E targets but not to such an extent.
Last month, the JPUH saw 86.4pc of patients within four hours - placing it 34th in the country out of 129 trusts.
While QEH saw 84.7pc putting it as 50th. The national average was 85.1pc.
It was reported in March that the target could be scrapped but doctors warned getting rid of the it would have a "near-catastrophic impact" on patient safety.
Norfolk A&E consultant and regional chairman for the Royal College of Emergency Medicine, Dr Jim Crawfurd, previously said: "I think the overwhelming feeling of my generation, and I qualified in 1999, was when we qualified in the late 90s seeing patients on trolleys in the ED was completely normal and when the four-hour target came in that rapidly changed."