Inquiry NHS Trust still failing on 11 standards

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An NHS Trust at the centre of a public inquiry over its "appalling" patient care is still falling short on 11 key standards, a health watchdog said today.

The Care Quality Commission (CQC) found Mid Staffordshire NHS Foundation Trust complied with just five out of the 16 objectives set out by law to maintain quality and safety in hospitals.

While the trust had improved in some areas, the latest inspection report said problems with the way hospitals handled medicine had increased in the last 12 months.

The number of medication-related incidents rose from 339 in 2008/09 to 403 in 2009/10, according to the report. Inspectors also found 45% of prescriptions had a recording error.

The CQC said it had minor concerns about eight other standards and moderate concerns about three including the management of medicine as well as supporting workers and complaints.

Inspectors said many of the concerns would be addressed once action plans were in place.

"Our findings lead us to have a moderate concern in the management of medicines," the report said.

"There are inconsistencies in practice and the standard of record keeping on the wards. There has been a significant year on year increase in the number of medication-related incidents reported.

"The reasons for this and the trust's response to gaps in practice identified following recent audits are not clear, however the trust will address these issues through further audits and action plans."

Mid Staffordshire NHS Foundation Trust was condemned by the Prime Minister in June for its "appalling" standards of care between 2005 and 2008 when hundreds of patients died.

A CQC report in July found the trust had "come a long way" in two years and mortality rates had fallen.

But today's report warned services must continue to improve to meet the minimum standards of care.

The trust's managers have been given 28 days to provide a plan of action to reach its targets, and CQC inspectors will return to assess the improvement.

The CQC said: "We have identified areas of non compliance in 11 of the 16 essential standards of quality and safety we reviewed.

"Whilst we have eight minor concerns and three moderate concerns, we have concluded that we would want to support the delivery of long term improvements through ongoing compliance monitoring of the trust and close working arrangements with key stakeholders."

There were also concerns over the trust's complaints system and supervision, with the CQC imposing one condition on the trust relating to supporting workers.

But the trust, which runs Stafford Hospital and Cannock Chase Hospital, was found to be compliant with standards for patient consent, meals, partnership working, keeping people safe from harm, and assessing and monitoring services.

Andrea Gordon, regional director of CQC in the West Midlands, said: "I am satisfied the hospital is moving in the right direction, but the trust must not relax its efforts to improve.

"We believe that with the right support the management team at the trust has the capability to make the necessary improvements.

"The trust needs to take action to address the issues we have identified. The law says these are the standards that everyone should be able to expect when they receive care. Providers have a duty to ensure they are compliant - or face the possibility of enforcement action.

"Management of medicines is one of the areas that gives us most concern because there are inconsistencies on the wards and the trust's own audits point to significant problems which must be addressed.

"Staff training has improved, but arrangements for regular supervision are still not satisfactory and need urgent attention.

"People who depend on these services need to know that they are safe. If we had an immediate concern, we would step in quickly to protect the public.

"In the meantime we will follow up and monitor the improvements identified in this report, and we will take firm action to ensure that Mid Staffordshire NHS Foundation Trust comes up to standard."

A full public inquiry into the failings at the trust, which left patients "routinely neglected", will be led by Robert Francis QC.

In a statement, Antony Sumara, chief executive of Mid Staffordshire NHS Foundation Trust, said the trust had raised its own concerns with the CQC and had plans in place to address them.

Referring to concerns over the management of medicine, Mr Sumara said: "We need to improve further our practices around prescribing and administering medicines so that we are more consistent across the trust, and we have developed action plans to address this."

Dealing with the way the trust supports staff, he added: "We have put in additional clinical leadership, including more ward sisters, as well as putting in 140 additional nurses across the organisation. We have worked hard on achieving a high level of appraisals across the trust, with now over 90% of staff having had appraisals. A formalised clinical supervision policy and structure will be rolled out over the next three months."

Addressing the issue of the trust's complaints system, he said: "We raised our concerns with the CQC in respect of not meeting our complaint responses in a timely manner and in training our staff. At that time we provided a delivery plan to the CQC and we are on target to deliver it by December 1."