The Care Quality Commission (CQC) carried out a comprehensive inspection which included an announced inspection visit between the 16 and 18 September 2014 and subsequent unannounced inspection visits on 21 and 28 September. We carried out this comprehensive inspection of the acute core services provided by the trust as part of Care Quality Commission’s (CQC) new approach to hospital inspection. We returned on 2 January 2015 to ensure that the care provided on Apple Tree and Juniper wards and in the Emergency department had improved. We did not re-inspect the whole hospital nor did we look at every aspect of care at this inspection. We reviewed many aspects of the domains of safe and well led in the Emergency services, safe caring and well led in Medicine and caring in Surgery as these were all previously rated as inadequate. Where we inspected we have amended the report in line with our most recent findings.
Hinchingbrooke Hospital is an established 304 bed general hospital, which provides healthcare services to North Cambridge and Peterborough. The trust provides a comprehensive range of acute and obstetrics services, but does not provide inpatient paediatric care, as this is provided within the location by a different trust. The trust is the only privately-managed NHS trust in the country, being managed by Circle since 2012. The Trust’s governance is derived from the Franchise Agreement and Intervention Order approved by the Secretary of State for Health. This approach empowers all members of staff to take accountability and responsibility for the planning and implementing of a high quality service.
Prior to undertaking the inspection in September 2014 we spoke with stakeholders and reviewed the information we held about the trust. Hinchingbrooke Health Care NHS Trust had been identified as low risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was in band 6, which is the lowest band.
The hospital was first built in the 1980s. It was the first trust in the country to be managed by an independent healthcare company, Circle, which occurred in February 2012. It is led by a multidisciplinary team of clinical and non-clinical executives partnered with a non-executive Trust Board. However we found that the trust was predominantly medically led but a new director of nursing had been appointed four months prior to our visit and was beginning to address the input of nursing within the hospital.
We found significant areas of concern during our inspection visit in September 2014 which we raised with the chief executive, director of nursing, head of midwifery and the chief operating officer of the trust and the next day with the NHS Trust Development Authority. We were concerned about patients safety and referred a number of patients to the Local Authority safeguarding team. Since the inspection the Trust Development Authority have given the trust significant support to address the issues raised in this report. CQC served a letter which informed the trust of the nature of our concerns in order that action could be taken in a timely manner. CQC also requested further information from the trust as we considered taking urgent action to reduce the number of beds available on Apple Tree Ward. However the trust took the decision to reduce the number of beds as part of their action plan and so this regulatory action was therefore not necessary. The matter has been kept under review and the CQC has undertaken two unannounced inspections, attended the Annual Public Meeting [i.e. the Annual General Meeting] on 25 September 2014 and held two follow up meetings with the trust to ensure that action has been taken. We returned on 2 January 2015 to review progress made in Apple Tree and Juniper wards and in the ED in respect of the inadequate ratings. We found that improvements had been made in respect of the inadequate ratings for medicine and surgery but that there was little or no improvement within the emergency department. We have rated the domains of safe, caring and well led in medicine and caring in surgery as requiring improvement but the emergency department remains inadequate for well led but has moved to requires improvement in safe. Overall the location is now rated as requires improvement.