Bucks Healthcare Trust rated ‘Good’ overall but concerns raised over safety

A report published today by the Care Quality Commission (CQC) has awarded the Buckinghamshire Healthcare NHS Trust an overall rating of ‘Good’ but highlighted ‘Safety’ as requiring improvement.

Following the report, Neil Macdonald, Chief Executive of Buckinghamshire Healthcare NHS Trust, paid tribute to the Trust's 6,500 employees.

The inspection, which took place in February 2022, assessed the medical and surgical services at the Trust's Stoke Mandeville and Wycombe Hospitals only. They did not inspect any of the Trust's community services or other acute services.

Four of the six category rankings remained the same as the last report in 2019, with ‘Caring’ retaining its ‘Outstanding’ rating.

‘Well-Led’ improved from requiring improvement to ‘Good’.

However, ‘Safety’, which received a rating of ‘Good’ in 2019, has dropped to ‘Requires Improvement’.

Commenting on the rating, Neil Macdonald said: "We are pleased with the outcome of the inspection because there is not one person within the Trust who does not want to do the right thing for our patients and has not worked tirelessly to try and deliver that in exceptional circumstances.

“The last two years have undoubtedly been the most challenging in the history of the NHS and at the time of the inspection, we had a high rate of staff absence due to Covid-19 and were still looking after a significant number of patients with Covid-19 due to the virulent Omicron variant.

“Despite these challenges my colleagues continued to treat patients with compassion and kindness, respecting their privacy and dignity and taking account of their individual needs. This was recognised by the CQC who upheld our rating of Outstanding for caring.

“I am proud that the CQC acknowledged that, despite our workforce challenges, staffing levels were carefully monitored to ensure that we could continue to deliver safe care. They also recognised that the Trust is committed to continually looking at ways to improve services, engaging with the local community and patients to ensure their voice is heard.

“The purpose of CQC is to, on behalf of the public, hold us to account for the quality of our services and to help us to identify areas where we need to learn and make further improvements.

“Whilst it is disappointing that our overall rating for safety moved from 'Good' to 'Requires Improvement', I would like to reassure the public that there were no immediate safety concerns raised by the CQC in this report and in fact the report stated that "staff understood how to protect patients from abuse and managed safety well."

We will approach the recommendations made by the CQC, particularly regarding safety, with the same relentless dedication and commitment to our patients and colleagues that we have demonstrated over the last two years.

“This will include renewed focus on some of things which, understandably, took a back seat during the pandemic such as annual appraisals, training and professional development.

“There is clearly more we need to do to ensure we have consistent compliance with infection, prevention and control measures and medicine management whilst continuing to progress our plans to upgrade our ageing estate.

“I want to assure our patients that our top priority will always be to provide the very best care we can for everyone that needs us – whether that is in one of our hospitals or in their homes. I would like to thank the public for their continued patience as we work tirelessly to see people as quickly as possible, which we will do based on clinical need.

“I am privileged to lead a dedicated, highly-skilled and compassionate workforce which is equally committed to achieving this."

The Care Quality Commission said:

• Staffing levels were carefully monitored, and steps taken to maintain safe staffing levels.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients' individual needs, and made it easy for people to give feedback.
• In most areas' leaders were visible and approachable and staff were supported to develop their skills. Staff understood the Trust's vision and values.  In general staff felt respected, supported and valued. The Trust promoted equality and diversity in daily work and provided opportunities for career development.
• The Trust engaged well with patients and the community to plan and manage services and staff were committed to improving services continually.
• The Trust had worked to maintain some of their elective services during the COVID-19 pandemic and recovery plans were being implemented to ensure that the backlog was addressed.

However, the inspection also showed that the following areas require improvement:

• Staff adherence to infection control guidance was variable.
• Staff were not always supported to develop through yearly, constructive appraisals of their work.
• Engagement in and understanding of quality improvement was variable. 
• Training in working with people living with dementia and those with learning disabilities was not mandated. 
• Substances that were subject to COSHH regulations were not always managed safely.

Work is already underway to address these areas such as extra vigilance around adherence to infection control guidance; improving engagement and understanding of quality improvement and offering additional training on dementia and learning disabilities.