Lessons have been learned and improvements are continuing: this is the message from the head of North Cumbria University Hospitals NHS Trust after a report said the trust “requires improvement”.

The trust is responsible for hospitals including the Cumberland Infirmary and West Cumberland Hospital.

The Care Quality Commission (CQC) inspected the trust in July and August and released its report this week.

The trust was ranked “good” in most areas.

But its overall rating of “requires improvement” came due to shortcomings in A&E and medical care.

Speaking about the findings, England’s chief inspector of hospitals, Professor Ted Baker, said: “Since our last inspection, North Cumbria University Hospitals Trust has not been able to consistently sustain the pace of improvements that we had previously seen. Patients were left without treatment for too long in these hospitals’ urgent and emergency departments, which resulted in a number of serious incidents.”

Stephen Eames, chief executive of the trust, told The Cumberland News: “There was risk of harm to those patients, as opposed to real harm. We’ve worked very hard at putting that right.

“The risk had been identified. The pressures on the department were leading to greater risks. Because staff were under pressure, some procedures that should have been followed weren’t.”

The report also said a room in the emergency department used to accommodate patients with mental health conditions was not fit for purpose.

Problems included ligature points, which could be used to attach a cord for hanging or strangulation.

“The room wasn’t up to date,” said Mr Eames. “I was concerned about that. What it suggests is that the system for checking it had broken down. We put all that right. I wouldn’t anticipate any further problems.”

The CQC said staff shortages and sickness were a factor in many problems, ‘with several wards having teams that were described as ‘burnt out’.’

“They are not words I would use,” said Mr Eames of the phrase ‘burnt out’. “Staff in some areas are very stretched and under a lot of pressure. Staffing is an ongoing challenge. You’ll see the same sorts of challenges in most hospitals up and down the country.

“As the report says, we’ve improved that a lot. At the start of 2016 our vacancy rate in medicine was 30 per cent. Now it’s 14 per cent. We’re still using temporary staff when necessary.

“Staff sickness is about four per cent, which is very good for the NHS. In certain areas it’s running higher.

“We’re looking after our staff, moving them to areas with less pressure if need be.”

Mr Eames could not rule out the possibility that Brexit might make recruitment more difficult.

“I’m not a fan of Brexit as far as recruiting staff to work in our hospitals is concerned.

“We’ve got quite a number of staff from overseas, including Europe, who hold up some of our services.

“The government are working on that. There’s no word yet on whether Brexit will make things more difficult.”

He denied that the issues identified in the report were caused by any shortage of funding.

“I don’t think the budgets are really an issue. The issue for us is spending up to budget in some areas.”

The trust has cut the number of beds at the Cumberland Infirmary and in cottage hospitals.

Last year the trust revealed its intention to ease ‘bed blocking’ by moving more care out of hospitals and into people’s homes.

Mr Eames claimed this would help to alleviate problems caused by staff shortages.

“The real answer is to provide people with care away from hospital. The CQC do recognise the work we’re doing to stop people coming to hospital and getting them out quickly if they are in hospital.”

He pointed out that the trust is doing better than ever in meeting the NHS target of patients in A&E being seen within four hours of arrival.

“It’s the best it’s ever been. Last month we were 27th out of 150. The month before we were 18th.”

In 2013 the trust was one of 11 around the country to be placed in special measures. It was the last to have that status lifted, in March 2017. Mr Eames said: “Eighteen months after coming out of special measures there’s been a huge amount of improvement. I’m particularly pleased about the improvements to maternity and childcare services in Whitehaven and Carlisle.

“That’s important in building the confidence of the community. The report is really positive about those services.”

On the report in general, Mr Eames said: “I’m very pleased with it. It demonstrates that we’ve come a long way in improving our services. We’ve still got work to do.

“In a couple of areas things have not moved on as consistently as they might have done. Of the services looked at, the vast majority were ‘good’.

“Two areas - A&E and medical care - are ‘requires improvement’. Another service reaching ‘good’ would have meant the overall rating was ‘good’.

“I was hoping we would get that rating. We were very close. We’re continuing to make improvements.

“There’s a good rating throughout for quality of care. That’s what we all see every day.”

Positive quotes from the CQC report include:

“Patients’ feedback was positive and we saw that staff were providing compassionate care. Everyone was clearly working hard to deliver the best care they could under pressure.”

“Staff proactively involved patients and their family to consider all aspects of holistic wellbeing.”

“Ward environments were clean and staff used personal protective equipment appropriately to protect themselves and the patient from infection exposure.”

“Patient outcomes in many national audits were good and there had been improvements in others.”

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