NHS England has today [25 October 2013] welcomed regulatory intervention from the health watchdog Monitor that sees the Queen Elizabeth Hospital Trust, King’s Lynn (QEH), placed under special measures. Monitor’s findings are endorsed fully by NHS England, the Care Quality Commission (CQC), and partner organisations.

The findings of a Rapid Response Review, which was led by NHS England. The CQC’s report, which is published in conjunction with NHS England.

NHS England’s intention is to work in close partnership with Monitor, the CQC, and the QEH to align service standards at the Trust with the excellence of care offered across the rest of the NHS.

Background

The East Anglia Quality Surveillance Group commissioned the NHS England-led Rapid Responsive Review at QEH in August 2013, and subsequent Risk Summit, following the initial findings of the CQC inspection in May.

The risk summit brought together the views of commissioning, oversight and regulatory bodies and agreed six high-level risks to quality at the QEH:

• Ineffective systems management
• Inadequate staffing levels
• Inefficient systems underpinning patient pathways
• Poor patient experience
• Tracking and monitoring systems have not reported trolley breaches
• Several concerns identified by partners and action plans have either not been addressed or addressed inadequately.

The biggest area of concern raised by both patients and staff was the lack of nursing staff on the wards.

The RRR panel was led by the Regional Medical Director and comprised members of the NHS England Regional and Local Area Team; a patient advocate, NHS West Norfolk CCG; CQC, other senior clinicians and supported by the QEH.

NHS England subsequently chaired a risk summit on 12 September, 2013, in response to the initial findings of the CQC inspection.

The summit comprised: CQC, Monitor, Local Area Team; CCG; General Medical Council (GMC); Nursing & Midwifery Council (NMC); NHS England regional Medical Director; Chief Nurse; Head of Operations & Delivery; Health Education England (HEE); Healthwatch; and the QEH.

Recommendations

The RRR panel made a number of recommendations grouped under the key lines of enquiry, namely:

• Governance and leadership
• Clinical and operational effectiveness
• Patient experience
• Workforce and safety.

Accordingly, a number of mitigating actions were agreed for the QEH and partner organisations to be implemented as a matter of urgency.

Of these, an immediate recommendation has been made that the QEH puts in place processes to ensure that wards are never staffed below the minimum levels or, where staffing could not be increased, beds are closed to ensure that staffing levels are safe.

A further 13 recommendations were made that need urgent attention and a further 24 recommendations were made that require medium term attention. Further details of these recommendations are contained within the report.

Dr David Levy, Medical Director, NHS England (Midlands and East) said:

“We are publishing the Rapid Response Review report today as we think it is important to be open and honest about the findings and to reassure the public that decisive action will been taken to prevent this happening again.

“This report, and that of the CQC, recommends major changes to be made by the QEH. The reports will help the whole of the NHS to learn the lessons and ensure services for patients and working conditions for front-line staff are improved.

“We have worked with the QEH, and with Monitor and the CQC, to ensure that action plans have already been implemented to improve the quality of care for patients, and that further agreed actions take place at pace. Furthermore, we endorse fully the determinations and recommendations of our partner agencies.”