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A Chief Hospital Inspector called for further improvements to health services in North Cumbria following an inspection.
Concerns were expressed by Professor Ted Baker, Chief Inspector of England Hospitals, following an inspection by the NHS Trust Care Quality Commission (CQC) at NHS Cumbria University in July and August.
CQC staff focused specifically on emergency and emergency care, as well as medical care at Cumberland's Carlisle Infirmary at West Hospital. Cumberland of Whitehaven and Penrith Hospital Birth Center.
Inspectors also examined services for the elderly, as well as surgery, maternity and child and adolescent services. The management and leadership of the trust were also reviewed.
As a result, trust maintains its "Good for Care" rating, even though it is safe, effective, responsive and well directed as needing improvement.
The CQC also released the report on the use of trust resources, based on an assessment undertaken by NHS Improvement.
Trust has been classified as requiring improvement for the productive use of its resources.
Overall, the combined confidence assessment, taking into account CQC's inspection of service quality and NHSI's assessment of resource utilization, requires improvement.
Speaking about the results, Professor Baker said, "Since our last inspection, North Cumbria University Hospitals Trust has not been able to steadily maintain the pace of improvements already observed.
"I am concerned that the flow of patients through the Cumberland Infirmary and West Cumberland Hospital has deteriorated.
"Patients have been left untreated for too long in the emergency and emergency departments of these hospitals, resulting in a number of serious incidents.
"However, the patients' reactions were positive and we saw that the staff provided compassionate care.
"Everyone was clearly working to provide the best possible care under pressure.
"We recognize that recruitment remains a longstanding challenge to trust and I am pleased that the management team is responding to the concerns we have expressed.
"Trust has come a long way but further improvements are needed.
"We will continue to closely monitor trust and will return in time to re-inspect its services."
Inspectors who visited the Cumberland Infirmary and West Cumberland Hospital found that patients waited a long time before being treated, as the number of beds available in the trust was limited, putting pressure on other services and preventing patients from being admitted quickly.
Several serious incidents occurred at West Cumberland Hospital because patients were not transferred quickly enough to their specialized department.
Throughout the trust, vacancies among nurses remained vacant and reliance on surrogate physicians was high.
The staff illness was also high and several shifts of service were not fully supported, which put the safety of staff at risk.
In the Mental Health Assessment Areas of the Cumberland Hospital and West Cumberland Hospital, they did not follow the best practice guidelines.
The rooms contained inappropriate equipment and a number of ligation risks, which made them dangerous to the patients' health.
The trust took immediate action after the inspectors raised these concerns.
A number of improvements have also been described as a result of the CQC inspection.
In the report on the use of resources, published after an evaluation of NHS Improvement, the area was also classified as needing improvement.
However, CQC has noted a remarkable practice of working together to reduce deferred care transfers (medically fit patients but with delays), innovative recruitment efforts, the use of technology and a significant reduction in referrals in musculoskeletal health (MSK) screening.
The CQC also raised several areas for improvement and the trust indicates that work is already underway to resolve them.
Stephen Eames, Executive Director of the NCUH and the Cumbria Partnership NHS Foundation Trust, said: "The report shows that we have made significant improvements since the last inspection in 2017, despite pressures on our services.
"In particular, our surgical and maternity departments have both received better ratings, which is great news for our staff and patients.
"During the inspection, I said that we were aiming for good intentions and although we did not achieve this goal, we have made real progress that we should all be proud of.
"The fact that all services have been rated" good "for care is a testament to the hardness of our staff. I want to thank them all for the dedication they show day after day.
"We know the pressures on these services, not just in northern Cumbria, and as we approach the winter, we have plans in place to improve patient flow and ensure patients are treated in the right place at the right time.
"It was encouraging to see the report highlight the impact of collaboration across the health care system. By doing so, we will ensure that people are treated in the best place to meet their needs. "
All report details, including scores for all essential services, are available online at www.cqc.org.uk/provider/RNL.
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