We have not taken the previous ratings of services at Burton Hospitals NHS Foundation Trust into account when aggregating the trust’s overall rating. CQC’s revised inspection methodology states when a trust acquires or merges with another service or trust in order to improve the quality and safety of care, we will not aggregate ratings from the previously separate services or providers at trust level for up to two years. During this time, we would expect the trust to demonstrate that they are taking appropriate action to improve quality and safety.

We rated them as requires improvement because:

• Patients could not always access care and treatment in a timely way. Waiting times for treatment and arrangements to admit, treat and discharge patients were worse than the England average and national standard.
• Mandatory training, safeguarding training, mental capacity act training and role specific training rates were variable across all staff groups.
• Morbidity and mortality governance was variable with sporadic representation from some teams and inconsistent evidence of investigation and lessons learned.
• Some services did not have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. There was a reliance on temporary staff to cover staff vacancies in some areas
• Changes to the leadership and governance structures since the acquisition were not yet fully embedded; information technology systems had not been integrated, service guidelines and standard operating procedures were not always up to date or aligned to the new trust and systems to extract and separate data were not well developed.
• Medicines and medicines stationery were not always stored securely and managed in accordance with local policies.
• Some services did not have suitable premises and patient’s security had not been considered. However, the trust took immediate action and put into place measures to ensure premises were secure. In critical care there were unmitigated fire safety and security issues despite on-going escalation through annual risk assessments.
• Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms did not always contain sufficient evidence that mental capacity assessments had been carried out or considered.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. However, staff did not fully understand the new structure since the acquisition and were not aware of future plans for the service.
• The approach to continually improving the quality of some services and safeguard high standards of care was not robust, however we saw plans in place to make improvements.
• Culture was variable across some services.

However:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The majority of services, controlled infection risk well. Staff kept themselves, equipment and the premises clean. They mostly used control measures to prevent the spread of infection.
• Staff cared for patients and women with compassion. Feedback from patients and women confirmed that staff treated them well and with kindness.
• Most services managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Most services provided care and treatment based on national guidance.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action.
• Managers at all levels, and in most areas, had the right skills and abilities to run a service providing high-quality sustainable care.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Services took account of patients’ individual needs and staff were committed to meeting patient’s personal and emotional needs in addition to their clinical needs.