Inspectors report on RUH

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by Royal United Hospital Bath NHS Trust. Overall the report concludes that the Royal United Hospital is providing patients with safe and effective care, with caring staff, and good clinical outcomes. The trust has been making progress in providing a seven-day service, with new models of care in some areas which meant that people received quick and effective treatment, reducing the length of stay in hospital.
The inspectors also identified a number of areas where the trust needed to improve to maintain standards of care.
The trust was one of the first to be inspected under radical changes which have been introduced by the Care Quality Commission providing a more detailed picture of care in hospitals than before.
An inspection team spent two days a the RUH during December. They examined the care provided in accident and emergency, medical care, surgery, intensive care, children's care, end of life care and outpatients.
Inspectors also visited the hospital unannounced on one weekend.
The report which CQC publishes today is based on a combination of their findings, information from CQC's Monitoring system, and information provided by patients, the public and other organisations. The full report is available at http://www.cqc.org.uk/directory/rd130
The team found areas of good practice which included:
 The trust had made good progress towards seven-day working where staffing and services at the weekend were similar to weekdays.

 A number of innovative services have been developed to cope with high demand during the winter.

 The A&E department had a rapid assessment team which had improved the speed at which patients who arrived by ambulance were assessed and treated.

 The trust had been recognised for developing its model of dementia care at ward level. Coombe Ward had been refurbished as a dementia-friendly ward, with an environment designed to feel more like home than a hospital ward.

 The end of life care team had developed an integrated pathway of care with GP and community services and provided a 24-hour service based on good out-of-hours arrangements with a local hospice.

 Patients told inspectors that the breast care clinic provided an excellent service.

Inspectors said that the trust should improve in the following areas:

 The trust needs to ensure there are effective operations systems to regularly assess and monitor quality of the services provided; to identify, assess and manage risks and to make changes in treatment and care following the analysis of incidents that resulted in, or had the potential to result in harm.

The Chief Inspector, Mike Richards, said: "The RUH has faced significant challenges in the past year, particularly during the period from December 2012 to March 2013. There was a high demand on its services and the hospital did not have always have the capacity to cope with emergency admissions. Patients were waiting in corridors in the A&E to be treated and the day surgery unit was being used for overnight stays. But the trust has demonstrated that it can lead significant change effectively. It had been open about its challenges and has used extra funding to support alternative solutions across the local health and social care community which should improve the flows of patients in and out of the hospital. These changes have significantly improved how the trust manages the demand on its services and should help to ensure that patients receive good quality care. The staff have told us that with this renewed focus the trust is now in a better position to manage winter pressures and peaks in demand."

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team's findings.