PROSPECT Hospice bosses say they have reorganised senior management posts and invested thousands to get systems up to scratch.

The comments came as the Care Quality Commission severely criticised the Wroughton-based hospice, saying managers had failed to make sufficient progress on an improvement plan drawn up following a damning inspection of the inpatient unit earlier this year.

Inspectors warned that some of the assurances offered to the CQC by Prospect were factually inaccurate.

CQC: 'Deep seated issues unresolved'

Mary Cridge, head of hospital inspection at the CQC, said: “While Prospect Hospice continues to provide an essential service, it is troubling to report that some of the deep-seated cultural issues that we found within the team are still not being resolved.

“It is worrying that the hospice took the sudden decision, following our inspection to temporarily reduce the number of beds on the inpatient unit from 12 to six. This closure was not well planned and the impact of this closure on patients and the wider healthcare system had not been assessed.”

What did the CQC find?

The CQC inspected the hospice in February 2018, following concerns from staff on the inpatient unit about bullying and staffing levels.

Inspectors issued a warning notice in March, identifying four key areas where improvements were required.

They said staff did not receive appropriate support or training. There was no process for formally recording when agency staff were being used to fill gaps in the rota. Similarly, there was no formal system for logging delays in admitting patients due to low staffing levels.

Seven anonymous complaints had been sent to the CQC about a culture of bullying on the unit. These had not been investigated promptly.

The CQC returned to the hospice twice in August, when they said the requirements of the warning notice had not been met.

Managers were taking too long to respond to address staff grievances, inspectors warned. A move to temporarily half the number of inpatient beds in August had been poorly planned, communicated and implemented.

But the CQC said that there was a better use of agency staff to fill gaps in the rota and nurses were up to date with training. Patients praised care at the hospice. One relative told inspectors: “I’ve visited every day for three weeks and I am very happy with the staff and the care provided. Everyone is so helpful."

New systems and senior posts at Prospect

Yesterday, bosses at Prospect Hospice said they now had clear systems in place to monitor the areas of concern for the CQC, including staffing levels on the inpatient unit.

Three new senior posts were being created to improve oversight of patient care and governance. Among the new posts would be a medical director, with Prospect hoping to fill the role by spring next year. Thousands had been spent on removing carpets and installing sinks at the inpatient unit.

David Barrand, deputy chairman of trustees at Prospect Hospice, told the Swindon Advertiser: “We are now pleased to say we have met all the requirements they’ve laid down and we’ve sent them the evidence.

“We’re absolutely not being complacent. We’re not window dressing. In hindsight I’m sure in a year’s time we will look back at this and think it was actually very good for us, although it was a painful experience at the time.

“We spent the three months after the original CQC report in June really laying the foundations for the changes that they were recommending for us.

“When they came in August to see how we were getting on those foundations had been laid, but I think the progress against the actions wasn’t where the CQC wanted it to be.”

A new assurance framework had been put in place, he said, which would flag concerns to the board of trustees over staffing levels and other issues on the wards. Advice on governance arrangements had also been sought from GWH director Carole Nicol.

'We've not been complacent'

“Our inpatient unit records, use of agency staff records, our training records – all things that were highlighted originally by the CQC – now have a rigorous reporting structure,” added Warren Finney, Prospect’s head of community engagement.

“We haven’t been complacent. We’ve taken the things said by the CQC incredibly seriously.

“Part of the reason why it has taken us longer to achieve them than the CQC would have preferred, was because we wanted to do it from a grassroots level and not have a short term fix.

“This is about ensuring that whatever we put in place is there for the long term and not just simply to respond to a CQC report. While that’s incredibly important, for us this is about how we work as a hospice and ensuring that whatever we put in place now is fit for purpose one year, two years and beyond.”

Response to bullying claims

Trustee David Barrand said addressing reports of bullying at Prospect was a key focus for the board.

The Care Quality Commission received seven anonymous tip-offs from staff members concerning the culture on the inpatient unit earlier in the year, which the watchdog said had not been investigated promptly.

There were also reports of a fractious relationship between staff and senior managers. Four workshops looking at the culture in the organisation and ordered in the wake of bullying reports on the inpatient unit had ended with a request that staff sign a pledge to promote a positive culture on the unit.

In June, the CQC reported: “The majority of staff we spoke with told us they felt pressured into signing the pledge and some told us they had pretended to sign it.

“Almost all of the 23 members of staff we spoke with felt the workshops were handled poorly, were inappropriate and disagreed with the content of them. Staff described feeling humiliated, bullied, put down, undervalued and rubbish.

“They felt they had not been listened to and had been unable to stand up for themselves.”

In the latest report, published yesterday, the CQC said some staff had reported an improvement in morale. However, they added: “Instability in the management team had caused staff to feel unsettled and anxious about the future.”

David Barrand, deputy chairman at Prospect Hospice, said the CQC concerns over culture at the inpatient unit was a key focus for the board of trustees and “absolutely unacceptable” if it happened anywhere in the organisation.

Clinical Commissioning Group responds

A spokesman for Swindon NHS Clinical Commissioning Group said: “This latest report from the Care Quality Commission has not highlighted anything that we, as a commissioner, were not already aware of.

“Since the inspection we have been working closely with Prospect to help address the concerns of the CQC, offering practical support and advice to the hard-working teams caring for patients and families at what is often the most difficult period of their lives.

“It is the CCG’s responsibility to quality assure all local services and ensure that improvements are well embedded, and we are encouraged by the initial progress made by Prospect in the time since the CQC’s visit in August and we are hopeful that any future inspection would reflect this.”