PROSPECT Hospice has been heavily criticised by the Care Quality Commission in its latest probe.

Inspectors said systems at the Wroughton-based hospice’s inpatient unit designed to prevent people from infection were ineffective and did not keep people safe. Staffing levels on the ward were occasionally too low and potentially unsafe, inspectors said.

The CQC branded a move to temporarily reduce the number of beds on the inpatient unit from 12 to six inappropriately planned, communicated or implemented. “The impact of this closure on paitents and the wider healthcare system had not been assessed,” Nigel Acheson, CQC deputy chief inspector of hospitals, said.

Bosses were still taking too long to address staff grievances. The CQC initially inspected Prospect Hospice earlier this year following reports of bullying at the inpatient unit.

However, the CQC acknowledged that there was a better use of agency staff to fill gaps in the rota, nursing staff were up to date with mandatory training and improvements had been made in respect of staff appraisals.

Patients and relatives also praised 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.”

The hospice has retained its overall CQC rating of Good.

Why was Prospect Hospice inspected?

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.

:: Staff did not receive appropriate support, training, supervision or appraisals necessary for them to carry out their roles effectively and safely.

:: 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 recording, monitoring or reviewing delays in admitting patients due to low staffing levels.

:: Seven anonymous staff 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.

‘Insufficient pace’

In his report, Nigel Acheson, CQC deputy chief inspector of hospitals, said: “The provider had submitted an improvement plan to us, as asked by CQC, in response to our previous concerns. We judged that they had not made progress at sufficient pace. The improvement plan was not supported by sound evidence and we found some assurances provided by the organisation were factually inaccurate.”

The chief executive and trustees had not scrutinised or challenged the improvement plan sufficiently.

Inspectors hinted bosses at the hospice had glossed over details: “There was incomplete evidence to support the assurance given to us, that most staff were up to date with clinical competencies and had completed a performance appraisal.”

What happens now?

Prospect Hospice must send the CQC a report to explain how they are going to ensure effective governance arrangements are put in place to provide assurance that patients on the inpatient unit receive safe and high quality care and treatment.

Angela Jordan, chief executive at the time of the inspection, left the hospice in October. Bosses at Prospect said she had left for "personal reasons".

Prospect responds...

A spokesman for the Prospect Hospice said: "We are disappointed with the latest Care Quality Commission report. We accept that at the time of follow-up visit in August there was still work to do following the original CQC report published in June.

"However, we had purposely focused our time up to August on bolstering the team in areas of operations specifically in training, appraisals, staff engagement and service improvement, as well as getting under the skin of the issues that we needed to address so we didn’t leave any stone unturned.

"We also appointed Irene Watkins as Interim Chief Operating Officer and arranged for specialist staff to be seconded to the hospice from partner organisations in order to focus on delivering the action plan. This took time, but we believe this approach will ensure we deliver sustainable improvements for the long term and not just a quick-fix solution.    

"We are very confident that we have addressed the issues raised by the CQC, which in the main were to do with processes and administration. We were pleased that the CQC had acknowledged improvements we had made in relation to dealings with our agency staff, medication and staffing levels linked to admissions. 

"All our training records are now up to date. We have reviewed our monitoring and recording of agency staff. We are also monitoring the complexity of needs of our patients, not just the numbers, to ensure we have the appropriate resourcing in place at any given time.  

"We would like to thank our patients and families for their patience whilst we’ve had to make these internal changes We are delighted to say that in our latest patient and families survey overall satisfaction was 95 per cent, with 96 per cent saying they would recommend our services to their family."