Date Published: 27 November 2009

Regulators demand improvement at Basildon and Thurrock University Hospitals NHS Foundation Trust

Healthcare regulators are taking action to address concerns around leadership and quality of care at Basildon and Thurrock University Hospitals NHS Foundation Trust.

Monitor, the independent regulator of NHS foundation trusts has used its formal powers of intervention to require the Trust to take immediate action to deliver improvement.

This follows a decision by Monitor's Board that the Trust is significant breach of the terms of their Authorisation as a result of concerns around compliance with healthcare standards, Board effectiveness and governance.

These concerns include the Trust Board's rate of progress and success in designing, overseeing and implementing effective actions to address high hospitalised standardised mortality rates.

The Care Quality Commission (CQC), the regulator of health and adult social care, has also raised these serious concerns, as well as highlighting other specific problems around the quality of the services provided by the Trust, and has shared its evidence with Monitor.

CQC's concerns include:

• a poor care environment in A&E, in particular a lack of privacy for patients
• inadequate arrangements to treat children, with few specialist paediatric staff
• breaches of infection control standards, for which CQC has already issued a warning notice

Although the Trust has made some progress in addressing these issues, the regulators are not satisfied with the pace of progress, or that the Trust Board currently has the capacity to deliver the improvements necessary within an acceptable timescale. Monitor is therefore requiring the Trust to take specific actions within a set timescale in order to ensure a swifter delivery of the necessary improvements.

Through the use of its formal powers of intervention, the actions Monitor is requiring the Trust Board to take are to:

• appoint external advisers, agreed with Monitor, as an expert taskforce to manage and report on the delivery of plans to improve quality of service;
• agree with Monitor the objective performance metrics against which the Trust's performance will be measured and reviewed monthly; and
• take immediate steps to strengthen senior clinical capacity, in particular, to provide additional support to the Medical Director and Director of Nursing.

Dr William Moyes, Monitor's Executive Chairman, said:

" Monitor is intervening to ensure strong clinical leadership and the delivery of rapid improvement of services at the Trust. This formal use of our powers is needed to quickly and effectively deliver the improvements in patient care which have been too slow to date. Our concerns about Board effectiveness, together with the concerns that the CQC has raised about quality of care, mean that we are placing a requirement on the Trust to take action with immediate effect to resolve these issues.

While some progress has been made, the pace needs to accelerate in order to ensure the Trust is in a position to provide the best possible care to patients. We will be reviewing the Trust's performance regularly and in detail - if we don't see measurable results quickly, we'll take further action."

Cynthia Bower, CQC chief executive, said:

" Swift action is needed at Basildon to nip problems in the bud. We want to ensure the trust takes swift and positive action to prevent poor quality care. We believe that effective action will now take place as a result of this joint regulatory action.

Our work has uncovered serious failings . The trust has high mortality rates for emergency admissions and we have found evidence of significant problems in different parts of the organisation. The trust has taken our concerns seriously but improvements are simply not happening fast enough. Our confidence in the management's ability to deliver on commitments and to turn the situation around has been severely dented. We have shared our concerns with Monitor, which is now using its formal powers to accelerate improvement.

We want rapid progress and we will work with Monitor to ensure this happens, carrying out spot checks where necessary. From next April, our new regulatory regime will apply, and with this will come a range of further strong powers to bring about change. Every trust will have to meet essential standards of quality and safety in order to function. Without radical improvement, Basildon's registration will be affected."

About the CareQuality Commission: The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. The CareQuality Commission inspects health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations. It also protects the interests of people detained under the Mental Health Act. (Until 31 March 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.)

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