The trust that runs the Royal Stoke and Stafford's County Hospital has been ordered to improve by the health watchdog.
The Care and Quality Commission has rated the University Hospitals of North Midlands NHS Trust as ‘Requires Improvement’.
It had previously been Outstanding under the question of whether the service is caring, but is now Good.
Under whether it was effective and well-led, previously rated as Good, it now Requires Improvement.
Safety and responsiveness remain as Requiring Improvement.
The new rating follows an inspection of core services between 5 June and 1 August 2019.
Professor Ted Baker, CQC’s Chief Inspector of Hospitals, said: “On our return to The University Hospitals of North Midlands NHS Trust we found a number of improvements were needed.
“We found significant concerns regarding the care and treatment of patients in the emergency department at Royal Stoke Hospital. During busy periods, we were not assured that there were enough staff available to manage patients safely in the corridor. Staff did not follow a consistent approach to monitoring and recording observations.
“Governance systems, although embedded, were over-complicated and unreliable. However, we found that the newly appointed chief executive was undertaking extensive work to improve these systems.
“Despite improvements being needed across some services, we also found examples of outstanding practice, most notably in children and young people’s services.
“We have given our feedback to the trust and we will return to carry out further inspections to check on its progress with improvement.”
Chief Executive of UHNM appointed in April 2019, Tracy Bullock, says work has already been taking place to make changes and address some of the concerns raised.
She said: "We did agree as a board that we would recruit 27 additional nurses in the emergency department, and we have recruited through the majority of those.
"There are at least 15 new doctors in the department.
"We increased the size of the emergency department as well.
"Although we clearly recognise that patients have to wait too long in the emergency departments we absolutely know our outcomes, what happens when patients have their treatments, are the second best in the country."
The trust has been told it must make several improvements including:
- All staff must be up to date with mandatory training across services,
- Patient privacy must be maintained within urgent and emergency care. All reasonable efforts should be made to make sure that discussions about care, treatment and support only take place where they cannot be overheard,
- Patient observations must be completed in medical care within required timeframes to monitor potential deterioration of health,
- Sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed in urgent and emergency services.
- Systems for monitoring patient outcomes and key performance indicators in outpatients must be comprehensive and reliable.
- Deliveries of chemotherapy in outpatients must be done in a timely manner.
Inspectors also found examples of outstanding practice at Royal Stoke University Hospital, including:
- Distraction bags were given to children and young people with mental health needs. These bags contained items to help children and young people manage their mental health during their assessment or admission. Items contained within the bags included; fidget toys, stress toys, puzzles, therapeutic colouring and a notepad and pen,
- The children’s service worked with the local authority and National Literacy Trust to provide each neonate with a story pack. These packs contained a book for parents to read to their neonate helping parents to bond with their child when they were unable to hold them for lengthy periods,
- The whole staff team, from consultants to health care support workers prioritised their time to celebrate the end of treatment with children, young people and their families. Inspectors attended a bell ringing celebration and saw the staff had decorated and personalised the wall around the bell for the child and staff who had been involved in the child’s care,
- The outpatients service ran a #keepstokesmiling campaign about oral hygiene. The campaign aimed to help educate young people in Stoke on Trent about the damaging effects of too much sugar on teeth.