AFTER the dust had settled at Burton Hospitals NHS Foundation Trust following the damning Keogh report, chief executive Helen Ashley admitted she knew there had been problems within the organisation.
At the time, she insisted the findings of the Keogh panel had galvanised the senior team into making changes within the organisation, assuring the public that she was the right person to lead it to success.
But as a new report finds the hospital is still failing – one of only five in the UK to be doing so – the concerned people of Burton are rightly asking what change has taken place.
The latest investigation by the Care Quality Commission (CQC) came across areas of major concern in surgery, critical care, end-of-life care and, worryingly, services for children and young people. Medical services were classed as inadequate by the people who reviewed Queen's.
The Belvedere Road site was not operating at an acceptable level in seven out of eight areas when inspectors visited in April and May – 12 months after the Keogh panel investigated higher-then-expected mortality rates within the trust.
The good news is that mortality levels have now dropped – a fact praised by inspectors. They also spoke highly of the contribution of friendly, knowledgeable and caring staff, and an excellent maternity service.
But in terms of the way the organisation is run, there were real concerns – and the issues remain similar to those raised last year. Under the category 'well-led', the trust was classed as 'requires improvement'.
"Action was not always taken to ensure staffing was in line with national guidelines," the report said.
Services for children was one of the biggest areas in the report, with the CQC commenting on provision in the accident and emergency department and across the hospital.
"We had multiple concerns regarding children's safety which were not seen as a priority. Not all staff had completed the appropriate level of safeguarding training; some staff were delivering care to children without having an appropriate level of knowledge," inspectors said in their write-up.
Some of these issues were not raised by the Keogh panel, who gave the organisation 47 points to action 12 months ago. While most were considered to have been done, 16 have not been addressed.
Staffing levels were still a problem, as the trust relies heavily on agency and bank staff to fill nursing vacancies.
Inspectors also noted a continuing failure to learn from mistakes. Furthermore, there was a lack of responsibility for risks. For example, staff in the intensive care unit said they were aware of the risks around the fact there was not an isolation room, yet nothing had been done.
There were also risks at the acute assessment centre, opened in a blaze of glory last year.
Communication remains a problem for the trust, though improvements have been made. Patients still report they do not know what is happening with their care. More than 40 per cent of people who made complaints did not receive a response within the target time.
The top team at Queen's has faced a barrage of criticism in recent years, forcing Mrs Ashley to defend her position time and time again.
Another Keogh chief executive, at a trust in Lancashire, stepped down after facing similar levels of vitriol – and a second poor report from the CQC. There have been no suggestion of that course of action in Burton, but if the site continues to fail questions will inevitably be asked.