Why the Care Quality Commission rated Addenbrooke’s as inadequate

I strongly refute McNeil’s statement that Care Quality Commission inspectors “came in with a preconceived idea of what they wanted to find.”1 We were aware that performance and the financial position had declined markedly in the year before inspection, but we were not expecting to find safety, quality, and leadership issues of sufficient severity to merit a rating of “inadequate.”

An inadequate rating means risks to safety are real and immediate.

Although we find that raised mortality is generally a reliable marker of poor quality, our inspections have found that its absence is not a reliable marker of good quality.

The trust’s performance on the national inpatient diabetes audit and the heart attack audit (MINAP) were below the national average. The stroke audit (SSNAP) was scored as D. Risk assessments for venous thromboembolism were conducted in 79% of patients against a national average of 96%.

In maternity services we found serious concerns: evidence of changes to improve safety after incidents relating to fetal heart rate monitoring was limited. Staffing levels in critical care fell below national guidelines: staff knew this, but initially our findings were refuted by the then chief executive.

Staff told us about the disconnect between ward and senior executives. This is corroborated by the 2014 NHS staff survey in which the trust had 16 of the 28 items in the bottom 20% and none in the top 20%.

The trust has responded positively to our report and I have confidence that it will take the actions needed for improvement.