The Care Quality Commission (CQC) has issued Northern Devon Healthcare NHS Trust (NDHT) with two requirement notices to ensure services are improved after an unnanounced inspection in July. It comes after the CQC rated the trust as requires improvement in October last year, and NDHT was told it must make changes to its urgent and emergency care, maternity services, end of life care and outpatient services. The July inspection, following up on its October visit, looked specifically at these services. The trust was not rated as part of the visit, so remains as requires improvement. The latest report, published today (Tuesday) recognised NDHT had addressed areas such as investigations into incidents in the maternity unit, and better waiting lists for outpatients. But areas for improvement include the cleanliness of the emergency departments, and addressing mandatory staff training in the maternity unit and across the trust. NDHT has also been told it must ensure the chemotherapy and day treatment unit has the right mix of skilled staff to deliver a safe service. In the maternity unit, the trust must produce audits to measure how effective the service is. Chief inspector of hospitals, Professor Ted Baker said: When we last inspected services at this trust we raised a number of significant concerns about the quality of care in the four core services we examined. After this inspection, whilst it is fair to say that some progress had been made, it is clear that further work needs to be completed to ensure that the required systems and processes are fully embedded to continue these improvements. At present, the requirements of the warning notice have not been fully met and we have issued the trust with two requirement notices which make it clear to the trust the actions it must take to improve services. The trust has been told to provide an action plan to us setting out how it will address the areas of concern highlighted and we will continue to monitor the services involved and take further action to protect the interests of patients if it is required Suzanne Tracey, chief executive of NDHT, said it was positive the CQC had recognised some of the improvements the trust had made. It isnt easy and I want to take the opportunity to thank staff for the hard work they have put into this, whilst dealing with significant operational pressures, she said. This shows that we are heading in the right direction. The visit fell just a few weeks after the trust entered into a collaborative agreement with the Royal Devon and Exeter NHS Foundation Trust. Suzanne added: In the first couple of months of the collaborative agreement, we have really focused on where we need to be, how we are going to get there and what support we need to put in place for staff. We recognise that there is work to do to address some of the more complex issues, but I am confident that we now have the right plans and priorities in place to get there. We have fantastic staff at NDHT and I know that we are all absolutely committed to getting this right for our patients. We look forward to welcoming the CQC back in due course and we are confident that they will see further improvements. Full details of the inspection can be found on the CQC website.