United Lincolnshire Hospitals NHS Trust back into special measures
The United Lincolnshire Hospitals NHS Trust has gone back into special measures after the latest inspection by the Care Quality Commission.
England's Chief Inspector of Hospitals has recommended that the trust should return to special measures following the CQC’s latest inspection of its services.
The inspection included Lincoln County Hospital, Pilgrim Hospital and Grantham Hospital.
Overall the trust has been rated as Inadequate although caring has been rated as Good. Inspectors found significant concerns in medical care and outpatients at Pilgrim Hospital.
The trust was one of 11 NHS trusts placed into special measures by Sir Bruce Keogh in July 2013 as part of his review of high mortality rates. The trust exited the special measures regime in February 2015 following improvements at the time.
CQC found deterioration across a number of services resulting in the trust being rated inadequate overall following the latest inspection in October 2016.
An unannounced inspection was also carried out on 19 December at Pilgrim Hospital’s emergency department following information of concern highlighted to the commission.
Ratings for Lincoln County Hospital:
Inspectors found there were ongoing delays in patients being able to access treatment and care, with growing numbers of patients having to wait too long for their outpatient appointments or inpatient treatments. Arrangements to respond to emergencies and major incidents were not sufficiently robust.
Patients had been unable to access services in a timely way for an initial assessment, diagnosis or treatment, including when cancer was suspected. During 2016 the trust failed to meet the majority of the national standards for the cancer referral to treatment targets.
In addition, inspectors found low levels of staff satisfaction coupled with high levels of stress and work overload. Some staff told us they did not feel respected, valued or appreciated and many reported they did not feel comfortable raising concerns.
CQC found poor leadership and oversight in a number of services and at a senior level within the trust. There were weaknesses in the governance framework to support the delivery of the trust’s vision and strategy and inspectors were not assured that the board were sufficiently cited on risks. Inspectors were not assured that all incidents were reported or investigated in a timely way.
In addition, whilst it was isolated to a small number of wards at Pilgrim Hospital, inspectors were not assured that all staff understood the trust values because they observed care being delivered that was not respectful or compassionate.
However, inspectors saw improvement across some services. For example, governance arrangements in the maternity service had been strengthened significantly over the past two years. Inspectors also observed good care across several services including services for children and young people, critical care, surgery and urgent and emergency services at Grantham Hospital, all of which were rated Good overall.
Areas of poor practice, where CQC has told the trust to make improvements include:
Staff in the emergency department at Lincoln County Hospital must be appropriately trained and supported to provide the care needed by patients at risk of self-harm
There must be are processes in place at Pilgrim Hospital to ensure that patients whose condition deteriorates are escalated appropriately
Staff working in the emergency department at Lincoln County Hospital must receive appropriate supervision, appraisal and training to enable them to fulfil the requirements of their role
There must be effective systems and processes in place to identify and treat patients at risk of sepsis
The trust must ensure governance and risk management arrangements are robust and are suitable to protect patients from harm.
The trust must take action to ensure there is a robust process in place to report incidents appropriately and investigate incidents in a timely manner
Safety systems, processes and standard operating procedures must be in place at Pilgrim Hospital to ensure there is an on-call gastrointestinal bleed rota to protect patients from preventable harm
The trust must take action to ensure they are compliant with the Fit and Proper Person requirement
The inspection also identified some areas of positive practice:
The trust had introduced a carer’s badge, which enabled any family members and trusted friends to be involved in the care of their loved ones. The carers badge encouraged carer involvement, particularly for patients with additional needs
A traffic light system had been introduced on elderly care wards to identify patients who required more assistance than others. Red signified those patients who required the most help, whilst green identified those patients who required the least
Staff on the children’s ward at Pilgrim Hospital had learnt sign language to enhance their communication skills with children who had hearing difficulties
The trust had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine
The Board of ULHT has said it is disappointed with but accepts the findings of the CQC report, and with the decision to place the Trust into special measures.