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Inspection Summary


Overall summary & rating

Good

Updated 27 March 2015

We carried out a comprehensive inspection in 2014 because United Lincolnshire Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was one of 11 trusts placed into ‘special measures’ in July 2013 after Sir Bruce Keogh’s review into hospitals with higher than average mortality rates. We returned in February 2015, and found that significant improvements had been made to services. We inspected only the areas which were found to require improvements at our previous inspection.

We inspected Lincoln County Hospital, Pilgrim Hospital, Grantham and District Hospital and County Hospital Louth. We did not inspect the other services provided at John Coupland Hospital or Skegness and District Hospital as these are not operated as part of the acute sites. The announced inspection at County Hospital Louth took place on 30 April 2014.

In April 2014 the hospital was found to require improvement, although we rated it good in terms of having caring staff.

We returned on 2 March 2015, and found that improvements had been made to services elevating the hospital to a rating of good although formal governance processes were not embedded in the nursing teams in both surgery and outpatients.

Our key findings were as follows:

  • The surgery service was able to demonstrate good outcomes for patients.
  • Mandatory training attendances had improved in surgical services and the outpatients department.
  • The link between trust management and the staff at County Hospital Louth had improved.
  • Feedback from people who use the service, those who are close to them and stakeholders is consistently positive about the way staff treat people at County Hospital Louth.

However, the hospital should make improvements to clarify and embed the link into the governance systems in place within the trust.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 27 March 2015

Effective

Good

Updated 27 March 2015

Caring

Good

Updated 27 March 2015

Responsive

Good

Updated 27 March 2015

Well-led

Good

Updated 27 March 2015

Checks on specific services

Surgery

Good

Updated 27 March 2015

In April 2014, we found that the surgical units and inpatient ward at County Hospital Louth could show good outcomes for patients following surgery. The safety quality dashboard demonstrated good performance for managing patient risks and the consistent feedback from patients and carers showed that they would recommend the hospital to family and friends.

However, County Hospital Louth surgical service requires improvement as mandatory training provision for staff was poor, especially in key risk areas, such as: safeguarding, health and safety management and mental capacity assessment practices, which could impact on patient safety.

On 2 March 2015 staff confirmed they received feedback from any incidents they raised and lessons were learned. Mandatory training levels for staff had improved and we were assured patients at risk of deterioration would be identified at an early stage. Regular health and safety meetings were in place and action plans developed to address concerns.

We had found in April 2014 that there was a lack of shared vision and strategy with the staff to assure them of a sustainable future. More visible leadership was required to ensure that County Hospital Louth surgical services were well-led. Staff noted that there was a disconnect between leadership at board-level and frontline clinical teams in County Hospital Louth. Staff engagement was lacking and formal communication practices were limited, which resulted in staff not always being fully aware of the bigger picture or future plans for the hospital.

Leadership had improved in March 2015 with the appointment of a matron for County Hospital Louth. Staff felt better connected with the rest of the hospital sites in the trust although work was needed to embed formal governance processes in Fotherby ward.

Outpatients

Good

Updated 27 March 2015

In April 2014 the outpatient department could show a good service for patients following surgery or treatments. The safety quality dashboard demonstrated good performance for managing patient risks across the hospital. The consistent feedback from patients and carers was that they would recommend the hospital to family and friends.

However, County Hospital Louth outpatient service required improvement as mandatory training provision for staff was poor especially in key risk areas, such as: safeguarding, health and safety management, basic life support, recognising the deteriorating patient and mental capacity assessment practices. This could impact on patient safety and requires improvement.

In March 2015 staff confirmed they received feedback from any incidents they raised and lessons were learned. Mandatory training levels for staff had improved, regular health and safety meetings were in place and action plans developed to address concerns. However, simulation training for a collapsed patient had yet to be undertaken.

We found in April 2014 there was a lack of shared vision and strategy with the staff to assure them of a sustainable future. More visible leadership was required to ensure that County Hospital Louth outpatient services were well-led. Staff noted there was a disconnect between leadership at board-level and frontline clinical teams in County Hospital Louth. Staff engagement was lacking and formal communication practices were limited which resulted in staff not always receiving feedback or being fully aware of the bigger picture or future plans.

We saw leadership had improved in March 2015 with the appointment of a matron for County Hospital Louth. Staff felt better connected with the rest of the hospital sites in the trust although work was needed to embed formal governance processes in the department.