Burnley General Hospital

Updated 6 January 2023

We inspected the maternity service at Burnley General Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

The inspection was carried out using a post-inspection data submission and an on-site inspection where we observed the environment, observed care, conducted interviews with patients and staff, reviewed policies, care records medicines charts and documentation. Following the site visit, we conducted interviews with senior leaders and reviewed feedback from women and families about the trust.

We ran a poster campaign during our inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We received 315 feedback forms from women. We analysed the results to identify themes and trends.

Burnley General Hospital is the main site for maternity services for the trust. It comprises of a central birth suite with maternity theatres and a close observation unit, post and antenatal wards, day assessment unit, maternity triage and fetal medicine unit. Ante and postnatal clinics are also provided at this location and there is an alongside midwife led birth unit adjacent to the central birth suite.

The local maternity population come from higher levels than deprivation than the national average with 34% in the most deprived decile compared to 12% nationally. More mothers were Asian or Asian British (24% compared to the national average of 14%) and fewer were White than the national average.

Maternity services delivered 5,857 babies between January and December 2021. Since February 2022, the trust has been in the upper 25% of all organisations for women who were current smokers at booking appointment.

We did not rate this hospital at this inspection. The previous rating of good remains.

We also inspected 2 other maternity services run by East Lancashire Hospitals NHS Trust. Our reports are here:

Blackburn Birth Centre – https://www.cqc.org.uk/location/RXR78

Rossendale Primary Care Centre – https://www.cqc.org.uk/location/RXRE9

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 12 February 2019

Our rating of this service improved. We rated it as good because:

• The service provided mandatory training in key skills to all staff and this was completed.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service used safety monitoring results well and this was shared with staff, patients and visitors.
• Staff kept appropriate records of patients’ care and treatment
• The service controlled infection risk well and staff followed trust guidance for infection prevention and control.
• Managers closely monitored staffing levels to ensure there were sufficient staff to keep people safe and to provide the right care and treatment.
• Care and treatment was based on national guidance and evidence based practice and staff followed patient care plans.
• Staff gave patients enough food and drink to meet their needs and improve their health. Dieticians and speech therapists were available for patients needing nutritional support.
• The service monitored the effectiveness of care and treatment and used the findings to improve them.
• The staff made sure staff were competent for their roles and appraisal completion rates were high.
• Staff of different kinds worked together as a team to benefit patients and there was extensive multi-disciplinary working as part of day-to-day practice.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff cared for patients with compassion and kindness and patient experience feedback was positive; patients were supported for their emotional needs.
• The Rakehead rehabilitation centre provided a fully accessible environment for rehabilitation patients, including a patient flat, recreation areas and a garden.
• People could access services when they needed them. Referral to treatment times in medicine for the elderly met the 18-week standard.
• A range of services were available to support patients appropriately, according to their needs. Staff had good awareness of the needs of patients who were living with dementia or a learning disability
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care
• The trust’s vision and values were well embedded across the service and staff felt supported and valued.
• Leaders were aware of key risks in the service and identified improvement plans for these areas.
• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However

• The service did not always ensure staff were aware of the shared learning following serious incidents.
• We observed staff failing to observe infection control protocols when nursing a patient isolated in a side ward.
• Whilst the service prescribed, stored and gave medicines well, prescription records did not always identify any patients’ allergies.
• The service did not always look after equipment well and we observed some items of equipment where maintenance was overdue.
• Staff were frequently moved during shifts to other areas of high demand, leaving wards depleted.
• Therapy services did not provide seven-day services and this had particular impact on patients in the Rakehead rehabilitation centre.

Updated 9 July 2014

Children, young people and neonates (newborn infants) received safe and effective care from appropriately trained and competent staff. We saw that staff treated patients with dignity and respect, showing compassion and empathy to them and their families or carers.

Staff were positive about working in the family care division of the trust and told us they felt supported and valued in their roles. Parents and carers were satisfied with the care and treatment delivered to their children and told us they felt included and involved.

The environment was clean, bright and airy with sufficient equipment to deliver the necessary treatments. Toys were available in waiting and treatment areas. However, on the neonatal intensive care unit NICU, there were no facilities for parents/carers to have a hot drink or sit on the ward away from the cot side. There was a refurbished waiting area outside of the unit which provided seating, toys and a cold water fountain.

The care and treatment provided to children and young people was based on national guidelines and directives. Policies and procedures were reviewed regularly and updated as necessary. The care and treatment was audited to monitor quality and effectiveness and, as a result action had been taken to improve the service.

Staff were provided with regular and appropriate training and an annual performance development review. There was no process for staff to receive formal supervision throughout the year but, during our discussions with staff, we were told the managers were approachable and provided support when required.

Services for children and young people were caring. Patients and their families/carers were treated with dignity and respect. Surveys took place to gather feedback from patients and their families/carers. Interpreter services were available when required.

Updated 20 May 2016

The EOL care service at the Royal Blackburn hospital was rated good overall with no domain requiring improvement. Although there were few deaths at the hospital, the SPCT team managed end of life care effectively. Staff attended full team meetings with the consultants from the EOL team and with the palliative care lead nurse.

The clinical leadership in the specialist palliative care team was effective. There was a strategy and a vision for the end of life service and effective reporting mechanisms to the trust board. All directorates were engaged in the delivery of good quality end of life care.

Staff were enthusiastic and caring and enjoyed working for the trust. They said that the last few years had been difficult but the stability of the current board and executive team contributed greatly to the culture of continuous improvement. The nursing staff ensured that they were up to date with policies and procedures for EOL care and asked for advice from the SPCT if necessary. Staff we spoke with were aware of the EOL care lead and the trust EOL strategy.

Systems were in place to keep people safe and incidents were reported by staff through effective systems. Lessons were learnt and improvements were made. An integrated care plan had been launched which was comprehensive and staff had been trained to use it. The plan identified priorities for patients in the last few days and hours of their lives. Patients and their relatives were involved in the planning of their care.

The service had a well-developed education programme for medical staff, nurses and unregistered staff in EOL care. Staff in the SPCT and on the wards were committed to providing good compassionate care for patients and their relatives. There were good audit systems in place and the outcomes of these were used to improve the service.

The bereavement services were responsive and death certificates were issued in a timely way to meet the needs of different religions. Porters were respectful of patients when they took them to the mortuary.

However, consultant cover for out of hours and seven day working was not always available. The specialist palliative care telephone advice line for out of hours was answered by a nurse and referred to a doctor if necessary. This doctor was not always a consultant in palliative medicine and could be a GP. This did not fully meet the National Institute for Health and Care excellence (NICE) quality standards for end of life care.

Updated 6 January 2023

Updated 9 July 2014

Patients were treated with dignity and respect by caring staff. Patients spoke positively about their care and felt they had been involved in decisions about their care. Staffing numbers and skills mix met the needs of the service. There was a clear process for reporting and investigating incidents. Themes and trends were identiifed and action taken to minimise risks. The outpatients departments we visited were clean and well-maintained.

Patients and staff told us that clinics were sometimes cancelled at short notice and we found that clinics frequently ran late. Patients spoke of the anxiety and incovenience this caused them. Staff were auditing this and were considering ways to address it. Changes to the patients’ ambulance transport services had caused confusion for staff, resulting in them not knowing which patients had transport arranged. Patients could wait for long periods for transport if their appointment was late.

There was good local leadership and a positive culture within the service. Staff worked well as a team and supported each other. Staff said they had confidence in their managers and all disciplines worked together for the benefit of patients.

Updated 12 February 2019

Overall, we found the services to be good.

• We saw evidence that incidents were being reported and staff we spoke with were aware of the system and how to use it. We saw evidence of learning from incidents and how this learning was shared across the service and trust wide. We saw evidence of change to practice following learning from incidents.
• Cleanliness and hygiene was of a high standard throughout the hospital departments and staff followed good practice guidance in relation to the control and prevention of infection.
• Patients cared for in the surgical division were receiving care in line with current evidence-based guidance and standards. Policies and procedures were in place and staff were aware of how to access them. Frequent audits were being completed and subsequent action plans implemented.
• The trust participated in National audits including the hip fracture, bowel and lung cancer audits, which showed that overall the trust was achieving better than the National average.
• The hospital had consistently achieved better than the England average in respect of the 18 weeks target from referral to treatment between and although surgical procedures were sometimes cancelled at short notice, systems were in place to ensure patients were rescheduled within 28 days of the cancellation.

• Leadership within the surgical division was very positive, visible and proactive. Managers had a strong focus on the needs of patients and the roles staff needed to play in delivering good care.
• Staff were proud of the work they did; they worked well together and supported each other when the service was under pressure from increased demand. The trust ranked in the top 100 places to work in the NHS in an external health journal. Staff and patients told us they felt well engaged with and their views were valued.

Updated 12 February 2019

• The service provided mandatory training in key skills and delivered appropriate safeguarding training to all staff and the majority had completed it.
• The service controlled infection well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had systems in place for assessing and responding to patient risk. The service took prompt action to respond to deteriorating patients.
• The service managed patient safety incidents well. Staff recognised incidents and knew how to report them appropriately. The service had developed systems to ensure lessons learned were shared with the team and wider service.
• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The safety thermometer results for the service were exemplary and showed that they were focused on delivering harm free care.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• The service assessed, managed and monitored pain well. Patients were given adequate and timely pain relief.
• Staff worked together as a team to benefit patients. There were good examples of multidisciplinary working from initial assessment through to discharge and beyond.
• The service was available for 24 hours a day, seven days a week and patients had access to the service at all times.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to consent to care and treatment.
• Staff cared for patients with compassion and provided emotional support to minimise their distress. Patients and those close to them were involved in decisions about their care and treatment and the service kept them updated.
• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs including those living with dementia and mental health needs.
• People could access the service when they needed it. The service prioritised the care and treatment of patients with the most need.
• The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
• There were established governance systems in place to continually monitor and improve the quality of its services.
• The service had developed a systematic approach to identify and managing risks and in planning to reduce or eliminate them
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service was committed to improving services by learning from when things go well and when they go wrong. A collaborative approach was taken with staff and other health care organisations to improve services.

However:

• Resuscitation equipment checks and monitoring were not always completed appropriately. The service did not always identify that essential equipment was not present.
• Although the service had a number of pathways and protocols in place to assess and respond to patient risk they did not cover the initial assessment of patients by reception staff, before they were triaged.
• The service did not audit documentation and could not therefore assure themselves that documentation was being completed correctly or monitored for themes and trends.
• The service did not have robust systems in place to ensure that medicines were stored at the correct temperature and that patient group directions were in date.
• Waiting times for treatment and arrangements to admit, treat and discharge patients were not always in line with targets set by the Department of Health and recommendations set by the Royal College of Emergency Medicine.
• The percentage of patients that left the trust’s urgent and emergency care services before being seen for treatment was consistently higher than the England average.
• Despite having an extensive communication and engagement strategy there was still confusion surrounding the level of care the service offered and there were numerous inappropriate self-presentations to the service.