Updated 26 October 2021
Liverpool University Hospitals NHS Foundation Trust was formerly called Aintree University Hospital NHS Foundation Trust. It changed its name on 1 October 2019 when it acquired Royal Liverpool and Broadgreen Hospitals NHS Trust.
The trust has four hospitals – University Hospital Aintree, Royal Liverpool University Hospital, Liverpool University Dental Hospital and Broadgreen Hospital – which provide a full range of acute services, including acute medicine, urgent and emergency care, acute frailty units, rehabilitation services, dental services and surgical services, to a population of approximately 630,000 people.
When a trust acquires another trust in order to improve the quality and safety of care we do not aggregate ratings from the previously separate trust at trust level for up to two years.
The ratings for the trust in this report are therefore based only on the ratings for University Hospital Aintree and our rating of leadership at the trust level.
Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, our usual inspection work has been curtailed by the COVID-19 pandemic.
At Royal Liverpool University Hospital we inspected only those services where we were aware of current risks. We did not rate the hospital overall.
In our ratings tables starting on page 30 we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect this time.
We carried out an unannounced inspection of Urgent and Emergency Services, Surgery, and Medical care at University Hospital Aintree and Royal Liverpool University Hospital because of continuing concerns about the quality and safety of some services.
We also inspected the well-led key question for the trust overall.
Overall, we rated the trust as requires improvement.
Following this inspection, due to the concerns we had identified in Urgent and Emergency Services at University Hospital Aintree and Royal Liverpool University Hospital, and Medical Care at University Hospital Aintree, we wrote to the trust under Section 31 of the Health and Social Care Act 2008, in a Letter of Intent to take urgent action. Following this we received limited assurance and therefore issued urgent conditions requiring the trust to take urgent action.
Safe
- Mandatory training compliance was low for medical staff in urgent and emergency services
- Patients in emergency departments did not always receive appropriate care and treatment in a timely way, exposing them to the risk of harm.
- There were not always sufficient medical and nursing staff with the right qualifications, skills, training and experience to keep patients safe in emergency departments and medical wards.
- Staff did not always have the correct level of training on how to recognise and report abuse and not all staff at the trust had completed safeguarding children level three training.
- Staff did not always adhere to trust and national infection prevention and control guidance in urgent and emergency and medical care services at Royal Liverpool University Hospital.
- The service did not always use systems and processes to safely prescribe, administer, record and store medicines in line with requirements.
- Staff did not always recognise and report incidents and near misses in the emergency department at Royal Liverpool University Hospital, and medical care and surgery at University Hospital Aintree. Services did not always manage patient safety incidents well and did not always share lessons learned with the whole team.
However:
- In surgery there was enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well.
- The emergency department at Royal Liverpool University Hospital was well designed in the major’s area with individual rooms with glass sliding doors.
Effective
- Staff did not always provide care and treatment based on national guidance and evidence-based practice and in urgent and emergency departments and medical care fluid documentation was not always accurate and complete.
- Staff did not always assess and monitor patients regularly to see if they were in pain and gave pain relief in a timely way.
- Services did not always make sure staff were competent for their roles.
- Key services in medical care were not available seven days a week.
However:
- Staff provided good care and treatment, gave patients enough to eat and drink. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
Caring
- The trust did not always maintain patients’ privacy and dignity, specifically when needing to be cared for in a corridor in the urgent and emergency department.
However:
- Staff treated patients with compassion and kindness and took account of their individual needs and helped them understand their conditions. They provided emotional support to patients, families and carers.
Responsive
- The trust did not always manage the access and flow of patients, in the urgent and emergency care department and in medical care services; with patients spending long periods waiting for an in-patient bed.
- Surgery services performed worse than the national average for the percentage of cancer patients treated within 62 days. The average length of patient stay was worse than the national average.
- Provision for patients who had a diagnosis of dementia was not well developed and there was variation in appropriate care to meet individual needs for these patients.
However:
- The trust planned care to meet the needs of local people and made it easy for people to give feedback.
Well-led
- Although the trust had an overall vision and strategies, the trust strategy was due to launch and was not yet embedded. Not all services had their own vision and strategy.
- Staff were supported by local leadership, but some did not always feel respected, supported and valued. Senior managers were not always visible in services.
- Trust governance processes were not robust or always effective. Risks were not always identified correctly with appropriate mitigations put in place.
- However:
- Staff were focused on the needs of patients receiving care. Most staff were clear about their roles and accountabilities. The trust engaged with patients and the community to plan and manage services and all staff were committed to improving services continually.
- The trust had been a lead participant in several COVID-19 research programmes.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection