Updated 8 February 2022
United Lincolnshire Hospitals NHS Trust (ULHT), situated in the county of Lincolnshire, is one of the biggest acute hospital trusts in England serving a population of over 736,700 people. The trust provides acute and specialist services to people in Lincolnshire and neighbouring counties. The trust has an annual income of £447 million and employs nearly 8,000 people.
In the last year the trust had around 642,000 outpatient attendances, around 145,000 inpatient episodes and around 147,000 attendances at their emergency departments.
The trust provides acute hospital care for the people of Lincolnshire from their sites in Lincoln, Boston and Grantham and also delivers services from community hospitals and centres in Louth, Gainsborough, Spalding and Skegness.
Between 5 October 2021 and 11 November 2021, we inspected four core services provided by the trust across two locations. We carried out an unannounced inspection of urgent and emergency care, Services for children and young people, Medical care (including older people's care) and a focused unannounced inspection of Maternity at Pilgrim Hospital and Lincoln County Hospital. We also inspected the well-led key question for the trust overall.
We carried out this unannounced inspection of services provided by this trust because the trust was placed in financial and quality special measures in 2017/18 and is currently placed into System Oversight Framework (SOF) segment 4 of NHS England & NHS Improvement (NHSEI) Recovery Support Programme (RSP). At our last inspection we rated the trust overall as requires improvement.
We plan our inspections based on everything we know about services, including whether they appear to be getting better or worse.
On 5, 6, 7, 8 October 2021 we inspected four core services provided by the trust across two locations. We inspected urgent and emergency care, Services for children and young people, Medical care (including older people's care) and Maternity at Pilgrim Hospital. At our last inspection, Urgent and Emergency Services and Services for children and young people were rated as inadequate overall. Medical care (including older people's care) and Maternity were rated as requires improvement overall.
At Lincoln County Hospital we inspected urgent and emergency care, Services for children and young people, Medical care (including older people's care) and Maternity. At our last inspection, Urgent and Emergency Services was rated as inadequate overall. Services for children and young people and Medical care (including older people's care) were rated as requires improvement overall. Although Maternity at the Lincoln County Hospital was rated good overall at our last inspection, we inspected this service because we had concerns.
We did not inspect Outpatients previously rated requires improvement because we are monitoring the progress of improvements to outpatients and had no concerns. We will re-inspect them as appropriate.
Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level. Our findings are in the section headed ‘is this organisation well-led’. We inspected the well-led key question between 9 and 11 November 2021. A financial governance review was also carried out at the same time as the well-led inspection, this was undertaken by NHS England and Improvement (NHSEI). There was not a separate ‘Use of Resources’ assessment in advance of this inspection.
Our rating of the trust stayed the same. We rated them as requires improvement because:
- We rated safe and responsive as requires improvement and effective, caring and well-led as good.
- We rated six of the trust’s services as good and two as requires improvement. In rating the trust, we took into account the current ratings of services not inspected this time.
- We inspected maternity using our focused maternity framework and guidance. Focused inspections can result in an updated rating for any key questions that are inspected if we have inspected the key question in full across the service and/or we have identified a breach of regulation and issued a requirement notice, or taken action under our enforcement powers. In these cases, the ratings will be limited to requires improvement or inadequate.
- In maternity services at Lincoln County Hospital we rated safe as requires improvement, the key questions of effective and well led remained the same. In maternity services at Pilgrim Hospital we reviewed actions the trust had taken to address areas for improvement identified in Maternity services following our 2019 inspection. We found the trust had taken sufficient action and improved Maternity services at Pilgrim Hospital and have therefore updated our ratings for this service. We rated the key questions of safe, effective and well led as good, the key questions of caring and responsive remained the same.
- Not all services had enough staff to care for patients and keep them safe and not all staff were up to date with mandatory training or additional safeguarding training.
- Medicines were not always stored safely and patient records were not always stored securely.
- Outcomes from national audits were not always positive and some services did not always use systems to manage performance effectively.
- The design, maintenance and use of facilities, premises and equipment did not always keep people safe or follow national guidance.
- Services in urgent and emergency care were not designed in a way that always met the needs of local people, were inclusive and took account of patients’ individual needs and preferences.
- People could not always access services when they needed to, and they did not always receive the right care promptly.
- Risks on the risk register, in some services, were not always effectively managed and not all risks were identified and escalated to reduce their impact.
However:
- Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Most services controlled infection risk well. Staff assessed risks to patients, acted on them and mostly kept good care records. Most services managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve services.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. 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. Key services were mostly available seven days a week.
- Without exception, staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- Services planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
- Leaders had the skills and abilities to run services. They understood and managed the priorities and issues services faced. Improvements were observed in clinical leadership.
- Staff felt respected, supported and valued and were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. Services engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
How we carried out the inspection
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.