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Luton and Dunstable Hospital Good

All reports

Inspection report

Date of Publication: 13 July 2011
Inspection Report published 13 July 2011 PDF

People should be protected from abuse and staff should respect their human rights (outcome 7)

Meeting this standard

We checked that people who use this service

  • Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld.

How this check was done

Our judgement

The Trust had responded positively and swiftly to the concerns raised about its ability to fully safeguard vulnerable people receiving care at the hospital. It had shown a determination to drive wide reaching improvements and had worked closely with key partners to clarify, streamline and improve the safeguarding pathway.

A range of improvement activity had been undertaken and there were clear indications that progress had been made. Safeguarding alerts were being reported in a timely manner and the Trust had taken swift action to safeguard people at risk and managed incidents appropriately. The number of alerts had subsequently increased.

Most of this activity had focused on the procedural infrastructure in place and an audit carried out by an external reviewer suggests that the staff's ability to recognise signs of abuse and respond appropriately had improved. However it highlighted an ongoing challenge for the Trust to ensure that all staff fully understand how the Mental Capacity Act and patients consent is linked to safeguarding processes.

The Trust needs to fully embed the improvements in practice and carry out a further evaluation of the impact of its improvement activity.

CQC consider that the Trust had achieved the focused improvements that it had asked to the Trust to complete in February 2011. It was evident that the improvement activity was making a difference and things were moving in a positive direction. However the Trust needed to evidence that the improvement activities undertaken had consistently been translated into improved practice in this area and that it was fully compliant with all elements of this essential standard.

User experience

We did not speak with people who use this service as part of this review.

Other evidence

Following our review in February 2011, we asked the Trust to make focused improvements in the systems and processes that it had in place to safeguard and protect vulnerable people within the hospital. The Trust responded swiftly. They outlined in a report to us how they were addressing the issues, and they had kept us informed of their progress.

It had shown determination to address the development needs within its safeguarding practice and had undertaken a range of improvement activities.

The Trust had worked closely with key partners, including Luton Borough Council and Central Bedfordshire Council to review and strengthen the safeguarding processes and arrangements in place. It had clarified roles and responsibilities and had streamlined the reporting and notification processes. All referrals are sent directly to Luton Borough Council who oversees the investigation processes and monitors the outcomes.

Luton Borough Council had confirmed that the referral rates had increased and that it was confident that it was receiving copies of all safeguarding alerts made by or about the hospital. It said that it now had a clear picture of all safeguarding concerns at the hospital, and this had enabled it to monitor patterns and emerging trends relating to incidents within the Trust.

The Trust had also worked closely with the Strategic Health Authority to conduct a wide reaching review of nursing. It had commenced a review of its internal safeguarding processes and had commissioned an external review to benchmark its' current practice against other similar Trusts.

The Trust had demonstrated a willingness to work in an open and transparent way to secure the required improvements. Safeguarding had become a Trust wide priority, and the board now discussed this as a core agenda item at its' monthly meetings, and a nominated physician had taken a lead role in safeguarding within the hospital.

All safeguarding policies and guidelines had been reviewed, approved by the board and disseminated to all staff; this had included a review of the Mental Capacity Act policy. Further safeguarding training had been introduced for all staff, and by the end of May 2011 86% of all staff had undergone this training, and all those that had not, had been identified and booked on training for 15 June 2011. More specific training in the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) had been introduced with assistance from Luton Borough Council safeguarding and MCA leads.

The Trust had streamlined the safeguarding notification pathway and since our last review in February 2011 we had seen a marked improvement in this area. We were receiving all safeguarding notifications as required by regulations, and we were getting these in a timely manner. Staff that were employed by the Trust were not involved in screening or risk assessing safeguarding alerts prior to submission to Luton Borough Council. Where a risk assessment was required, a health professional that was not employed by the Trust was being assigned this task.

There had been a high level of improvement activity undertaken in a short period of time, and most of this had focused on strengthening the systems and processes that were in place. The increased level of referrals was a positive sign that staff awareness had increased, however this had not yet been fully assessed.

From the notifications received it was evident that the Trust were responding appropriately to allegations in order to minimise the risks to people. For example we were aware of occasions where the Trust had proactively suspended staff whilst awaiting the conclusion of investigations, thus protecting both people who use the service and staff.

The Trust had commissioned an audit to evaluate the impact of the its' improvement activity on increasing staff's ability to recognise signs of abuse and their ability to respond appropriately where a concern was raised or identified. This was conducted by a