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Blackpool Victoria Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 March 2018

Our rating of services stayed the same. We rated them as requires improvement because:

  • Although surgical and medical services had improved, urgent and emergency care services required improvement.
  • The emergency department had consistently failed to meet the Royal College of Emergency Medicine recommendation that the time patients should wait from time of arrival to being triaged (having an initial assessment undertaken) is no more than 15 minutes. This is important as it is a system that emergency departments use to make sure that the patients who may need immediate treatment are prioritised.
  • The emergency department and medical care services did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. This was because the planned establishment for nursing and medical staffing had not always been met.
  • The service had not always planned services in a way that met the needs of local people. The emergency department faced challenges to make sure that that the environment matched the needs of patients. We observed some patients were cared for in corridors.
  • People could not always access the service when they needed it. The emergency department had consistently failed to meet the four hour standard for admission, transfer or discharge.
  • Patient outcomes for urgent and emergency care continued to be poor and information submitted to the Royal College of Emergency Medicine showed that results were worse than the national average in most areas.
  • The service did not provide a suitable environment for high risk mental health patients within the emergency department. This was because the department did not have a designated area, which for example, was free of ligature points.
  • The service did not always ensure that each mandatory training area was completed to the trust target for the identified staff within the emergency department. Information provided indicated compliance with training was lower for medical staff.
  • Staff within the emergency department did not always have the correct level of training to prevent patients from abuse. Safeguarding training was not always provided in line with the Intercollegiate Document, 2014.
  • The service did not always manage medicines well. Controlled drugs were not always checked appropriately and patients’ own medicines were not reconciled in line with trust policy within the emergency department. The review dates for medicines were not consistently documented and there was a lack of adherence to the medicines self-administration policy within the medical wards.
  • The service had not always made sure that staff were competent in their roles and up to date competency records were not always available. This was because not all new staff within the emergency department had completed mandatory training before taking on the role and only 55% of nursing staff were up to date with annual appraisals.
  • The emergency department had a vision for what it wanted to achieve. However, not all of the aims had workable plans in place.

However,

  • Staff of different kinds worked together as a team to benefit patients. We observed positive examples of collaborative working.
  • Staff understood their role and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff continued to care for patients with compassion.
  • The service took account of patients’ individual needs.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

Inspection areas

Safe

Requires improvement

Updated 22 March 2018

Effective

Good

Updated 22 March 2018

Caring

Good

Updated 22 March 2018

Responsive

Requires improvement

Updated 22 March 2018

Well-led

Good

Updated 22 March 2018

Checks on specific services

Critical care

Good

Updated 4 February 2014

There were effective systems and processes in critical care services to provide safe care and treatment for patients. Patient safety was monitored and incidents were investigated to assist learning and improve care. The critical care services performed in line with similar-sized hospitals and performed within the national average for most measures.

There were not enough appropriately trained nursing staff to meet patients’ specialist needs in the intensive therapy unit and the high dependency unit. The number of middle grade doctors was not sufficient to ensure that there was 24-hour cover available by at least one registrar. The trust had identified that it needed to improve staffing levels, and it had plans to do this.

We found that there was room for improvement in communication between the cardiac ITU and the general ITU and HDU.

Care was provided by trained staff in accordance with national guidelines, and staff used enhanced care pathways. The critical care services were clean, safe and well maintained. There was sufficient capacity to ensure patients could be admitted promptly and receive the right level of care. Patients or their representatives spoke positively about their care and treatment. There were systems in place to support vulnerable patients.

There was effective teamwork and clearly visible leadership within the critical care services. Staff were appropriately supported with training and supervision and encouraged to learn from mistakes. 

Outpatients and diagnostic imaging

Requires improvement

Updated 4 February 2014

Patients received effective, safe and appropriate care. The outpatient areas were clean and well maintained. However, we observed staff taking patients into sluice rooms to be weighed, which is not clinically appropriate.

Patients told us that waiting times were at times unacceptably long, up to 40 minutes in some departments. However, the 18 patients we spoke with told us that they were generally satisfied with the service they received.

We found that all of the outpatient areas respected patients’ privacy and dignity, as people were seen in consultation rooms.

We also noted that if English was not a patient’s first language an interpreter could be booked in advance of their appointment. However, we were unable to meet with any interpreters at the time of our inspection.

Staff were aware of how to report an incident and the procedure for completing the report.

We saw there were clear leadership structures in place and staff were very supportive of their colleagues. All outpatient staff said that they were well supported in their roles.

Urgent and emergency services

Requires improvement

Updated 22 March 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • The department had consistently failed to meet the Royal College of Emergency Medicine recommendation that the time patients should wait from time of arrival to being triaged (having an initial assessment undertaken) is no more than 15 minutes. This is important as it is a system that emergency departments use to make sure that the patients who may need immediate treatment are prioritised.
  • The department had a limited bed capacity, which meant that access and flow through the emergency department was restricted. We observed patients had to wait, sometimes in inappropriate areas of the department such as the corridor, on a number of occasions during the inspection.
  • The service did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. This was because the planned establishment for nursing and medical staffing had not always been met.
  • The service had not always planned services in a way that met the needs of local people. The department faced challenges to make sure that that the environment matched the needs of patients.
  • People could not always access the service when they needed it. The department had consistently failed to meet the four hour standard for admission, transfer or discharge.
  • Patient outcomes continued to be poor and information submitted to the Royal College of Emergency Medicine showed that results were worse than the national average in most areas.
  • The service did not provide a suitable environment for high risk mental health patients. This was because the department did not have a designated area which for example, was free of ligature points.
  • The service did not always ensure that each mandatory training area was completed to the trust target for the identified staff. Information provided indicated compliance with training was lower for medical staff.
  • Staff did not always have the correct level of training to prevent patients from abuse. Safeguarding training was not always provided in line with the Intercollegiate Document, 2014.
  • The service did not always manage medicines well. Controlled drugs were not always checked appropriately and patients’ own medicines were not reconciled in line with trust policy.
  • The service had not always made sure that staff were competent in their roles and up to date competency records were not always available. This was because not all new staff had completed mandatory training before taking on the role and only 55% of nursing staff were up to date with annual appraisals.
  • The service had a vision for what it wanted to achieve. However, not all of the aims had workable plans in place.

However,

  • Staff of different kinds worked together as a team to benefit patients. We observed positive examples of collaborative working.
  • Staff understood their role and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff continued to care for patients with compassion.
  • The service took account of patients’ individual needs.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

Maternity and gynaecology

Good

Updated 29 January 2016

At the last inspection areas were identified in the maternity services which were inadequate and others that required improvement and an action plan had been developed to address these which has been monitored regularly. At this inspection in September 2015 we found improvements had been made in the number of incidents being reported and the number of post-partum haemorrhages had reduced at the trust. Staffing levels in maternity services were being safely managed and a new midwifery staffing model had been introduced which had impacted positively on the department.

We found that women using maternity services had a high regard for staff and clinical teams, who were caring and treated patients with dignity and respect. There was a good incident reporting culture and systems were in place to ensure lessons were learned. Policies and procedures were up to date and in line with NICE guidance.

The outcomes for patients were in line with the England average on most of the compared measures. Where they were worse this had been investigated and actions taken. There was a good system to triage patients who were admitted to the unit. Patients were offered choice of place for delivery and were included in the decision making for their care. There was good inclusion of the patients and systems for engagement with patients and staff were in place.

However, not all areas of the maternity unit or equipment met with infection prevention and control guidance. The systems for checking the maintenance of equipment and its readiness for use in an emergency were not robust. Training compliance in some key areas including skills and knowledge in emergency situations did not yet meet the trust’s target.

Medical care (including older people’s care)

Good

Updated 22 March 2018

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

  • The service made sure staff were competent for their roles and they provided care and treatment based on national guidance. Managers appraised staff’s work performance.
  • Staff kept appropriate records of patients’ care and treatment. The service controlled infection risk well.
  • Staff recognised incidents and reported them appropriately. The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors.
  • Staff gave patients enough food and drink to meet their needs and improve their health.

  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide patient care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Managers had the right skills and abilities to run the service. They recognised the challenges faced to provide high-quality sustainable care. There was a vision and divisional objectives.
  • Staff told us they were proud of the hospital and the care they delivered. They felt there was an open and honest culture. Staff’s strong patient focus was evident.
  • There were effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However

  • The planned number of registered nurses and health care assistants on the medical wards was not always achieved. The hospital relied heavily on the use of bank and agency staff due to a high number of vacancies.
  • Medicines were not always managed appropriately. The review dates for medicines were not consistently documented and there was a lack of adherence to the medicines self-administration policy.
  • The outcomes for patients were variable.
  • We saw some examples on one ward when patients’ privacy and dignity needs were not being maintained. This was due to the unsuitable environment in which they were being cared. This was addressed during the inspection. We were not able to ensure this was sustained.

Surgery

Good

Updated 22 March 2018

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

  • The service had improved since we last inspected in 2014.
  • We found the trust now carried out timely and appropriate pre-operative assessments by a specialist. Improvements had been made in the fracture neck of femur pathway.
  • Staffing on surgical wards and departments was sufficient to meet the needs of the patients. This was identified as an area for improvement at the last inspection.
  • We found at this inspection that patient records and clinical notes were completed appropriately. This included the World Health Organisation surgical safety checklist and five steps to safer surgery and risk assessments.
  • Staff provided care and treatment based on national guidance and evidence and used these to develop new policies and procedures.
  • Patients were treated in accordance with their individual needs with dignity and privacy.
  • The division had governance, risk management and quality measures to improve patient care, safety and outcomes. Performance outcomes were used to focus areas for improvement.
  • Managers were well respected and supportive of their staff. Staff were on the whole positive and proud of their work and happy in their roles. Teamwork was good and relationships were positive.

However:

  • Performance in some national audits was worse than England average performance.
  • The number of cancelled operations continued to be a concern.

Services for children & young people

Good

Updated 4 February 2014

Children care was safe, effective and well-led.

The environment provided excellent service for children and young people. The layout of the facilities and the thought in design of the building was seen by the team as an excellent example of a children’s unit. There were appropriate toys, well equipped play areas and a sensory room for children with special needs. Children and young people received care from a range of staff who had specialist knowledge in caring and treating children and young people. Parents we spoke to reported that they had been kept informed and involved in the care of their child by the staff.

Children and young people were listened to and had the opportunity to shape the service for the future.

End of life care

Good

Updated 4 February 2014

The trust has a multi-professional approach to end of life care, working in partnership with Trinity Hospice and the trust’s palliative care services. This means that good practice was shared across both the trust and Trinity Hospice. The trust continues to use the Liverpool Care Pathway for people in the last few days of their lives. Staff we spoke to within all areas visited were aware of the procedure to follow in end of life care, ensuring a good experience for patients and a safe approach to care.

The palliative care team focused on ensuring the provision of high quality services that meet the needs of the patients and their families who used their service. It underpinned its practices with the belief that care for the dying is part of the core business of the organisation. If care was necessary within the hospital environment, the palliative care team provided support and information to the patient, their families and the care team working on the ward.

People told us that they were satisfied with the care they received from the palliative care team. For patients who remained in hospital, plans were put in place to ensure that their wishes were respected. We spoke to one patient and two families of patients who were using palliative care services at the hospital. They told us they were satisfied with the care being provided. One patient told us they were happy with all of the care and support provided by staff. They said, “It’s a wonderful place.”

The evidence we found indicated that the ‘care of the dying’ pathway was being followed from diagnosis until after death and that patients were receiving appropriate support and compassionate care.

Other CQC inspections of services

Community & mental health inspection reports for Blackpool Victoria Hospital can be found at Blackpool Teaching Hospitals NHS Foundation Trust.