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Blackpool Victoria Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 October 2019

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

  • We rated safe, effective, responsive and well-led as requires improvement. We rated caring as good.
  • The rating for medical care, surgery and critical care went down. The rating for urgent and emergency care, maternity and services for children and young people stayed the same. Because we previously inspected outpatients with diagnostic services and end of life care jointly with community end of life care, we cannot compare our new ratings directly with previous ratings. The rating for outpatients was requires improvement. The rating for end of life care was good.
  • The overall rating for community services was good. The rating for community health services for adults, community inpatient services, services for children and young people, sexual health services and dental services stayed the same. The rating for child and adolescent mental health services went down. Because we previously inspected community end of life care services jointly with acute end of life care, we cannot compare our new ratings directly with previous ratings. The rating for community end of life care was good.
Inspection areas

Safe

Requires improvement

Updated 17 October 2019

Effective

Requires improvement

Updated 17 October 2019

Caring

Good

Updated 17 October 2019

Responsive

Requires improvement

Updated 17 October 2019

Well-led

Requires improvement

Updated 17 October 2019

Checks on specific services

Medical care (including older people’s care)

Updated 17 October 2019

Our rating of this service went down. We rated it as inadequate because:

  • We rated effective, responsive and well led as inadequate. We rated safe as requires improvement and caring as good.
  • The service did not have enough staff to care for patients and keep them safe. Staff did not always assess the risks to patients appropriately nor act on them and did not keep good care records. They did not manage safety or medicines well. Staff collected safety information but did not always use this to improve the service. Staff did not always report safety incidents and did not always learn lessons from them.
  • The care provided was not always in line with best practice and some aspects were based on the judgment of staff. We were concerned regarding patient outcomes, as they were below the national average in a number of areas. Some patients who needed help with food and drink were not always provided with it. Staff did not always follow the principles of the Mental Capacity Act. Staff did not always use the findings of their monitoring of the effectiveness of care and treatment to make improvements to outcomes for patients.
  • We were not assured that the service planned and provided care in a way that met the needs of local people and the communities served. The service did not work well with others in the wider system and local organisations to plan care. The service did not always take into account patients’ individual needs. Care was not consistently tailored to individual patients. People trying to access the service sometimes waited too long for treatment.

However:

  • Staff had training in key skills, understood how to protect patients from abuse. The service controlled infection risk well.
  • Managers made sure staff were competent. Staff advised patients on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • 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 for children & young people

Good

Updated 17 October 2019

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

  • Staff understood of how to protect patients from abuse and the service worked well with other agencies to do this is an appropriate way. All areas of the children’s and young people’s services were located in suitable premises and the service-controlled infection risk well. The service prescribed, administered and recorded medicines in line with guidance.
  • Risk assessments for each patient were completed by a paediatric nurse and kept in the patient record. Staff kept detailed paper-based records of patients’ care and treatment. However, due to the size of the patient record this made it challenging for staff to retrieve information quickly.
  • Nursing and medical staff had the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. However not all staff had completed their mandatory training, compliance rate amongst nursing and medical staff was low in some training.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Children and young people were given a choice of food and drink and pain was managed well. Managers monitored the effectiveness of care and treatment and used the findings to improve them. Local results were undertaken to further improvements.
  • Patients and parents were supported by staff who were kind and compassionate. Staff cared for children in a way that met their personal preferences and needs. Staff provided emotional support to patients, families and carers to minimise their distress and encouraged parents to be active partners in the care and treatment they delivered.
  • The service was inclusive and took account of children, young people and their family’s individual needs and preferences. Staff made reasonable adjustments to help patients access services. Patients could access the service when they needed it but those needing surgery did not always have their surgery on time.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. The service had a vision for what it wanted to achieve. All staff understood and were invested in the vision and values of the organisation. Staff felt respected, supported and valued. Staff felt there was a no blame culture and a strong team ethos.
  • There were effective governance processes in place. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The service and staff were committed to improving services by learning from incidents, promoting training and innovation.

Critical care

Requires improvement

Updated 17 October 2019

Our rating of this service went down. We rated it it as requires improvement because:

  • Facilities and premises in critical care and the high dependency unit were not always appropriate for the services being delivered. The service did not have enough allied health professional staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Medical staffing levels did not always allow for sustainable and effective working rota’s and practices which was also identified at the last inspection in 2014.
  • The service did not always provide care and treatment based on national guidance and evidence-based practice. Implementation of evidence based guidance was variable. Several guidelines and policies required updating or had not been formally approved. Key services were not always available seven days a week to support timely patient care. There was limited input into ward rounds during weekends because of the lack of allied health professional services. Teams in critical care did not always include all necessary staff, or they did not meet frequently enough to provide effective care.
  • The service did not always use a systematic approach to continually improve the quality of its service. The service did not always have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. The risk management approach was applied inconsistently. Staff did not always understand how their role contributed to achieving the strategy. Staff in critical care did not always feel actively engaged or empowered. There was a limited approach to sharing information with and obtaining the views of staff. Staff in critical care did not always feel supported and valued.

However

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. Staff completed and updated risk assessments for each patient. Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. The service used systems and processes to safely prescribe, administer, record medicines.
  • Staff assessed and monitored patients regularly to see if they were in pain. Staff gave patients enough food and drink. Managers monitored the effectiveness of care and treatment and used the findings to improve them. Staff supported patients to make informed decisions about their care and treatment. Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. The service had systems to help care for patients in need of additional support or specialist intervention. The service took account of patients’ individual needs.

End of life care

Good

Updated 17 October 2019

We rated it as good because:

  • We rated safe, effective, caring, responsive and well led as good
  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. End of life care was not part of the trusts mandatory training for all staff.
  • Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • 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 available seven days a week.
  • 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. Staff demonstrated care and compassion to patients.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment. The service did not monitor, audit and evaluate rapid discharges from hospital led by the specialist palliative care service.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually. There was a non-executive director at board level for end of life care. Staff told us they did not always feel valued by senior managers.

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.

Surgery

Requires improvement

Updated 17 October 2019

Our rating of this service went down. We rated it as requires improvement because:

  • The service did not always have enough staff to care for patients and keep them safe. The service did not ensure that staff completed mandatory training. Staff did not consistently asses risks to patients, act on them or keep good care records. The service also did not follow best practice when administering and storing medicines and did not routinely report incidents. However, staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff prescribed and recorded medicines appropriately. The service managed reported safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff did not always give patients pain relief when they needed it. The service did not always ensure staff were competent. Key services were not always available seven days a week. However, the trust monitored the effectiveness of the service, and staff provided good care and treatment and 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.
  • 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.
  • The service did not always take account of patients’ individual needs. Whilst people could access the service when they needed, they did not always receive the right care promptly. However, the service planned care to meet the needs of local people and made it easy for people to give feedback.
  • Staff did not always understand the service’s vision and values. Staff did not always feel respected, supported and valued. Leaders used systems to manage performance, but it was not always clear what action had been taken to mitigate risk. However, staff were focused on the needs of patients receiving care and were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Urgent and emergency services

Updated 17 October 2019

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

  • The service did not always have enough staff to care for patients and keep them safe. Staff did not always assess the risks to patients appropriately nor act on them and did not always keep good care records. Safety incidents were not always investigated appropriately.
  • The care provided was not always in line with best practice and the effectiveness of the service was not always monitored. Staff did not always follow the principles of the mental capacity act and best interest decisions were not always undertaken or documented.
  • Multidisciplinary working with the wider hospital was less positive and impacted on patient care.
  • The service did not always consider patients’ individual needs, care was not tailored to individual patients. People trying to access the service sometimes waited too long for treatment.
  • Leaders did not always run services well using reliable information systems and managing risk competently. The service vision and strategies were not clear, and it was not apparent how these would be achieved.

However:

  • There had been significant improvements since the last inspection. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk well.
  • Pain relief was assessed and reassessed appropriately. Managers made sure staff were competent. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service was planned to meet the needs of local people and made it easy for people to give feedback.
  • Staff felt supported and valued and they were clear on their roles and responsibilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services.

Maternity

Updated 17 October 2019

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

  • The service had enough staff to care for women and keep them safe. Staff had training in key skills, understood how to protect women from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to women, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave women 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 women, 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 available seven days a week.
  • Staff treated women 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 women, families and carers.
  • The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.

Outpatients

Requires improvement

Updated 17 October 2019

  • People struggled to access services when they needed them and receive the right care promptly. Patients were frequently and consistently not able to access services in a timely way for assessment or diagnosis, and experienced unacceptable waits for some treatments.
  • Staff collated reliable data and teams used systems to monitor performance. However, leaders lacked the knowledge and capacity to lead the service and effectively drive improvements. The service was failing to manage services to meet key performance measures.
  • There were governance processes in place. However, these were not always used to successfully manage risks and improve performance. Leaders didn’t consistently act on risks and identify and implement actions in a timely manner to reduce their impact.
  • The service used paper-based patient records, and this presented a risk to the security and loss of patient information. We saw patient records, although complete and stored securely, were not always clear and easily available to all staff providing care.
  • The number of cancelled appointments were not always kept to a minimum and had increased over time. The service did not have systems in place to sufficiently manage cancelled appointment rates.

However:

  • The service had enough competent staff to keep patients safe from avoidable harm; and different professionals worked together as a team to benefit patients. Staff understood how to protect patients from abuse. Staff identified and quickly acted upon patients at risk of deterioration.
  • Staff were focused on the needs of patients receiving care. 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. Staff followed national guidance to gain patients’ consent and supported patients to make informed decisions about their care and treatment.
  • The service used systems and processes to safely prescribe, administer, record and store medicines; and staff assessed and monitored patients regularly to see if they were in pain. The design, maintenance and use of facilities, premises and equipment kept people safe; and the service-controlled infection risk well.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action. We saw some evidence that leaders engaged with staff and local and partner organisations to plan and manage services for patients and encouraged innovation and participation in research.
Other CQC inspections of services

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