Blackpool Victoria Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

This means some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We identified concerns in areas that impacted the overall safety of the service. There was limited assurance that there were enough suitably qualified, skilled and experienced staff to always meet people’s needs safely. Mandatory training and appraisal compliance were below target in a number of key areas, records and patient observations were not always completed appropriately, and infection prevention and control practices were not consistently followed. We also found concerns relating to patient flow, the management of escalation areas, equipment availability and the suitability of some care environments, which increased the risk of avoidable harm. However, leaders had identified many of these challenges and were taking action to address them.

Despite these concerns, the service had a positive learning culture, staff understood their safeguarding responsibilities and worked effectively with specialist teams to protect people from abuse. Medicines were generally managed safely, incidents were investigated appropriately, and staff shared learning to support improvements in care. These arrangements helped to reduce risks and support people to receive safe care.

The service was in breach of staffing and good governance regulation. The service was also in breach of person-centred care as people’s privacy and dignity was not always maintained in temporary escalation areas.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

In the 6 months prior to inspection the service had 10 incidents that had Patient Safety Incident Investigations (PSII) undertaken in line with the trust’s Patient Safety Incident Response Plan (PSIRP).

Leaders met daily to discuss incidents reported in the 24-hour period. There was a governance process in place where complaints, incidents and risks were reviewed.

Staff knew what incidents to report and could explain how to report them however told us that sometimes reports would be delayed due to pressures in the department. Most staff understood the duty of candour and the service had an up-to-date duty of candour policy in place.

At the time of inspection, the service had a 100% compliance rate with duty of candour.

Staff told us they regularly received feedback from incident investigations through incident learning handover documents, team briefings and safety huddles. These forums enabled staff to discuss lessons learned and identify opportunities for improvement. For example, following an incident where an urgent CT scan request was not acted upon promptly, the service strengthened its radiology request processes and updated the medical induction programme. Medical staff were reminded of their responsibilities to prioritise deteriorating patients, actively follow up urgent investigations and ensure effective handovers. The learning from this incident was shared across clinical teams to enhance patient safety and minimise the risk of delays in diagnosis and treatment.

Staff were debriefed and received support after a serious incident.

Although the service had pathways and processes to support patient flow and continuity of care, these were not always effective. Record-keeping, patient monitoring and streaming processes were not consistently managed, meaning the service could not always be assured that safe systems of care were maintained.

Staff used a combination of paper and electronic patient records; however, records were not always complete, contemporaneous or well structured. This impacted the coordination of care, and we found examples where actions, including a repeat mental capacity assessment, had been missed due to poor record keeping.

Leaders were aware of the challenges associated with the transition from paper patient records to electronic records. During the assessment, we found that paper-based patient observation records were not always completed in line with trust policy. We identified 2 records where patient observation scores had not been calculated or repeated as required and escalated these concerns at the time of the assessment. This was a breach of good governance.

The department utilised a range of pathways and assessment areas, including Assessment A, Rapid Initial Investigation Triage (RIIT), Fit to Sit and Same Day Emergency Care (SDEC), to support patient flow. An Assessment A area in an emergency department is a dedicated space where patients undergo rapid initial evaluation, clinical triage, and diagnostic testing after arrival to determine the severity of their condition and prioritise urgent care. The trust had Standard Operating Procedures (SOPs) in place to support streaming within the Emergency Department and referrals to SDEC. Patients could also be streamed to the Urgent Treatment Centre when appropriate.

Staff described how these areas and pathways were used to manage demand and ensure patients received care in the most appropriate setting.

The service had multiple SDEC pathways available, including medicine, general surgery, ear, nose and throat, and gynaecology. Each pathway had defined inclusion and exclusion criteria and operated 7 days a week between 8am and midnight, except for Gynaecology which was 8am to 10pm. The trust had an up-to-date escalation protocol for the Emergency Department.

Of the 1,728 patients cared for in corridor or escalation areas between September and November, 92.2% spent less than 12 hours in these areas. The average time patients spent in corridor or escalation areas was 3 hours and 47 minutes, although 7.8% of patients remained for more than 12 hours and 1.3% remained for more than 24 hours.

Leaders told us of quality improvement work within the division of ‘Reducing Time Away From Home’. This work was to enable improved flow within the trust to reduce overcrowding in the Emergency Department with an aim to alleviate the requirement for corridor care.

Patients told us that staff did not always inform them of what was happening in relation to their care and treatment, and what was happening next. Some patients we spoke to had not been told why they were being moved in the department or what they were waiting on.

The service had specific pathways to support vulnerable groups. This included a standard operating procedure for the management of children and young people presenting with emotional, behavioural and mental health needs, which had been developed in partnership with system stakeholders.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff understood how to raise safeguarding concerns both during and out of hours in line with the trust's processes.

The safeguarding team attended daily huddles and did a daily walk around of the department alongside social care support to identify any safeguarding concerns and provide advice. Staff told us they had a good relationship with the safeguarding team and that they were visible in the department. There were safeguarding champions in ED and a dedicated team for domestic violence and abuse.

Trust-wide data showed staff training compliance for learning disabilities, autism and neurodiversity training was 98%; dementia training 96%; Mental Capacity Act and conflict resolution 95%.

The trust took part in National White Ribbon Day to educate and raise awareness of violence against women and girls. There was a giant White Ribbon cut-out featuring signatures of those who pledged to make the White Ribbon Promise.

The trust provided safeguarding training compliance data for the Integrated Medicine and Emergency Care Division, which included the Emergency Department. This showed that staff training compliance for children and adult safeguarding was above the trust’s expected target of 85% between December 2024 and November 2025.

Levels 1 and 2 for safeguarding adults was 93% with level 3 at 88%.

For children’s level 1 safeguarding, compliance was 91% with levels 2 and 3 at 83% and 87%.

The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We received mixed feedback from patients and their families, some felt that staff had communicated with them about their care, treatment and next steps but others did not.

Staff used a nationally recognised tool to identify deteriorating patients and escalate their conditions to medical staff. The National Early Warning Score (NEWS2) was used to identify patients at risk of deterioration. Our review of documents showed staff did not always complete scores correctly which meant that deteriorating patients may not be identified.

During the inspection, we reviewed a sample of patient records for people with suspected and confirmed sepsis. Records demonstrated that patients were appropriately assessed, screened, monitored and treated in line with recognised sepsis pathways. Documentation showed timely escalation and effective clinical management of patients identified as being at risk of sepsis. Performance data indicated the department was achieving antibiotic administration within one hour for 72% of patients who screened positive for sepsis, which was above the regional benchmark. However, this remained below the trust target of 90%, and leaders recognised that further improvement was required to ensure more patients received timely treatment in line with expected standards.

Leaders told us that restrictive practice was not common and that any use of restraint would be incident reported and monitored. We saw evidence that restrictive practice was incident reported.

Some young people known to community mental health services did not have a current care plan or risk assessment in place when attending the ED. We noted that certain risks had been documented within progress notes rather than separate risk assessments.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff told us and we observed delays in delivery of care and patient assessments due to availability of equipment to complete patient observations. This included thermometers and pulse oximeters used to monitor patients’ temperature and oxygen levels. The trust confirmed there were systems in place to review stock levels of equipment kept in the department. An additional order was placed during the assessment to replace items of equipment that were broken or being repaired.

Staff told us that the environment was mostly adequate however was too small for the numbers of patients attending. A designated room for personal care was available within the department, however sustained overcrowding and patient numbers exceeding capacity meant that this room was frequently occupied. During our inspection, we observed patients receiving personal care and undergoing examinations in corridor areas due to the lack of available private space which we fed back to leaders. This compromised patient privacy and dignity, as patients were exposed in a public environment that was not suitable for confidential and dignified care. This was a breach of person-centred care.

In non-escalation areas of the department, adaptations had been made so that patients could alter the lighting to promote better sleep. The department was well maintained and free from clutter.

The service had ligature light rooms for patients requiring mental health assessment and support.

There was a paediatric ED separate of the main department that had a play area and a dedicated toilet and baby change.

The service did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

We found that the trust did not meet the requirements of “Facing the Future: Standards for Children in Emergency Care Settings”. We saw that the service did not always have sufficient staff with the right training, skills and competencies to safely meet paediatric patient need. Following the inspection the trust recruited a substantive paediatric emergency consultant in response to our concerns identified during the inspection.

In ED, inconsistent staff cover in escalation spaces meant the risk presented by the area not having access to call bells was not effectively mitigated.

Training compliance for both medical and dental staff and nursing and midwifery registered staff was below the trust target of 95% across a number of mandatory training subjects. Resuscitation Level 2 (Adult Basic Life Support) compliance was 55.3% for medical and dental staff and 83.5% for nursing and midwifery staff.

Compliance with paediatric life support training was also below the trust target of 95%, with compliance rates of 73.5% for medical staff and 82.2% for nursing staff. Leaders told us that all nurses in charge of the paediatric area were required to hold European Paediatric Advanced Life Support (EPALS) certification and that electronic rostering systems were used to identify shifts without EPALS-trained staff. Rosters were regularly reviewed, gaps were escalated, and arrangements were in place to manage short-notice absences. Leaders also told us that all Tier 4 and Tier 5 doctors held APLS or EPALS certification and that at least one suitably trained senior doctor was rostered on every shift. However, leaders did not provide EPALS compliance data, and therefore we were unable to verify the level of compliance with these requirements or the assurances provided.

Sepsis training is included within the Trust’s Recognise and Act Training. The compliance for nursing staff in ED was just below the trust target at 93%, for SDEC it was lower at 73%. The Recognise and Act Training is not mandatory for medical staff, so compliance rates were not available. Care of the deteriorating patient training for the division was also below target at 74%. Moving and handling training compliance for the division for the previous year was on average 93% for level 1, just below target with level 2 compliance rate at an average of 75%.

Low levels of compliance increase the risk that staff may not be fully up to date with essential skills and knowledge required to respond effectively to deteriorating patients and medical emergencies. Trust leaders should continue to prioritise actions to improve compliance and provide assurance that staff are appropriately trained to deliver safe care. This was a breach of staffing.

The registered nurse staffing vacancy rate at the time of inspection was 19% which equated to 25.34 Full Time Equivalent (FTE) nurses. Registered nurse shift fill rates were monitored during safety huddles and systems were in place to monitor when bank and agency staff were used. For shifts allocated to bank and agency the average fill rate of these shifts between September and November was 74%.We were not assured that the department was being staffed as per the registered nurse establishment due to the vacancy rate and unfilled bank and agency shifts.

The trust had processes in place to oversee the medical workforce and took action to mitigate medical staffing gaps which included alternative staffing arrangements and the employment of doctors in other grades. For medical staffing, Between September and November 2025, 24% of medical staffing shifts were filled by bank and agency. Medical staffing data for ED indicated several substantive workforce gaps. The data showed fewer doctors in post than planned across several key roles, including Foundation Year 1 and Foundation Year 2 doctors, Specialty Doctors, Trust Grade Specialty Registrars and some consultant grades. We also noted that there were no doctors in post against some budgeted Specialty Registrar posts.

Many staff gave mixed feedback on their annual appraisal completion. The trust highlighted a recent reduction in appraisal compliance figures reported to the Workforce Assurance Committee in October 2025 with an improvement plan trajectory to be in line with trust targets by March 2026. At the time of our inspection appraisal compliance for ED was 31% though the organisation had identified a technical reporting issue affecting the accuracy of recorded data and was implementing measures to improve the recording and completion of appraisals. This was a breach of staffing regulation.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

In the Emergency Department, we identified concerns relating to Infection Prevention and Control (IPC). During our inspection, we observed staff did not always wash their hands between patient contacts and did not always use gloves appropriately. Staff did not consistently don and doff Personal Protective Equipment (PPE) correctly, particularly when caring for patients requiring isolation. We also observed staff who were not bare below the elbows. In the resuscitation area, we saw fabric curtains which did not display a date to indicate when they had last been changed. Following feedback provided during the inspection, leaders implemented an action plan to address IPC concerns within the department.

Training compliance for infection prevention and control within the Integrated Medicine and Patient Flow Division, which included the Emergency Department, met the trust target of 95%. However, local audit results demonstrated areas where practice did not consistently meet the organisation's standards. Quarter 2 2025 IPC audits showed compliance rates of 86% for commode cleanliness and hand hygiene, 92% for linen management and 91% for waste management, all below the trust target of 95%. Compliance with PPE and environmental audits met the trust target. These findings were consistent with some of the IPC concerns identified during our inspection.

However, patients and families told us that the environment was mostly clean and tidy.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Pharmacy support was in place within the urgent care department, and at the time of inspection, recruitment was actively being undertaken to increase the support available. The pharmacy team worked closely with ward staff to identify and prioritise patients requiring a review of their medicines. Where the pharmacy team had reviewed a patient’s medicines, the positive interventions they made and their contributions to medicines safety were evident from the patient records.

We were shown a new prioritisation tool by members of the pharmacy department to help pharmacy staff identify and prioritise people admitted on high-risk medicines and time critical medicines. This was due to be rolled out across the Trust shortly after the inspection took place.

People’s allergies were recorded accurately upon arriving at the department.

There was good accessibility to time-critical medicines such as medicines for the treatment of Parkinson’s disease and insulins for the management of diabetes, to ensure that these medicines were given in a timely manner.

Risk assessments for venous thromboembolism (VTE) were completed promptly and medicines were prescribed appropriately.

Intravenous antibiotics were prescribed when a patient was admitted with symptoms of sepsis. Rationale for antimicrobial choice was documented in patient’s notes and there was evidence of appropriate microbiology involvement where necessary. 

For patients requiring oxygen therapy, oxygen was correctly prescribed on the electronic prescribing and medicines administration system. 

We witnessed a patient’s own medicines being left on a window ledge and frequently left unattended. There was a risk that these medicines could have been mishandled. We escalated this and staff took immediate action.