Fleetwood Hospital

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• 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

We looked for evidence that people were protected from abuse and avoidable harm.

Leaders encouraged a positive culture of safety based on honesty and openness. Staff understood how to protect patients from abuse and recognised incidents and reported them appropriately. Leaders made sure there were enough competent staff to keep patients safe. Staff worked together within the department and across specialties to provide good patient care. The environment was clean and tidy, and staff managed infection risks effectively. The outpatient departments had effective systems to handle medicines and prescriptions safely and securely. 

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

This meant people were safe and protected from avoidable harm.

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 demonstrated a positive and proactive learning culture. Managers and staff provided examples of how learning was identified from incidents reported and used to improve practice. Staff told us they felt well supported by managers and described an open culture where learning was encouraged.

All staff members we spoke with were able to clearly explain how to report incidents and gave examples of incidents reported. Over the previous six months, 12 incidents had been reported. Of these, one was graded as low harm and 11 resulted in no harm to patients. Staff understood the duty of candour, and an up-to-date duty of candour policy was in place.

A security-related incident had been reported by a staff member. Appropriate actions were taken to reduce the risk of reoccurrence, and learning from the incident was shared with staff. Learning was communicated through posters in the department, the wider trust, and during daily staff huddles.

Weekly staff team meetings were held to share information, review performance, and discuss service improvements. This ensured that learning was shared consistently and that staff were kept informed of changes and developments within the service.

During our assessment, outpatient appointments ran to time. Patients attended appointments as scheduled and there were no delays observed.

Patients had previously raised concerns to the trust that written appointment letters, including appointment times and information about what to expect during the visit, did not always arrive in advance of their appointment. The trust had taken action to address this by introducing a text message reminder system and an accessible smartphone app to improve communication with patients.

Staff in the outpatient department told us about the use of ‘follow-up forms.’ These forms were completed at the end of a consultation by a registered healthcare professional and are used to record outcomes for patients, such as the need for a follow-up appointment or further investigations.

Some staff raised concerns that follow-up forms were not always completed by the appropriate healthcare professional responsible for the patient’s care and therefore were not consistently added to the patient record. The forms had recently been transferred to an electronic system, which staff told us had led to some confusion and resulted in some information being missed.

Managers were aware of these concerns, had a plan of action in place and provided reassurance that follow-up forms were being audited. Further work was planned with specialty teams that worked in the outpatient department to improve compliance and ensure patient records were completed accurately and consistently.

Staff demonstrated awareness and understanding of safeguarding principles and processes. Staff provided examples of safeguarding concerns that had been raised and explained how these were identified and managed. Staff spoke about recognising and responding to domestic abuse, modern slavery, self-neglect, and other safeguarding matters, particularly for those whose circumstances may make them vulnerable.

Staff demonstrated a good understanding of the needs of the local community and described how they supported patients who attended the service regularly with safeguarding plans in place. They explained how they would escalate concerns appropriately to ensure people were kept safe.

Staff demonstrated awareness of the need to protect people from discrimination. This included supporting patients who required reasonable adjustments due to caring responsibilities or who were at risk of abuse at home. Staff gave examples of how adjustments were made at the point of contact to meet individual needs.

Safeguarding information and escalation routes were clearly displayed throughout the service. Safeguarding posters were visible in public areas and staff rooms. Domestic abuse posters were displayed in toilets, including information on how people could ask for support discreetly within the service.

Chaperone posters were not always displayed both inside and outside consultation rooms. However, staff’s understanding about how the chaperone policy should be applied varied. For example, some consultants only requested a chaperone when undertaking a physical examination. Staff told us that chaperones were offered if a person appeared anxious or distressed and aimed more at younger female patients.

We escalated these concerns to the managers during the assessment who recirculated the trust chaperone policy to staff as it was not being followed consistently. The policy set out the role of a chaperone, particularly during intimate examinations, and highlighted the need to consider chaperones for people with language barriers, people living with dementia, and other vulnerable service users.

Staff told us they felt well supported by the trust safeguarding team, both in person and remotely, and offered advice and guidance. Multidisciplinary meetings were held to support people whose circumstances may make them vulnerable to attend their appointments and to coordinate care across other providers.

The trust provided safeguarding training compliance figures for the wider service group rather than specifically for the Fleetwood Hospital outpatient department. The trust safeguarding target was 85%. Staff safeguarding training compliance for the division was:

• Children’s safeguarding level 1: 94%
• Children’s safeguarding level 2: 84%
• Safeguarding adults level 1: 95%
• Safeguarding adults level 2: 88%

Patients we spoke to told us they knew what was happening in relation to their care and treatment, and what was happening next. Patients told us that staff communicated well with them and their families, ensuring they understood their care and treatment. Staff also used effective methods to support people with communication difficulties. For example, we saw posters advertising translation services for people whose first language was not English, as well as information about advocacy support. We also observed that communication passports were in place where needed. Records showed detailed notes of conversations held with patients and their family members.

Staff had access to policies and procedures to support them assessing risk of harm and deterioration of patient’s conditions. 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 completed scores correctly.

Staff worked with multidisciplinary teams which included the Speech and Language Team (SaLT), tissue viability nurses and physiotherapy.

The outpatient department at Fleetwood Hospital also provided a Narrowband Ultraviolet B (NB‑UVB) nurse‑led clinic. NB‑UVB therapy is used to treat a range of skin conditions, including eczema.

During our assessment, we observed the nursing team actively involving people who used the service in decisions about their treatment. Nurses explained the treatment clearly, including the benefits and associated risks, using non‑clinical language that was easy for patients to understand.

We saw examples of staff supporting patients to manage risks associated with their treatment. A nurse explained the purpose of NB‑UVB therapy, the importance of adhering to the treatment regime, and the potential risks of over‑treatment to the skin. This approach supported people to make informed decisions about their care and demonstrated good patient involvement.

The outpatient department provided a comfortable waiting area for people attending appointments. Facilities included seating, a children’s play area, a television, information about other services, and a water dispenser. As a result of previous security incidents, security personnel were present at the front entrance to the department and trained in trust policy and process.

However, we identified issues with disabled toilet assistance call bells. Some call bells were either not working or had not been installed. This concern was escalated to managers during the assessment and they told us action would be taken.

We were not assured that the emergency call bell system in the outpatient department was working effectively. Not all staff understood how the system operated or how they would identify the location of an emergency. A generic policy for community diagnostic centres was in place; however, this did not specifically reference Fleetwood Hospital. We did see emergency information posters displayed within the outpatient department, which included details of the location of emergency equipment and instructions on how to contact emergency services. We were later provided with evidence that emergency response information had since been updated and shared with staff in the department’s weekly updates.

Resuscitation equipment was stored behind a key‑coded door at reception. When we checked the equipment, one item was found to be past its expiry date. This issue was addressed immediately by a member of staff.

Staff did not always sign in and out of the building for fire register and security purposes. This meant that fire wardens would not have been able to accurately account for who was present in the event of an evacuation. CQC staff were not asked to sign in on arrival, although this was corrected when raised. The most recent fire drill had taken place in April 2024.

On the ground floor, designated fire marshals were clearly identified. However, on the second floor this was not clear, and some staff were unsure who the designated fire marshals were. The management team acknowledged this concern and told us that fire safety information had since been included in the weekly staff briefing.

We identified two store cupboards containing clinical equipment that were unlocked and accessible from public areas. Some clinical equipment stored within these cupboards was found to be out of date. These issues were escalated and resolved at the time of assessment by staff.

All concerns identified during the assessment were escalated to the management team. The trust provided assurances that actions had been taken, or were ongoing, to address and rectify these issues after our site visit.

At the time of our assessment safe staffing levels were met. Staff reported that staffing levels were appropriate for the services provided in the outpatient department. There were no incidents reported relating to staffing levels for this division. Managers explained in the event of staffing shortfalls, substantive outpatient nurses from Blackpool Victoria Hospital were used to cover sickness or absence. The service did not use bank or agency staff within the Fleetwood Hospital outpatient department. This was confirmed by staff we spoke with during the assessment.

The Trust provided service‑level information regarding mandatory training compliance. This showed that nursing and midwifery staff had achieved over 95% compliance with mandatory training requirements. Mandatory training compliance for medical and dental staff ranged from 77% to 90%.

Staff working within the service were trained to undertake electrocardiograms and venepuncture. This meant that patients did not need to attend additional appointments for these investigations, supporting timely care delivery and reducing delays in diagnosis and treatment.

Staff told us that annual appraisals were completed. However, we were not provided with appraisal compliance data specific to the Fleetwood Hospital outpatient department at the time of the assessment.

Cleaning records were up to date and demonstrated that clinical and public areas were cleaned regularly.

Staff adhered to infection prevention and control principles, including effective hand hygiene. All staff were responsible for cleaning equipment between patients and ensuring clinic rooms were maintained to a clean standard throughout the day. During the assessment, we observed staff cleaning equipment between patient use and applying ‘I am clean’ stickers to indicate equipment had been cleaned.

General cleaning services were provided by an external domestic contractor. Cleaning schedules were displayed on the walls in clinical rooms, toilets and public areas, showing when areas had last been cleaned. We spoke with a member of the domestic team, who told us they cleaned the outpatient department before and after clinics. Clinicians from specialty teams using the clinical rooms signed records to confirm they were satisfied with the cleanliness of the rooms prior to use.

We reviewed cleaning audit results for the outpatient department for the past six months. These showed 100% compliance throughout this period.

Handwashing facilities were available in all clinical rooms, and alcohol hand gel was accessible throughout the outpatient department. Personal protective equipment (PPE) was available in all clinical areas. We observed staff using appropriate handwashing techniques, complying with uniform standards and bare-below-the-elbows.

We spoke with people using the outpatient service at Fleetwood Hospital. They told us the department was clean and reported seeing staff wash their hands before and after care was provided.

We inspected the medicines storage arrangements within the outpatient department. The medicines cupboard was locked, and keys were held by the nursing team. Stock control records were in place to record medicines being signed in and out, and we found these records had been completed accurately.

Weekly medicines audits were undertaken; however, during the assessment we identified one item of medication that was past its expiry date. The audit record for that week had been signed to indicate that all medicines were within date. This discrepancy was addressed immediately by staff at the time of assessment.

During our visit, we identified a discrepancy between reception staff and the nursing team regarding the process for receiving and handling medicines deliveries. We observed a sealed bag of medication being signed for and left behind the reception desk. Nursing staff told us this practice was not in line with trust policy and acted immediately to resolve the issue.

We saw evidence that incident forms had been completed in relation to both the expired medication and the medicines handling concern. The concerns were escalated to the department manager during the assessment. The expired medication was removed, and staff were reminded of their medicines management responsibilities. Following the assessment, we were provided with assurance that incident forms had been completed, investigations were underway, and further guidance had been issued to staff to reinforce safe medicines management practices.

A medicines management policy was in place, outlining the correct processes for the handling and storage of medicines, and this had been shared with staff via the weekly departmental update.