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Inspection Summary


Overall summary & rating

Good

Updated 12 February 2019

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

  • Staff across the hospital had completed mandatory training in key skills and understood how to protect vulnerable patients from abuse and how and when to report incidents.
  • The hospital and equipment were suitable for the services provided and were clean and tidy. With few exceptions, staff followed infection control measures.
  • Staff completed risk assessments for patients and kept a good record of the care and treatment patients were receiving.
  • There were sufficient nursing, medical and other staffing to keep patients safe. While there were sufficient staff, the urgent care centre was reliant on locum doctors and nurses on medical wards were moved between areas when there were staffing gaps.
  • Services at the hospital delivered care in line with national guidelines and best practice. Services were participating in local and national audits to improve practice. Patients had good outcomes from their treatment.
  • Patients received food, drink and pain relief when they needed it. Staff had training and understood what to do if someone lacked capacity or experience mental ill health.
  • Staff received the right training for their roles and in medical care and surgery had annual appraisals. In urgent and emergency care the rates of appraisals was lower than the trust target. Staff worked well together and worked well with staff and services outside of the hospital.
  • Staff throughout the hospital were kind, compassionate and caring to patients, their carers and family members. Patients were involved in decisions about their care and given emotional support.
  • Services were planned to meet the needs of people using the hospital and services were responsive to the individual needs of patients.
  • The hospital had managers with the right skills and abilities to lead the services. There was a positive culture and morale was generally good throughout the hospital.
  • The services in the hospital had effective governance structures and systems to manage and act on risks and performance issues. The services were committed to improving services and used information and engaged with staff and the public to improve services.

However,

  • While patients received the right medicines, at the right doses, at the right time, the hospital was not always following best practice for the storage of medicines and the process for patient group directions was not robust.
  • Some equipment was not checked or serviced as frequently as it needed to be to ensure staff that it was safe and ready to use.
  • In the Rakehead rehabilitation centre patients did not receive a seven-day service as there was limited therapy support at the weekends.
Inspection areas

Safe

Good

Updated 12 February 2019

Effective

Good

Updated 12 February 2019

Caring

Good

Updated 12 February 2019

Responsive

Good

Updated 12 February 2019

Well-led

Good

Updated 12 February 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 12 February 2019

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

  • The service provided mandatory training in key skills to all staff and this was completed.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service used safety monitoring results well and this was shared with staff, patients and visitors.
  • Staff kept appropriate records of patients’ care and treatment
  • The service controlled infection risk well and staff followed trust guidance for infection prevention and control.
  • Managers closely monitored staffing levels to ensure there were sufficient staff to keep people safe and to provide the right care and treatment.
  • Care and treatment was based on national guidance and evidence based practice and staff followed patient care plans.
  • Staff gave patients enough food and drink to meet their needs and improve their health. Dieticians and speech therapists were available for patients needing nutritional support.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them.
  • The staff made sure staff were competent for their roles and appraisal completion rates were high.
  • Staff of different kinds worked together as a team to benefit patients and there was extensive multi-disciplinary working as part of day-to-day practice.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff cared for patients with compassion and kindness and patient experience feedback was positive; patients were supported for their emotional needs.
  • The Rakehead rehabilitation centre provided a fully accessible environment for rehabilitation patients, including a patient flat, recreation areas and a garden.
  • People could access services when they needed them. Referral to treatment times in medicine for the elderly met the 18-week standard.
  • A range of services were available to support patients appropriately, according to their needs. Staff had good awareness of the needs of patients who were living with dementia or a learning disability
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care
  • The trust’s vision and values were well embedded across the service and staff felt supported and valued.
  • Leaders were aware of key risks in the service and identified improvement plans for these areas.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However

  • The service did not always ensure staff were aware of the shared learning following serious incidents.
  • We observed staff failing to observe infection control protocols when nursing a patient isolated in a side ward.
  • Whilst the service prescribed, stored and gave medicines well, prescription records did not always identify any patients’ allergies.
  • The service did not always look after equipment well and we observed some items of equipment where maintenance was overdue.
  • Staff were frequently moved during shifts to other areas of high demand, leaving wards depleted.
  • Therapy services did not provide seven-day services and this had particular impact on patients in the Rakehead rehabilitation centre.

Services for children & young people

Good

Updated 9 July 2014

Children, young people and neonates (newborn infants) received safe and effective care from appropriately trained and competent staff. We saw that staff treated patients with dignity and respect, showing compassion and empathy to them and their families or carers.

Staff were positive about working in the family care division of the trust and told us they felt supported and valued in their roles. Parents and carers were satisfied with the care and treatment delivered to their children and told us they felt included and involved.

The environment was clean, bright and airy with sufficient equipment to deliver the necessary treatments. Toys were available in waiting and treatment areas. However, on the neonatal intensive care unit NICU, there were no facilities for parents/carers to have a hot drink or sit on the ward away from the cot side. There was a refurbished waiting area outside of the unit which provided seating, toys and a cold water fountain.

The care and treatment provided to children and young people was based on national guidelines and directives. Policies and procedures were reviewed regularly and updated as necessary. The care and treatment was audited to monitor quality and effectiveness and, as a result action had been taken to improve the service.

Staff were provided with regular and appropriate training and an annual performance development review. There was no process for staff to receive formal supervision throughout the year but, during our discussions with staff, we were told the managers were approachable and provided support when required.

Services for children and young people were caring. Patients and their families/carers were treated with dignity and respect. Surveys took place to gather feedback from patients and their families/carers. Interpreter services were available when required.

End of life care

Good

Updated 20 May 2016

The EOL care service at the Royal Blackburn hospital was rated good overall with no domain requiring improvement. Although there were few deaths at the hospital, the SPCT team managed end of life care effectively. Staff attended full team meetings with the consultants from the EOL team and with the palliative care lead nurse.

The clinical leadership in the specialist palliative care team was effective. There was a strategy and a vision for the end of life service and effective reporting mechanisms to the trust board. All directorates were engaged in the delivery of good quality end of life care.

Staff were enthusiastic and caring and enjoyed working for the trust. They said that the last few years had been difficult but the stability of the current board and executive team contributed greatly to the culture of continuous improvement. The nursing staff ensured that they were up to date with policies and procedures for EOL care and asked for advice from the SPCT if necessary. Staff we spoke with were aware of the EOL care lead and the trust EOL strategy.

Systems were in place to keep people safe and incidents were reported by staff through effective systems. Lessons were learnt and improvements were made. An integrated care plan had been launched which was comprehensive and staff had been trained to use it. The plan identified priorities for patients in the last few days and hours of their lives. Patients and their relatives were involved in the planning of their care.

The service had a well-developed education programme for medical staff, nurses and unregistered staff in EOL care. Staff in the SPCT and on the wards were committed to providing good compassionate care for patients and their relatives. There were good audit systems in place and the outcomes of these were used to improve the service.

The bereavement services were responsive and death certificates were issued in a timely way to meet the needs of different religions. Porters were respectful of patients when they took them to the mortuary.

However, consultant cover for out of hours and seven day working was not always available. The specialist palliative care telephone advice line for out of hours was answered by a nurse and referred to a doctor if necessary. This doctor was not always a consultant in palliative medicine and could be a GP. This did not fully meet the National Institute for Health and Care excellence (NICE) quality standards for end of life care.

Maternity and gynaecology

Good

Updated 9 July 2014

The maternity and family planning services were found to be safe and effective, with caring staff. The service was responsive to the needs of the local population, providing a mix of standalone birth centres, an alongside birth centre (both of which are midwife-led) and obstetric-led birthing options for women. The service was also found to be well-led. There were established governance processes in place. Staff received feedback from incidents and there was evidence of learning as a result.

Outpatients and diagnostic imaging

Good

Updated 9 July 2014

Patients were treated with dignity and respect by caring staff. Patients spoke positively about their care and felt they had been involved in decisions about their care. Staffing numbers and skills mix met the needs of the service. There was a clear process for reporting and investigating incidents. Themes and trends were identiifed and action taken to minimise risks. The outpatients departments we visited were clean and well-maintained.

Patients and staff told us that clinics were sometimes cancelled at short notice and we found that clinics frequently ran late. Patients spoke of the anxiety and incovenience this caused them. Staff were auditing this and were considering ways to address it. Changes to the patients’ ambulance transport services had caused confusion for staff, resulting in them not knowing which patients had transport arranged. Patients could wait for long periods for transport if their appointment was late.

There was good local leadership and a positive culture within the service. Staff worked well as a team and supported each other. Staff said they had confidence in their managers and all disciplines worked together for the benefit of patients.

Surgery

Good

Updated 12 February 2019

Overall, we found the services to be good.

  • We saw evidence that incidents were being reported and staff we spoke with were aware of the system and how to use it. We saw evidence of learning from incidents and how this learning was shared across the service and trust wide. We saw evidence of change to practice following learning from incidents.
  • Cleanliness and hygiene was of a high standard throughout the hospital departments and staff followed good practice guidance in relation to the control and prevention of infection.
  • Patients cared for in the surgical division were receiving care in line with current evidence-based guidance and standards. Policies and procedures were in place and staff were aware of how to access them. Frequent audits were being completed and subsequent action plans implemented.
  • The trust participated in National audits including the hip fracture, bowel and lung cancer audits, which showed that overall the trust was achieving better than the National average.
  • The hospital had consistently achieved better than the England average in respect of the 18 weeks target from referral to treatment between and although surgical procedures were sometimes cancelled at short notice, systems were in place to ensure patients were rescheduled within 28 days of the cancellation.

  • Leadership within the surgical division was very positive, visible and proactive. Managers had a strong focus on the needs of patients and the roles staff needed to play in delivering good care.
  • Staff were proud of the work they did; they worked well together and supported each other when the service was under pressure from increased demand. The trust ranked in the top 100 places to work in the NHS in an external health journal. Staff and patients told us they felt well engaged with and their views were valued.

Urgent and emergency services

Good

Updated 12 February 2019

  • The service provided mandatory training in key skills and delivered appropriate safeguarding training to all staff and the majority had completed it.
  • The service controlled infection well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had systems in place for assessing and responding to patient risk. The service took prompt action to respond to deteriorating patients.
  • The service managed patient safety incidents well. Staff recognised incidents and knew how to report them appropriately. The service had developed systems to ensure lessons learned were shared with the team and wider service.
  • The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The safety thermometer results for the service were exemplary and showed that they were focused on delivering harm free care.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • The service assessed, managed and monitored pain well. Patients were given adequate and timely pain relief.
  • Staff worked together as a team to benefit patients. There were good examples of multidisciplinary working from initial assessment through to discharge and beyond.
  • The service was available for 24 hours a day, seven days a week and patients had access to the service at all times.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to consent to care and treatment.
  • Staff cared for patients with compassion and provided emotional support to minimise their distress. Patients and those close to them were involved in decisions about their care and treatment and the service kept them updated.
  • The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs including those living with dementia and mental health needs.
  • People could access the service when they needed it. The service prioritised the care and treatment of patients with the most need.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • There were established governance systems in place to continually monitor and improve the quality of its services.
  • The service had developed a systematic approach to identify and managing risks and in planning to reduce or eliminate them
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service was committed to improving services by learning from when things go well and when they go wrong. A collaborative approach was taken with staff and other health care organisations to improve services.

However:

  • Resuscitation equipment checks and monitoring were not always completed appropriately. The service did not always identify that essential equipment was not present.
  • Although the service had a number of pathways and protocols in place to assess and respond to patient risk they did not cover the initial assessment of patients by reception staff, before they were triaged.
  • The service did not audit documentation and could not therefore assure themselves that documentation was being completed correctly or monitored for themes and trends.
  • The service did not have robust systems in place to ensure that medicines were stored at the correct temperature and that patient group directions were in date.
  • Waiting times for treatment and arrangements to admit, treat and discharge patients were not always in line with targets set by the Department of Health and recommendations set by the Royal College of Emergency Medicine.
  • The percentage of patients that left the trust’s urgent and emergency care services before being seen for treatment was consistently higher than the England average.
  • Despite having an extensive communication and engagement strategy there was still confusion surrounding the level of care the service offered and there were numerous inappropriate self-presentations to the service.

Other CQC inspections of services

Community & mental health inspection reports for Burnley General Hospital can be found at East Lancashire Hospitals NHS Trust.