Chief Inspector of Hospitals Rates North Lincolnshire and Goole NHS Foundation Trust as Requires Improvement

England's Chief Inspector of Hospitals has told North Lincolnshire and Goole NHS Foundation Trust that it must continue to make improvements following its latest inspection by the Care Quality Commission.

Overall the trust has again been rated as Requires Improvement. Scunthorpe General Hospital is rated inadequate overall, Diana Princess of Wales Hospital, Grimsby is Requires Improvement overall and Goole Hospital is rated as Good.

This was the first time CQC had inspected community services, this service was rated, overall as Requires Improvement. Full reports of the inspection are available on the CQC website: www.cqc.org.uk/provider/RJL.

Inspection teams had particular concerns with outpatients’ services at Scunthorpe General Hospital and Diana Princess of Wales hospital. There was evidence of patients coming to harm within the outpatient services because of poor management of the follow up appointment system.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Eighteen months ago, I could see North Lincolnshire and Goole NHS Foundation Trust was making real progress – and I was able to recommend that the trust should come out of special measures.

“My inspectors have found a positive change in some services, notably within critical care at Diana Princess of Wales hospital. Services at Goole Hospital are Good. However we found that the services in A&E at Scunthorpe, outpatients and surgical services had either not improved or had deteriorated since our last inspection.

“We were assured by the quality of the governance arrangements the trust had in place. However, we were significantly concerned that these governance arrangements were either, not widely understood, applied or embedded to ensure the delivery of high quality care.”

“I am particularly concerned by the backlog of patients waiting for outpatient follow up and the high levels of clinic cancellations, leaving some patients being cancelled time after time, without the involvement of doctors or nurses in reviewing their needs. Inevitably patients will suffer in those circumstances

“However, our findings from this inspection highlight some specific areas at the Trust where improvements have not been maintained. Where hospitals are providing care that is inadequate or requires improvement, I expect to see a sharp focus on improvement, but improvement that must be sustained. We will be returning later in the year when we will need to be assured that the trust has made significant progress.”

Inspectors could see that the trust was actively recruiting nurses, yet there remained a high number of nursing posts vacant on a number of wards and other services. Inspectors saw examples of delayed care and staff who were not familiar with ward environments and specialities.

There were significant gaps in the doctors’ rotas for some specialities: both A&E and critical care services were not staffed in line with nationally recommended levels of consultants. The medical cover overnight at Scunthorpe was delaying care and treatment of some patients.

In Scunthorpe A&E a registered children’s nurse was not on duty on every nursing shift, as recommended by national guidance.

People in community services were treated with kindness, dignity, respect and compassion while they received care. Inspectors observed interactions between staff and patients and saw staff found ways of making the experience of care as easy as possible for people. Relatives could record aspects of care in a diary in critical care, for example and staff told us this enabled them to review relatives’ experience of care and learn from it.

CQC inspectors saw and heard of some good examples of care and involvement of patients who were dying, and difficult conversations were held in a sensitive understanding way. Staff were compassionate and understanding of people as individuals.

The inspection highlighted areas for improvement which include:

• The trust must ensure that the outpatient backlog is promptly addressed and prioritised according to clinical need. It must ensure that the governance and monitoring of outpatients’ appointment bookings are operated effectively, reducing the numbers of cancelled clinics and patients who did not attend, and ensuring identification, assessment and action is taken to prevent any potential system failures.
• The trust must ensure that all risks to the health and safety of patients with a mental health condition are removed in Scunthorpe emergency department. This must include the removal of all ligature risks, although must not be limited to the removal of such risks. The trust must undertake a risk assessment of the facilities (including the clinical room and trolley areas, but not be limited to those areas), with advice from a suitably qualified mental health professional.
• The trust must ensure the safe storage and administration of medicines including the storage of oxygen cylinders on the intensive care unit at Diana Prince of Wales hospital, Grimsby. The trust must ensure staff check drug fridge temperatures daily and record minimum and maximum temperatures. In addition it must ensure staff know that the correct fridge temperatures to preserve the safety and efficacy of drugs and what action they need to take if the temperature recording goes outside of this range.
• The trust must ensure it continues to improve on the number of fractured neck of femur patients who receive surgery within 48 hours The trust must ensure that staff, especially within surgery, have appraisals and supervision, and that actions identified in the appraisals are acted upon.

Inspectors saw several areas of outstanding practice including:

• The dental health education team developed a package of resources offering oral health promotion support and training to dental practices in the North Lincolnshire region. This online learning package enabled dental professionals to earn continuing professional development hours as part of the General Dental Council requirements to maintain their registration. They could also use the resources to take part in a strategy called ‘making every contact count’, aimed at improving the community’s oral health.
• There was a highly motivated and compassionate quality matron who had the lead for dementia and also learning disabilities.

CQC inspected Northern Lincolnshire and Goole NHS Foundation Trust from 13 to 16 October 2015 and performed an unannounced inspection on 6 November 2015 and the 5 January 2016.

CQC will be presenting its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings

Full copies of the reports relating to the trust can be found at: www.cqc.org.uk/provider/RJL 

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