Chief Inspector of Hospitals rates University Hospitals of Leicester NHS Trust as Requires Improvement

England's Chief Inspector of Hospitals has told University Hospitals of Leicester NHS Trust that it must make improvements following an inspection by the Care Quality Commission.

The trust was rated as Requires Improvement overall following an inspection which took place in June 2016. It was rated as Good for being caring and Requires Improvement for being safe, effective, responsive and well-led.

University Hospitals of Leicester NHS Trust provides specialist and acute hospital services to a population of around one million patients across Leicester, Leicestershire and Rutland.

Inspectors visited the trust’s three main hospital sites, Leicester Royal Infirmary, Leicester General Hospital and The Glenfield Hospital as part of the inspection.

Following the trust’s previous comprehensive inspection, in April 2014, CQC rated it as Requires Improvement. While the trust’s rating hasn’t changed as a result of this inspection, some improvement was found to have taken place.

However, more work is needed for the trust to meet the standards people should be able to expect.

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

“Our inspectors found that while some improvement had taken place at the University Hospitals of Leicester NHS Trust further work was needed.

“We found monitoring processes were being used to identify areas of the trust which required additional support but, we found some areas - such as the outpatients department at the Leicester Royal Infirmary- had not been identified through those processes.

“The trust cancelled more outpatient appointments than average, resulting in patient dissatisfaction, delays and a clinical need to re-assess some patients. However, the trust was trying to recruit more doctors in a number of areas to help provide more outpatient clinics.

“The accident and emergency department experienced challenges which had an impact elsewhere in the trust. The department was increasingly busy and patients did not always receive the level of service they should be able to expect.

“Although we found poor performance during our inspection, the trust recognised it needed to make improvements to how it managed the care of deteriorating patients and sepsis. Evidence we have received since our inspection shows the trust’s improvement plans are having an impact.

“Inspectors observed some areas of good practice and found patents were treated with kindness, dignity and respect. Staff commented on the positive culture change in the trust under the current Chief Executive’s leadership. Staff had confidence in the leadership and the trust’s vision and values were generally embedded at the trust.

“We have been monitoring the trust and are aware of improvements the trust been made since our inspection. This includes the accident and emergency department where we have been able to lift a condition placed on the trust in December 2015.

“The trust leadership knows what it needs to do to bring about further improvement and our inspectors will return to check on the trust’s progress.”

Across the trust, the inspection team found areas where improvements must be made, including:

• All directors and non-executive directors must have a Disclosure and Barring Service check undertaken to ensure they are of good character for their role.
• The trust must take action to ensure nursing staff adhere to the trust’s guidelines for screening for sepsis on wards and the emergency department.
• Standards of cleanliness and hygiene must be maintained to prevent and protect people from a healthcare associated infection.
• Hazardous substances must be stored in locked cabinets.
• The trust must ensure staff know what reportable incidents are, ensure that reporting is consistent throughout the trust and incidents must be reported in a timely way.
• Children aged under 18 must not be admitted to wards with patients who are 18 years and above without supervision.
• 'Do not attempt cardiopulmonary resuscitation' (DNACPR) forms must be completed appropriately in accordance with national guidance, best practice and trust policy.
• All equipment must be regularly checked and maintained.
• Action must be taken by the trust so it complies with single sex accommodation law in the diagnostic imaging changing areas and it must provide sufficient gowns to ensure patient dignity.
• The trust must ensure it has oversight of planning, delivery and monitoring of care and treatment so it can take timely action in relation to treatment backlogs in the outpatient departments.
• Patient tests must take place in a way which maintains patients’ privacy.

Inspectors also witnessed some good and outstanding practice across the trust, including:

• One ward held a monthly ‘posh tea round’ which provided an opportunity for staff and patients to engage in a social activity whilst enjoying cakes which were not provided during set meal times.
• The meaningful activities facilitator sat and had their dinner with a patient who was refusing to eat on one ward. They told inspectors that by making the meal a social event they hoped the patient would eat.
• A 24-hour telephone service was available for direct patient advice and admission in oncology and chemotherapy. This was in addition to a follow up telephone service for patients undergoing chemotherapy, at 48 hours, one week and two weeks post treatment.
• The trust had introduced a non-religious carer to provide pastoral support in times of crisis to those patients who do not hold a particular religious affiliation and also to provide non-religious pastoral and spiritual care to family and staff.

The pain management service won the national Grünenthal award for pain relief in children in 2016. The Grünenthal awards recognised excellence in the field of pain management and those who were striving to improve patient care through programmes, which could include the commissioning of a successful pain management programme.

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