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Chief Inspector of Hospitals recommends the University Hospitals of Morecambe Bay NHS Foundation Trust is taken out of special measures, but with continuing support
England’s Chief Inspector of Hospitals has recommended that the University Hospitals of Morecambe Bay NHS Foundation Trust should be taken out of special measures following an inspection by the Care Quality Commission (CQC).
The trust had been placed into special measures in June 2014 after a CQC inspection identified concerns about its ability to ensure safe and well managed services for patients.
Following the latest inspection, Sir Mike Richards has found that the trust has made sufficient progress in most services to exit special measures, subject to the agreement of Monitor, the body responsible for foundation trusts. He has given the trust overall a rating of Requires Improvement.
If Monitor accepts the recommendation, Morecambe Bay will be the eleventh trust to leave special measures since the regime began in July 2013. The trust would receive on-going support to ensure that its performance continues to improve.
Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Since our last inspection changes have been made that give me, and more importantly local people, confidence that the services provided by the trust are improving. Steps have been taken to strengthen the way the trust is run and the way it manages risks to patient safety. In addition, staff numbers have increased in key areas.
“I am satisfied that University Hospitals of Morecambe Bay NHS Foundation Trust has made steady progress to meet the recommendations set by Dr Bill Kirkup following his investigation into maternity services, with maternity and paediatric services now working better together.
“However there is still work for the trust to do to ensure that people using its services consistently receive good quality care and treatment. The trust still has to make significant and sustainable improvements in maternity services. I have made it clear that they must continue to develop a culture of strong team working and continuous learning in order to maintain the progress seen to date.
“Monitor must continue to provide support to oversee the trusts progress and help develop relationships with other credible maternity units. CQC will monitor the trusts improvement plan closely and we intend to undertake an early review of maternity services.
“The trust knows that it still has some complex staffing issues to address with regards to professional relationships and culture within some teams. The work underway to tackle these important issues must continue.
“Special measures are designed to provide intensive support to struggling trusts and Morecambe Bay has clearly benefitted from this support. There is good evidence that the trust is heading in the right direction, however, I believe it will continue to benefit from on-going support."
Inspectors visited the trust in July 2015 to follow up on progress made since their previous inspection February 2014. They also looked at the action taken by the trust in response to the recommendations made by Public Health England following its review of the breast screening service, and the recommendations made as a result of the investigation into maternity services by Dr Bill Kirkup.
Overall, the inspectors rated the quality of care provided by Furness General Hospital and the Royal Lancaster Infirmary as Requires Improvement, while the Westmorland General Hospital overall was rated as Good.
Inspectors found that the executive team had stabilised and was working well together to secure improvements. A new chief operating officer had been appointed and senior managers were more visible and accessible to staff.
Inspectors noted that staffing levels in the high dependency unit had been comprehensively addressed and there were enough nurses to meet the needs of patients. Although staffing levels met the needs of the patients in other wards, the skill mix of staff on Ward 39 and Ward 20 at Royal Lancaster Infirmary was still variable, and there was a reliance on bank and agency staff in some areas. The trust acknowledged that this was not a sustainable position and was recruiting additional nursing staff nationally and internationally.
Care and treatment was being provided in line with national guidelines and patients were positive about their interactions with staff. Inspectors saw that staff were caring and compassionate, and treated people with dignity and respect.
The trust had improved its patient safety incident reporting and had made good progress regarding the management of serious incidents requiring investigation. The trust had launched a monthly communication for staff in March 2015 which shared lessons from incidents, complaints and other safety or governance issues.
CQC has identified seven areas for further improvements:
- The trust must ensure that all premises are suitable for the purpose for which they are being used and properly maintained - particularly physiotherapy services and medical care services provided from Medical Unit One.
- Enough suitably qualified, competent, skilled and experienced people must be deployed to meet the needs of the patients. Staff should receive appropriate support, training and appraisal.
- The trust must ensure that staff understand their responsibilities under, and act in accordance with, the requirements of the Mental Capacity Act 2005 and associated code of practice.
- Staff must follow policies and procedures around managing medicines, including intravenous fluids particularly in medical care services and critical care services.
- Referral to treatment times in surgical specialities must improve.
- The trust must ensure that the resuscitation trolleys on the children’s ward are situated in areas that make them easily accessible in an emergency. All staff must be clear on who has responsibility for the maintenance of the resuscitation trolley on the delivery suite.
- The trust must ensure that it maintains an accurate, complete and contemporaneous record for each patient.
An inspection team which included doctors, nurses, hospital managers, allied health professionals, CQC inspectors and analysts spent four days at Furness General Hospital, Royal Lancaster Hospital and Westmorland General Hospital in July 2015. They examined the care provided in accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, maternity and family planning, children’s care, end of life care and outpatients.
The Care Quality Commission has already presented 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.
CQC will return in due course to check that improvements have been made.
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- Last updated:
- 29 May 2017
Notes to editors
For further information about the special measures regime for NHS trusts, please visit: http://www.cqc.org.uk/sites/default/files/special_measures_guide.pdf.
The 16 trusts that are currently in special measures are:
- Barking, Havering and Redbridge University Hospitals NHS Trust
- Colchester University Hospital NHS Foundation
- Medway NHS Foundation Trust
- East Kent Hospitals University NHS Foundation Trust
- Sherwood Forest Hospitals NHS Foundation Trust
- Medway NHS Foundation Trust
- Wye Valley NHS Trust
- Hinchingbrooke NHS Trust
- Norfolk and Suffolk NHS Foundation Trust (mental health trust)
- Barts Health NHS Trust
- West Hertfordshire NHS Trust
- East Sussex Healthcare NHS Trust
- Cambridge University NHS Foundation Trust
- Worcester Acute Hospitals NHS Trust (subject to TDA’s decision)
- London Ambulance Service NHS Trust
- North Cumbria University Hospitals NHS Trust
The 11 trusts which have been taken out of special measures are:
- Basildon and Thurrock University Hospitals NHS Foundation Trust
- Buckinghamshire Healthcare NHS Trust
- East Lancashire NHS Trust
- George Eliot Hospital NHS Trust
- Heatherwood and Wexham Park Hospitals (now dissolved, but part of Frimley Health)
- North Lincolnshire and Goole NHS Foundation Trust
- United Lincolnshire Hospitals NHS Trust
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust
- Tameside Hospital NHS Foundation Trust
- Burton Hospitals NHS Foundation Trust
- University Hospitals of Morecambe Bay NHS Foundation Trust (subject to Monitor’s decision)
The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?
Since 1 April, providers have been required to display their ratings on their premises and on their websites so that the public can see their rating quickly and easily. For further information on the requirement for providers to prominently display their CQC ratings, please visit: http://www.cqc.org.uk/content/display-ratings.