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CQC recommends a return to special measures for United Hospitals Lincolnshire NHS Trust

Published:
11 April 2017
Provider:
United Lincolnshire Hospitals NHS Trust
Categories:
  • Media,
  • Hospitals

England's Chief Inspector of Hospitals has recommended that United Hospitals Lincolnshire NHS Trust should return to special measures following the Care Quality Commission’s latest inspection of its services.

The inspection included Lincoln County Hospital, Pilgrim Hospital and Grantham Hospital. Overall the trust has been rated as Inadequate although caring has been rated as Good. Inspectors found significant concerns in medical care and outpatients at Pilgrim Hospital.  

The trust was one of 11 NHS trusts placed into special measures by Sir Bruce Keogh in July 2013 as part of his review of high mortality rates. The trust exited the special measures regime in February 2015 following improvements at the time.

CQC found deterioration across a number of services resulting in the trust being rated inadequate overall following the latest inspection in October 2016. An unannounced inspection was also carried out on 19 December at Pilgrim Hospital’s emergency department following information of concern highlighted to the commission. 

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Having seen improvements to patient care previously, we are disappointed that our latest inspection of United Hospitals Lincolnshire NHS Trust found these improvements had not been sustained and there had been an overall deterioration in quality and patient safety."

“For this reason, we have recommended that the trust should re-enter special measures so that it can receive support at the highest level to deliver all the necessary improvements. The focus of the improvement plan must be to ensure that patients receive safe, high quality and compassionate care at all times."

“In particular, there must be significant improvements in the quality and safety of patient care, leadership and managerial oversight of quality and performance and effective implementation of the existing governance arrangements consistently across all of the services."

“Further improvement is required to ensure the trust is able to manage risk effectively, and cope with patient demand and flow across its services in a timely and sustainable way.  I note, for example, that there were significant delays in patients receiving their follow up outpatient appointment across several specialities with more than three thousand appointments being overdue by more than six weeks."

“We raised a number of issues with the trust that needed urgent attention at the time of the inspection.  We were impressed with the response by the Chief Nurse who sought opportunities to learn from other trusts to improve patient care."

“We will continue to monitor the trust and will return to check on the progress it must make. NHS Improvement will be working closely with the trust to ensure full support is available to make the improvements needed.”  

Inspectors found there were ongoing delays in patients being able to access treatment and care, with growing numbers of patients having to wait too long for their outpatient appointments or inpatient treatments. Arrangements to respond to emergencies and major incidents were not sufficiently robust.

Patients had been unable to access services in a timely way for an initial assessment, diagnosis or treatment, including when cancer was suspected. During 2016 the trust failed to meet the majority of the national standards for the cancer referral to treatment targets. 

In addition, inspectors found low levels of staff satisfaction coupled with high levels of stress and work overload. Some staff told us they did not feel respected, valued or appreciated and many reported they did not feel comfortable raising concerns. 

CQC found poor leadership and oversight in a number of services and at a senior level within the trust. There were weaknesses in the governance framework to support the delivery of the trust’s vision and strategy and inspectors were not assured that the board were sufficiently cited on risks. Inspectors were not assured that all incidents were reported or investigated in a timely way.

In addition, whilst it was isolated to a small number of wards at Pilgrim Hospital, inspectors were not assured that all staff understood the trust values because they observed care being delivered that was not respectful or compassionate.

However, inspectors saw improvement across some services. For example, governance arrangements in the maternity service had been strengthened significantly over the past two years. Inspectors also observed good care across several services including services for children and young people, critical care, surgery and urgent and emergency services at Grantham Hospital, all of which were rated Good overall.

Areas of poor practice, where CQC has told the trust to make improvements include:

  • Staff in the emergency department at Lincoln County Hospital must be appropriately trained and supported to provide the care needed by patients at risk of self-harm.
  • There must be are processes in place at Pilgrim Hospital to ensure that patients whose condition deteriorates are escalated appropriately
  • Staff working in the emergency department at Lincoln County Hospital must receive appropriate supervision, appraisal and training to enable them to fulfil the requirements of their role. 
  • There must be effective systems and processes in place to identify and treat patients at risk of sepsis.
  • The trust must ensure governance and risk management arrangements are robust and are suitable to protect patients from harm. 
  • The trust must take action to ensure there is a robust process in place to report incidents appropriately and investigate incidents in a timely manner. 
  • Safety systems, processes and standard operating procedures must be in place at Pilgrim Hospital to ensure there is an on-call gastrointestinal bleed rota to protect patients from preventable harm
  • The trust must take action to ensure they are compliant with the Fit and Proper Person requirement.

The inspection also identified some areas of positive practice:

  • The trust had introduced a carer’s badge, which enabled any family members and trusted friends to be involved in the care of their loved ones. The carers badge encouraged carer involvement, particularly for patients with additional needs.
  • A traffic light system had been introduced on elderly care wards to identify patients who required more assistance than others. Red signified those patients who required the most help, whilst green identified those patients who required the least.
  • Staff on the children’s ward at Pilgrim Hospital had learnt sign language to enhance their communication skills with children who had hearing difficulties.
  • The trust had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine.

Full reports, including ratings for all of the provider’s core services, are available on our website 

Ends

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Last updated:
29 May 2017

Notes to editors

There are currently 13 NHS trusts across the country in special measures (including United Hospitals Lincolnshire NHS Trust, subject to NHS Improvement accepting the recommendation) and 19 that have exited the regime following improvements. 

The United Lincolnshire Hospitals NHS Trust has three main hospitals and provides a range of hospital-based medical, surgical, paediatric, obstetric and gynaecological services to the 700,000 people of Lincolnshire. The trust employs 7,500 staff

CQC inspected United Lincolnshire Hospitals NHS Trust between the 10-14, 18-19 and 26-27 October 2016. Unannounced inspections were also carried out at Lincoln County Hospital and Pilgrim Hospital on 24, 25 and 27 October 2016. On 19 December, an unannounced inspection was undertaken at Pilgrim Hospital’s emergency department and medical wards in response to some information of concern we had received.  

We included the following locations as part of the inspection:

• Lincoln County Hospital

• Pilgrim Hospital

• Grantham Hospital

CQC rated Pilgrim Hospital as Inadequate, Lincoln County Hospital as Requires Improvement, and Grantham Hospital as Good. CQC did not inspect County Hospital Louth, John Coupland Hospital in Gainsborough, Skegness and District General Hospital or the Johnson Community Hospital in Spalding.

 

Under CQC’s new programme of inspections led by Professor Steve Field, Chief Inspector of General Practice, all of England’s GP practices are being inspected and given a rating.

To get to the heart of people’s experiences of care, we always ask the following five questions of services.

  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people’s needs?
  • Are they well-led?

For every NHS GP practice and out-of-hours service, we will look at the quality of care for the following six population groups: Older people, People with long-term conditions, Families, children and young people, Working age people (including those recently retired and students),People whose circumstances may make them vulnerable, People experiencing poor mental health (including people with dementia). 

Providers are required to display their ratings on their premises and on their websites so that the public can see their rating quickly and easily.


About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.


We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.


We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.