The Care Quality Commission (CQC) has told University Hospitals of Morecambe Bay NHS Foundation Trust that it needs to make significant improvements following a recent inspection.
CQC carried out an unannounced inspection of the urgent and emergency care services, surgery, and maternity services in April and May. The inspection was carried out after CQC received concerns and whistleblowing information regarding the safety, quality and leadership of the services at Westmorland General Hospital, Royal Lancaster Infirmary and Furness General Hospital.
During the inspection, CQC also became aware of concerns about the stroke pathway for patients and included an unannounced responsive inspection of this service at Royal Lancaster Infirmary and Furness General Hospital at the same time.
Following the inspection, the overall rating of the trust remains requires improvement. The ratings for safe and responsive remain as requires improvement. Caring remains good. However, the rating for the effectiveness of services moves from good to requires improvement and how well-led services are moves down, from requires improvement to inadequate.
- Furness General Hospital moves down from good to requires improvement with safe and well-led also moving to requires improvement. The maternity rating for the hospital drops from good to inadequate.
- At the Royal Lancaster Infirmary, the overall rating remains requires improvement. Safe and responsive remains requires improvement, while caring remains good. Effective and well-led move down from good to requires improvement. In urgent and emergency services well-led also moved down from requires improvement to inadequate.
- At Westmorland General Hospital, the overall rating moves from good to requires improvement. Effective and caring remains good, with responsive remaining requires improvement. Safe and well-led moves down from good to requires improvement. However, the hospital’s urgency and emergency services improved and is now rated good overall.
Following an inspection of stroke services at the Royal Lancaster Infirmary and Furness General Hospital, CQC imposed conditions upon the trust. This was to ensure the trust had an effective system in place for managing and responding to patient risk. All patients who were experiencing a stroke in the emergency department should be cared for in a safe and effective manner and in line with national guidance. Inspectors were not assured that all patients on the stroke pathway received care and treatment in a timely way, exposing patients to the risk of harm. In light of this, the ratings for medical care including care for older people were suspended.
To support the trust, NHS England and Improvement have recently placed the trust into segment 4 of their Systems Oversight Framework and it will receive a package of support through the national Recovery Support Programme.
Ann Ford, CQC’s deputy chief inspector of hospitals in the north, said:
“This recent inspection of University Hospitals of Morecambe Bay NHS Foundation Trust makes disappointing reading. We found a significant downturn in the quality of services provided by the trust, and patients were not receiving the standard of care they deserve.
“In the past, Morecambe Bay has demonstrated that it is capable of making some sustained improvements to the quality of services. Surgical services at both Furness General Hospital and Royal Lancaster Infirmary is one example where they have managed to maintain a sustained improvement over time.
"It is very disappointing however, that this good work has not been replicated throughout the trust. The improvements which were demonstrated at previous inspections of Furness General Hospital’s maternity department have not been sustained and the service has deteriorated, affecting patients and staff.
“However, this does not detract from the excellent work carried out be staff within the trust who, on the whole are providing care, treating patients with compassion sometimes under difficult circumstances.
"While we understand that the leadership team is trying to resolve the issues, it’s clear to us the trust is unable to do so without support.
“Following the inspection, we fed back our findings to the trust leadership team and they have assured us that they were committed to ensuring immediate improvements would be put in place. We have also discussed our findings with NHS England and Improvement who are now supporting the trust via their Systems Oversight Framework and it will receive a package of support through the national Recovery Support Programme. This will give the trust the resources to embed the improvements they need to make.
“In the meantime, we will continue to monitor the trust closely and return to check on any improvements which have been made.”
- Inspectors saw that risks were not always identified correctly with appropriate mitigations put in place
- Not all senior leaders demonstrated the necessary experience or knowledge to lead effectively. They did not always identify and manage priorities in an effective and timely way
- In some of the services visited staff felt respected, supported and valued. However, there were also others where the culture was poor and had remained so for some time
- Patients identified for the stroke pathway did not always receive care and treatment in line with national guidance or trust policies
- There was not always sufficient staff to care for women in maternity services
- Women receiving maternity care, who were assessed for the risk of sepsis, did not always receive care and treatment in line with national guidance
- It was not clear if national guidance was followed to identify signs of deterioration as they were not always documented in patient records
- It was not always clear if all risks to women in labour were assessed, including when risk levels changed from low to high, with a need to escalate care safely
- There was no assurance that incidents were graded to reflect the level of harm
- There was not always sufficient staff with the right qualifications, skills and experience to provide care and treatment for children in the urgent and emergency departments
- There was not sufficient paediatric resuscitation equipment in the urgent and emergency care department and not all staff supporting children had completed paediatric advanced life support training
- Staff did not always adhere to trust and national infection prevention and control guidance regarding social distancing and wearing personal protective equipment in urgent and emergency services
- Controlled drugs were not always stored, administered and recorded safely. The process for the administration of medicines following patient group directions was not followed
- Risk assessments were not always completed for patients identified with mental health concerns
- The trust did not always manage the flow of patients, in the urgent and emergency care department with patients spending long periods waiting for an in-patient bed. This meant that some patients received care in corridors in the urgent and emergency department and this did not allow patients’ privacy and dignity to be maintained. In addition, the escalation plan for caring for patients in the corridor of the emergency department was not always adhered to.
However, inspectors also found:
- Staff had training in key skills, understood how to protect patients from abuse, and managed safety well
- In surgery there was enough staff to care for patients and keep them safe
- Staff were focused on the needs of patients receiving care; they provided compassionate care and gave patients enough to eat and drink
- Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information
- The trust planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback
- The trust engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
Full details of the inspection are given in the report published on our website.
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