England’s Chief Inspector of Hospitals has again rated the services provided by Southport and Ormskirk NHS Trust as Requires Improvement following an inspection by the Care Quality Commission in April 2016.
The inspection took place to review the progress of the trust following a previous inspection in November 2014 which identified a number of areas for improvement.
During the more recent inspection the team of inspectors visited Southport and Formby District General Hospital, Ormskirk District General Hospital and the North West Regional Spinal Injuries Centre.
Overall, the trust’s services have been rated as Good for being caring, but Requires Improvement for being safe, effective, responsive and well led. Full reports from the inspection can be found on this website.
While there had been significant improvements in some services, CQC has rated the accident and emergency department and the surgical services at Southport and Formby District General Hospital as Inadequate.
Inspectors found that the hospital did not give sufficient priority to safety in urgent care. Patients needing urgent care were waiting too long to be seen and assessed, with some patients remaining in the department under the supervision of ambulance staff for periods of up to 11 hours.
In surgery at Southport and Formby District General Hospital, staff did not always assess, monitor or manage risks to people who use the services and opportunities to prevent or minimise harm were missed. Medically deteriorating patients were not always identified promptly and there could be a delay before medical assessment was undertaken.
The recruitment of suitable medical staff was challenging with vacancies for junior doctors and consultants. Recruitment and retention of nursing and midwifery had been a longstanding issue.
However, the inspectors found there had been a notable improvement in both the maternity services and the North West Regional Spinal Injuries Centre which had both received Inadequate ratings at the last inspection.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Two years ago we identified a number of problems at Southport and Ormskirk NHS Trust and the purpose of this inspection was to check on their progress since then. I am disappointed that overall the progress has been limited and that we have found a deterioration in the safety and quality of some of the trust’s services, particularly in the emergency department at Southport and Formby Hospital.
“I note with concern the delays in patients being assessed in the accident and emergency department, and the risks to safety in surgery which must be addressed. Since our inspection earlier this year the trust has taken steps to improve – and we are monitoring that on a monthly basis.
“On the other hand, there have been significant improvements in all aspects of patient care and treatment at the North West Regional Spinal Injuries Unit that we had previously rated as inadequate for safety. It is now rated as Good with some aspects of outstanding practice.
“We have also found improvements within the maternity service although there is room for further progress.
“Until recently, the trust was led by an interim executive team, which inevitably limited the ability to demonstrate a clear vision and strategy for the future. It is important now that the new executive team focusses on the areas where we have identified continuing shortfalls.”
Inspectors identified a number of areas for improvement including:
- The trust must assess, monitor and act on the serious concerns raised regarding both the emergency department and surgical services, particularly around early warning scores, sepsis management and the flow of patients.
- All executive and non-executive appointments since November 2014 must be reviewed in line with the trust’s policy for recruitment and selection in regards to the Fit and Proper Person regulation.
- The trust must improve the management of risk including the embedding of the revised processes for serious incident reviews including the use of Root Cause Analysis by trained staff and meet the timescales of their policy for Board oversight.
Inspectors also identified good practice, including:
- The North West Regional Spinal Injuries Centre had improved information for healthcare professionals. For example, following assessment, the outreach team had produced a document with written advice and instructions. The document had been developed in cooperation and discussion with the outreach team at the Midlands Spinal Injuries Centre at Oswestry.
- The additional capacity the outreach service had brought to the centre had enabled patients referred to the centre from major trauma centres to be admitted faster. The length of referral to admission is now reducing ensuring patients are able to commence their rehabilitation sooner.
The Care Quality Commission will present its findings to a local Quality Summit later this month. The Quality Summit will involve NHS commissioners, providers, regulators and other public bodies to develop a plan of action and recommendations based on the inspection team’s findings.
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