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Provider: Liverpool Heart and Chest Hospital NHS Foundation Trust Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 3 July 2019

Our rating of the trust stayed the same. We rated it as outstanding because:

We rated safe and effective as good. We rated caring, responsive and well-led as outstanding.

We rated surgery, one of the trust’s five services, as outstanding. In rating the trust, we took into account the current ratings of the four services not inspected this time.

We rated well-led for the trust overall as outstanding.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RBQ/reports.

Inspection areas

Safe

Good

Updated 3 July 2019

Our rating of safe stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Patients wellbeing was central to what the trust did.
  • A proactive approach to anticipating and managing risks to patients was embedded and all staff recognised their responsibilities to protect patients.
  • There was a genuinely open culture in which all safety concerns raised by staff, patients and carers were valued as being integral to learning and improvement. There were safety systems in place that empowered patients, carers and staff to raise any safety concerns immediately.
  • The service followed best practice when prescribing, giving, recording and storing medicines.
  • Patients records were detailed, specific and accurately reflected the care planned and delivered.
  • Staffing levels and skill mix had been planned, implemented and reviewed to keep patients safe. Any staff shortages were responded to quickly.

However,

  • Staff had not received up-to-date mandatory training in all safety systems, processes and practices. Compliance for medical staff was particularly low. This had been recognised and actions put into place to increase access to training.

Effective

Good

Updated 3 July 2019

Our rating of effective stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Most outcomes for patients were consistently above national averages.
  • There was a holistic approach to assessing, planning and delivering care and treatment to patients. This included meeting patients’ specific needs in relation to food, drink and pain relief.
  • Accurate and up-to-date information about effectiveness was shared internally and externally and was understood by staff. This was used to improve patient care and treatment and improvements had been checked and monitored.
  • All staff had the skills and experiences they needed to carry out their roles effectively and in line with best practice. Staff were supported to deliver effective care and treatment, including meaningful and timely supervision and appraisal.
  • The service was consistent in supporting patients to live healthier lives, including identifying those who need extra support.
  • Practices around consent and records were actively monitored and reviewed to improve how patients were involved in making decisions about their care and treatment.

However,

  • There was insufficient training for medical staff with regard to Deprivation of Liberty safeguarding and the Mental Capacity Act 2005.

Caring

Outstanding

Updated 3 July 2019

Our rating of caring stayed the same. We took into account the current ratings of services not inspected this time. We rated it as outstanding because:

  • Staff cared for patients with compassion. Patients were respected and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.
  • Feedback from patients, carers and stakeholders was continually positive about the way staff treated them. Patients thought that staff went the extra mile and their care and support exceeded their expectations
  • Staff recognised and respected patients’ individual and specific needs. They always took patients personal, cultural, social and religious needs into account. Staff involved patients and those close to them in decisions about their care and treatment.
  • Patients emotional and social needs were seen as being as important as their physical needs. 24 hour visiting was in place to support patients emotional and cultural wishes.
  • Patients were always treated with dignity by all those involved in their care.
  • Patients and their carers were active partners in their care. Staff were fully committed to working in partnership with people and making this a reality for each person.

Responsive

Outstanding

Updated 3 July 2019

Our rating of responsive stayed the same. We took into account the current ratings of services not inspected this time. We rated it as outstanding because:

  • Services were tailored to meet the needs of individuals. Patients had been involved in the planning of services. These were monitored to ensure that they continued to be delivering flexibility, allowing for choice and continuity of care for the patients.
  • There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs, which was accessible and promoted equality.
  • Technology was used innovatively to ensure people have timely access to treatment, support and care.
  • Patients and carers were involved in regular reviews of how the service managed and responded to complaints. The service demonstrated where improvements had been made because of learning from reviews of safety and care and treatment.
  • The service used innovative ways of considering improvements, including using external people and professionals to make sure there was an independent and objective approach. A review had been undertaken for the service by external experts with their recommendations used to improve the service.

Well-led

Outstanding

Updated 3 July 2019

Our rating of well-led stayed the same. We took into account the current ratings of services not inspected this time. We rated it as outstanding because:

  • The leadership, governance and culture were used to drive and improve the delivery of high quality person centred care. Leadership was compassionate, inclusive and effective. Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. Leaders had a deep understanding of issues, challenges and priorities for their service.
  • There was a systematic and integrated approach to monitoring, reviewing and providing evidence of progress against the services strategy and plans. Safe innovation was celebrated. There was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care.
  • Staff were proud of the organisation as a place to work and spoke highly of the culture.
  • There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care.
  • Innovative practice included the usage of robotic assistance in surgery to improve patient outcomes.
  • Governance arrangements were proactively reviewed and reflected best practice. A systematic approach was taken to working with other organisations to improve care outcomes.
  • Services were developed with the full participation of those who used them, staff and external partners were viewed as equal partners.
Checks on specific services

Community health services for adults

Outstanding

Updated 16 September 2016

We rated community services at Liverpool Heart and Chest Hospital as outstanding in caring, responsive and well led key questions. We rated safe and effective key questions as good.

  • Feedback from patients and those close to them was consistently positive about the way staff treated them. Staff went the extra mile to provide care and support. There was a strong person‑centred approach to providing care.

  • Relationships between people who use services and staff were caring, respectful and promoted people’s dignity.

  • Services provided by the trust reflected people’s individual needs and preferences and continuity of care for patients was central for staff. The hospital had implemented a number of schemes to help meet people’s individual needs

  • Incidents were reported by staff through effective systems. Lessons were learnt and staff were able to recognise and respond to changes in risk to people who used community services.

  • Staff followed good hygiene practices.

  • Staffing levels were reviewedto ensure that there were enough staff with the correct skills to keep people safe.

  • Best practice guidance in relation to care and treatment was followed and community services participated in national and local audits. Action plans were in place to continuously monitor service quality and delivery and maintain standards. All staff were engage with monitoring and evaluating their services. The service was meeting or exceeding the majority of their key performance targets and met or exceeded outcomes in line with national benchmarking and guidance such as

  • Patients were supported to raise a concern or a complaint. Lessons were learnt and improvements made from complaint investigations. Community services captured views of people who used the services with changes made following feedback. The friends and family test showed that people would recommend the hospital to friends or a relative.

  • All staff knew the trust and service vision and were committed to driving continuous improvement setting their own internal targets to seek out and trial new models of care in the community.