You are here

Provider: Bedfordshire Hospitals NHS Foundation Trust Good

On 7 December 2018, we published a report on how well Luton and Dunstable University Hospital NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 7 December 2018

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

  • We rated safe as requires improvement and effective, caring, responsive and well- led as good.
  • We rated two of the trust’s services as outstanding and six as good overall, we considered the current ratings of the four services not inspected this time.
  • We rated well-led for the trust overall as good.
  • During this inspection, we did not inspect urgent and emergency services, maternity, end of life care and outpatients’ services. The ratings we published following the previous inspections are part of the overall rating awarded to the trust this time.
Inspection areas

Safe

Requires improvement

Updated 7 December 2018

Our rating of safe stayed the same. We rated it as requires improvement because:

  • Medical care, surgery and critical care services were rated as requires improvement. Not all services had enough staff with the right qualifications, skills and training. Not all staff had attended mandatory training and not all staff complied with infection control practices and medicines management was not always managed safely.
  • Not all patients had pre-operative assessments prior to surgery, which was not in line with national guidance, although the trust had plans to implement a pre-operative assessment hub in September 2018, which was planned to improve the process.
  • Not all patient records were kept in locked trolleys to maintain confidentiality.
  • Staff did not always assess, monitor and record patient’s safety to ensure they were supported to stay safe. We found inconsistencies in 15 of the 29 records regarding the recording of the malnutrition universal screening tool (MUST) within 24 hours in accordance with trust guidance. In response to our concerns the trust informed us a re-audit of the MUST was due August 2018.
  • We found ligature points in the discharge seating area within Ward 1 (emergency admission unit) which were bought to the attention of the trust. During the revisit on 20 August 2018 we saw action was being undertaken to address this.
  • Children and young people’s services was rated as good.

Effective

Good

Updated 7 December 2018

  • Medical care, surgery, critical care and children and young people services were rated as good. The services provided care and treatment based on national guidance and had evidence of its effectiveness.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • The services managed patients’ pain effectively and provided or offered pain relief regularly.
  • Staff supported patients to manage their own health, care and well-being and to maximise their independence following surgery and as appropriate for individuals.
  • Staff of different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care and were able to refer to specialists for support when necessary.
  • The services monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them. Data collected was within the expected limits.

However:

  • Patients at the trust had a higher than expected risk of readmission for elective admissions compared to the England average. We saw action plans were in place to address this.
  • The proportion of patients with a hip fracture having surgery on the day of or day after admission was 63%, which failed to meet the national standard of 85%. The trust had action plans in place to review the management of patients with a hip fracture.
  • There were inconsistencies in recording of pain scores in paediatrics.
  • In the CQC Children’s and Young People’s Survey 2016 the service performed worse than other trusts for three of six questions relating to effectiveness.
  • There had not been any improvement in attendance at conflict resolution training identified as a concern in the January 2016 inspection, this meant that staff may not have the necessary skills to deal with patients who displayed challenging behaviour.

Caring

Good

Updated 7 December 2018

  • All services were rated good for caring.
  • Staff cared for patients with compassion. Feedback from patients confirmed staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress. Patients and those close to them were able to receive support to help them cope emotionally with their care and treatment.

  • Staff involved patients, parents and those close to them in decisions about their care and treatment.

Responsive

Outstanding

Updated 7 December 2018

Our rating of responsive stayed the same. We rated it as good because:

  • Medical care, surgery, critical care and children and young people services were rated as good.
  • The trust planned and provided services in a way that met the needs of local people.
  • Services were planned to consider the individual needs of patients. Adjustments were made for patients living with a physical disability. The hospital had disabled access across all areas of the medical services.
  • The services treated concerns and complaints seriously, investigated them and learned lessons from the results. Lessons learned from complaints were shared with all staff members effectively.
  • Patients could access the service when required and there was minimal waiting time for patients to receive their procedure. The referral to treatment time (RTT) for admitted pathways for medical care was consistently better than the England average for all specialities. The average length of stay was just above the England average and trust target of six days.

There were good discharge processes in place after there were opportunities identified in the discharge internal audit of January 2018 resulting in a daily patient tracker report showing the status of the patient’s journey to include length of stay and progress.

  • The critical care service took account of patients’ individual needs. There were a variety of service provisions on both units, which assisted patients’ needs to be addressed. Patients were reviewed a minimum of twice daily and a daily plan was completed by consultants during ward rounds. This process ensured that patients’ treatments were individualised and timely.
  • The trust’s neonatal critical care bed occupancy rate was higher than the England average in the period May 2017 to April 2018. Data in the last three months showed the trust had been below the 80% trust target.

However:

  • Waiting times from referral to treatment were longer than the England average in four specialities from May 2017 to April 2018. As of April 2018, RTT data was improving, the trust was 4% below the national average. Overall the Trust is in the top quartile for 18 weeks.,
  • Complaints were not always managed in a timely manner within the surgical division.
  • The high dependency unit and intensive therapy units were limited in functionality by the estate. This included the provision of washing facilities for patients.
  • There were a high number of out of hour’s transfers between ITU and HDU and from HDU to main wards.

Well-led

Good

Updated 7 December 2018

Our rating of well-led for the core services stayed the same. We rated it as outstanding. The rating for well led for the trust was rated as good because:

  • Medical care, surgery, critical care and children and young people services were rated as good.
  • Leaders at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Senior leaders were visible and demonstrated commitment.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The services engaged well with staff and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • The services had effective systems for identifying risks, planning to eliminate or reduce them, coping with both the expected and unexpected.
  • Governance arrangements were proactively reviewed and reflected best practice.
  • Children’s services had a strategy and supporting objectives and plans were innovative while remaining achievable. There was a systematic and integrated approach to monitoring, reviewing and providing evidence of progress against the strategy and plans.
  • The trust has a stable executive board. Leaders had the experience, capacity, capability and integrity to identify the challenges and took actions to address these. Leaders at every level were visible and approachable.
  • The vision, values and strategy had been developed through a structured planning process in collaboration with people who use the service, staff and external partners.
  • The board and other levels of governance in the organisation functioned effectively and interacted with each other appropriately. Structures, processes and systems of accountability, including the governance and management of partnerships, were clearly set out, understood and effective. Staff were clear about their roles and accountabilities.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them and coping with both the expected and unexpected.

However:

  • While the investigation into serious incidents and findings were clear and patients/their relatives were asked about their involvement, there was a lack of documentation on any support provided by the trust to patients and their relatives.
  • In two of the complaints investigations reviewed, there were potential missed opportunities for actions to be taken and for lessons to be learnt
  • We found areas of concern that were highlighted in our January 2016 inspection within medical care and had not improved. For example, safeguarding adult’s and children’s training, infection control and conflict resolution training.
  • Frequent staff moves and perceived lack of support affected job satisfaction within ITU. Frequent moves had been raised as a concern during ward meetings, and were being addressed by ward managers.
  • Whilst the service was committed to improving services by learning from when things go well and when they go wrong, there were limited opportunities reported for innovation within ITU.
  • Respiratory patients on HDU were audited through the respiratory medicine team and not through ICNARC.
Assessment of the use of resources

Use of resources summary

Good

Updated 7 December 2018

Combined rating