Northern Lincolnshire and Goole NHS Foundation Trust

Updated 2 December 2022

Northern Lincolnshire and Goole NHS Foundation Trust provides acute hospital services and community services to a population of more than 450,000 people across North and North East Lincolnshire and East Riding of Yorkshire. The trust has approximately 750 beds across three hospitals: Diana Princess of Wales (DPoW) Hospital at Grimsby in North East Lincolnshire, Scunthorpe General Hospital in North Lincolnshire and Goole and District Hospital (based in the East Riding of Yorkshire).

The leadership of the trust had improved since our last inspection in 2019 but this was not yet enough to make an impact on the trust overall rating, however, we did see some areas improvement in ratings for core services from our previous inspection. Members of the board articulated they felt much more enabled, supported, listened to and empowered to undertake their roles than previously. The leadership team led by the CEO and chair had identified that the trust needed to continue with existing plans and strategies in order to improve both the people’s experience of services and the culture within the organisation more broadly. This was a message we heard consistently throughout our inspection.

It was recognised by the board there had been challenges regarding the trust's organisational culture over the last few years. To address this, targeted and focused work had been undertaken with the board and executive team. The trust had made good progress in strengthening its operational financial management and governance arrangements but there was further work needed to ensure new arrangements and ways of working were embedded at all levels throughout the trust.

Whilst the improvements in leadership and culture were evident since our previous inspection, the trust recognised more work needed to be done to embed service improvements and for these changes to be reflected in positive patient outcomes. When inspecting the core services at the trust we saw that some of the changes that had happened at a senior level in the organisation had not yet become embedded at ward/department level. There continued to be a slow progress in some areas against our previous inspection findings particularly in urgent and emergency care, medicine and end of life.

Information and data overall were well managed across the trust. New systems had been developed to strengthen data collection, analysis and we saw evidence of information being used to drive improvements and demonstrate sustained successes. However, we did see instances on wards and departments where patient information was not stored securely.

The trust was committed to continually learning and improving services. Quality improvement methods had been introduced and staff understood the skills needed to use them, and the trust recognised that there was a need to sustain and continue this commitment to improvement overall.

Whilst we inspected during the COVID 19 pandemic the risks and concerns identified by CQC during the inspection were not the result of the immediate pressures faced by the trust as a result of the COVID pandemic. The trust has reported the long-lasting impact of the COVID 19 pandemic for the preceding two years. These included the significant impact on staffing, increase in overall attendances, sub-optimal patient flow throughout services, ambulance pressures, increased wait times, the prolonged period of command and control arrangements and service remodelling.

We carried out this unannounced inspection of acute services provided by this trust as part of our continual checks on the safety and quality of healthcare services and as at our last inspection we rated the trust overall as requires improvement. The trust was in special measures to help it improve

We also inspected the well-led key question for the trust overall.

Our rating of some services improved. We rated them as requires improvement because:

• We rated safe, effective, responsive and well-led as requires improvement, and caring as good.
• At Diana Princess of Wales Hospital, we rated six core services as requires improvement and one core service as good. At Scunthorpe General Hospital, we rated five core services as requires improvement and three core service as good. At Goole and District Hospital, all core services are now rated as good. In rating the trust, we took into account the current ratings of the services (including Community Services) not inspected this time.
• Across most services there was still insufficient numbers of staff within the right qualifications, skills, training and experience to provide the right care and treatment. We observed issues in relation to staffing levels, vacancies and saw gaps in both nursing and medical rotas.
• The services provided mandatory training in key skills to staff but had not ensured everyone had completed it. Across most services there were continued low levels of mandatory training.
• Within urgent and emergency care people could not access the service when they needed it and continued to experience long delays waiting for treatment. The departments continued to experience long ambulance handover times as a result of access and flow issues.
• Waiting times, referral to treatment and arrangements to admit, treat and discharge across several core services continued to be a challenge. We noted that that across both sites, there were long lengths of stay which impacted negatively on access and flow throughout the hospital.
• The trust was continuing to develop a more open culture and improve communication with patients, their families and staff but there was more work required to progress this and have an impact.
• Visibility of senior leadership team was variable across the services we inspected.

However:

• We saw good examples of patients receiving compassionate care, with staff ensuring patients privacy and dignity was maintained. Patients and partners were happy with the care provided.
• We saw that the trust had worked hard to improve performance in terms of elective pathways and complaints management.
• Since the last inspection there had been a marked improvement in actions to address the backlogs for waiting times and reporting times within diagnostic services.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 7 February 2020

Updated 7 February 2020

Updated 7 February 2020

Our rating of this service improved. We rated it as good because:

• The service had made improvements to many areas of concern we identified at the last inspection.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. This was an improvement since our last inspection.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service used systems and processes to safely prescribe, administer, record and store medicines. The division had introduced a new pathway for prescribing governance and non-medical prescribers were now given the opportunity to discuss their prescribing history and report during supervision. Prescription pad use and storage was audited for all non-medical prescribers.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. Staff told us that supervision had improved since the last inspection.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress and supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• Staff gave patients practical support and advice to lead healthier lives. Complex care matrons provided health coaching for patients with long term health conditions to empowered them to manage their own conditions and to promote their own health.

However:

• The service did not always have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. We found that most teams were in a better position with staffing than at our last inspection, however, some teams were still under pressure due to vacancies and high sickness levels. The service had mitigation in place to manage staffing issues.
• People could not always access the service when they needed it and did not always received the right care in a timely way. Therapy staff in the care networks were not able to see patients within the recommended timescale and there were still long waits for patients to be assessed in the continence service. This was identified as an issue at our last inspection.

Updated 6 April 2017

Northern Lincolnshire and Goole NHS Foundation Trust provided services to children and young people up to the age of 19 across North Lincolnshire. The organisation provided a range of services including the family nurse partnership, health visiting, community children’s nursing, looked after children’s team and paediatric therapy services. These services were provided in people’s home, schools, clinics and children’s centres throughout the local area.

Children and young people under the age of 20 made up 23.2% of the population in North Lincolnshire and 11.2% of school children were from a minority ethnic group. The health and well-being of children in North Lincolnshire was mixed when compared with the England average. Infant and child mortality rates were similar to the England average. The level of child poverty was worse than the England average with 19.8% of children under the age of 16 living in poverty. The rate of family homelessness is better than the England average. Childhood obesity levels are in line with the England average; 9.7% of children aged 4-5 years and 20.7% of children aged 10-11 years.

We visited eight locations across the Northern Lincolnshire area. We attended two baby clinics, health visitor bases, children’s therapy bases, the child development centre, and the looked after children’s team, a monthly health visiting team meeting and with parents’ permission, went on three home visits.

We spoke with 46 members of staff, including senior managers and team leaders, health visitors, therapists, specialist nurses, administration and support staff. We did not inspect the school nursing service, as this was not provided by the trust.

Therapy services had moved to electronic records. We were shown how information was inputted and stored on the system and reviewed two electronic records for therapy services and ten records for health visiting.

Updated 7 February 2020

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment in line with nationally recognised guidance. Managers monitored the effectiveness of the service and made sure staff were competent. 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.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Staff morale was low within the service. This was due to a protracted re-structuring process.
• Patient’s post-operative blood pressure was not always recorded in the dental care records following intravenous sedation.
• There had been some issues with the boiler at Cromwell Primary Care Centre. This had led to a lack of hot water for four days on one occasion. There had been a delay in reporting this as a significant event.

Updated 7 February 2020

Our rating of this service went down. We rated it as requires improvement because:

• The service did not have enough staff to meet national guidance. Key management roles were unfilled.
• The service had not maintained its performance since our last inspection. For example, outcome measurement and local audit work had not taken place for the previous nine months, so leaders did not know how effective their service was.
• Staff knew how to report incidents but these were not discussed systematically and team meeting minutes did not show evidence of discussion or learning from incidents.
• There was no organisational strategy or vision.
• Safeguarding and mandatory training rates were low, and below the trust target.
• A specialist end of life service was not available 24 hours a day, seven days a week.
• There was a lack of governance systems to oversee safety, performance and risk within the service.
• Staff did not receive regular supervision, or in the case of the home care team, any supervision. Appraisal rates were below trust target which was something we had told the trust they must improve at our last inspection.
• Complaints were not always acted upon in line with trust policy.
• Rates of key training such as the use of syringe drivers to deliver medicine to people receiving end of life care, and mental capacity act training, were low, and where applicable, below trust targets.
• Shortages of key equipment meant that electronic records were not always updated contemporaneously, and staff could not always access the systems they needed when working away from their base.

However:

• Staff provided effective emotional support to patients and their families and feedback confirmed this.
• Equipment was clean and available for use when needed. Staff working in patients’ homes used appropriate techniques and personal protection equipment to minimise the risk of spread of infection.
• Staff worked well with other partners and teams both within and outside the trust.
• There had been no complaints about the service in the last 12 months.
• Staff felt respected, supported and valued, and were focussed on the needs of patients receiving care.
• Mandatory training rates were good and staff met the target for eight of nine training modules.