You are here

Provider: Northern Lincolnshire and Goole NHS Foundation Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 February 2020

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

  • We rated safe as inadequate. We rated effective, responsive and well led as requires improvement. We rated caring as good.
  • Our rating of Diana Prince of Wales Hospital stayed the same. We rated it as requires improvement. Of the nine services we inspected, we rated three as inadequate and we rated six services as requires improvement.
  • Our rating of Scunthorpe General Hospital stayed the same. We rated it as requires improvement. Of the nine services we inspected, we rated three as inadequate, five as requires improvement and one as good.
  • Our rating of Goole and District Hospital stayed the same. We rated it as requires improvement. Of the five services we inspected, we rated two as inadequate and three as good. Our decisions on overall ratings take into account the relative size of services. We have used our professional judgement to reach fair and balanced ratings.
  • Our rating of the trust’s community services stayed the same. We rated community health services as requires improvement. We rated one of the three services as requires improvement and two as good.
  • Our rating for well-led at the trust overall improved. We rated well led as required improvement.
  • We rated the trust’s use of resources as requires improvement.
Inspection areas

Safe

Inadequate

Updated 7 February 2020

Our rating of safe went down. We rated it as inadequate because:

  • There had been incidents where patients had come to harm due to delays in receiving appointments in both outpatients and diagnostic imaging. We had concerns regarding this and after the inspection, the Care Quality Commission completed a section 31 letter of intent to seek further clarification from the trust.
  • Across most services there was still insufficient numbers of staff within the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • The service provided mandatory training in key skills to staff but had not ensured everyone had complete it. Across most services there were continued low levels of mandatory training.
  • We had ongoing concerns that patients with mental health conditions were not always cared for in a safe environment.
  • Within the emergency department there were significant numbers of black breaches and the department failed to meet the medium time to initial assessment.
  • The services did not always manage infection control risks.

However:

  • On the whole the services managed incidents well and there was evidence that there was shared learning.
  • They managed medicines well. We saw improvements in the safe administration and storage and handling of medicine management.

Effective

Requires improvement

Updated 7 February 2020

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

  • The services did not always provide care and treatment in line with national guidance and best practice. We found examples of this in some of the core services inspected.
  • The services did not ensure that staff were competent to carry out their roles and compliance with annual appraisals continued to be low.
  • Within end of life we were concerned about the timeliness of pain relief given to patients and lack of documentation which would enable to trust to monitor the effectiveness of care and treatment and drive improvement.
  • Key services were not always available for seven days a week.
  • Managers did not always monitor the effectiveness of the services and use patient outcomes to drive improvement.

However:

  • Staff ensured that patients had enough to eat and drink and advised them how to lead a healthier lifestyle.

Caring

Good

Updated 7 February 2020

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

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. We observed many interactions between staff, patients and others during our inspection. We found most staff to be polite, respectful, professional and non-judgmental in their approach.
  • Most staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs. Patients told us they felt very well supported and said staff were attentive and listened to their needs.
  • Most staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. Patients and those close to them told us they felt involved in the planning and implementation of care and they had been given clear information.

Responsive

Requires improvement

Updated 7 February 2020

  • Within outpatients continued backlogs were identified and within diagnostic imaging there was also an increased backlog of patient awaiting diagnostic image services and the subsequent reporting of x-rays.
  • Services were not always planned to meet the needs of local services. This was particularly so in end of life services.
  • Waiting times, referral to treatment and arrangements to admit, treat and discharge across a number of core services continued to be a challenge. People could not always access the services when they needed to.
  • Investigations of complaints were not managed in a timely way and in line with trust policy.

However:

  • Staff took account of patients individual needs and made it easier for people to give feedback.

Well-led

Requires improvement

Updated 7 February 2020

Our rating of well-led improved. Previously we rated well led as inadequate. At this inspection we rated it as requires improvement because:

  • The systems to manage of risk, issues and performance had improved.
  • More effective governance processes had just been implemented and were evolving, throughout the trust and with partner organisations.
  • Overall staff felt respected, supported and valued. The trust was developing a more open culture where patients, their families and staff could raise concerns without fear but there was more work needed to ensure this became fully embedded.
  • Most services had an open culture where patients, their families and staff could raise concerns without fear.
  • The trust was focused on the needs of staff and patients receiving care. Equality and diversity was promoted in daily work and provided opportunities for career development.

However, we still had ongoing concerns that:

  • More pace was needed to deliver improvements at core service level within the trust.
  • Across most services there was a continued lack of clear strategies at this level. Although services had a vision for what they wanted to achieve there was a lack of supporting and enabling strategies.
  • Systems to manage performance were not consistently used to improve performance.
  • Some services identified and escalated relevant risks. However, the identification of issues and actions to reduce the impact of risks were still not embedded and some risks had not been managed in a timely manner.
  • The services did not always collect reliable data, analyse and use it to make improvements.
  • There continued to be changes in the governance structures and processes which had not become embedded and therefore there was limited oversight.
  • There was limited evidence of continuous improvement and innovation across most core services.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 7 February 2020

Combined rating

Combined rating summary

Requires improvement
Checks on specific services

Community dental services

Good

Updated 7 February 2020

  • 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.

Community health services for adults

Good

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.

Community end of life care

Requires improvement

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.

Community health services for children, young people and families

Good

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.

Reference: not found

Updated 7 February 2020