Updated 20 August 2021
We carried out an unannounced inspection of urgent and emergency care services, surgery and maternity core services of the (acute) services provided by this trust because at our last inspection we rated the trust overall as requires improvement and we had concerns about the quality and safety of some services.
During our inspection we became aware of concerns about the stroke pathway for patients and did a further unannounced responsive inspection of this service at Royal Lancaster Infirmary and Furness General Hospital.
Overall, we rated the trust and each location as requires improvement. We also inspected the well-led key question for the trust overall. We rated three out of the ten services inspected as good, three as requires improvement and two as inadequate.
Following this inspection, under Section 31 of the Health and Social Care Act 2008, we imposed urgent conditions on the registration of the provider in respect to the regulated activities; Diagnostics and Screening and Treatment of Disorder, disease and Injury. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so. Imposing conditions means the provider must manage regulated activities in a way which complies with the conditions we set. The conditions related to the stroke services at Royal Lancaster Infirmary and Furness General Hospital. In light of this, we suspended the ratings for Medical care including care for older people.
Our rating of services stayed the same. We rated them as requires improvement because:
- Not all staff supporting children had completed paediatric advanced life support training. Not all staff, at the trust, had completed safeguarding level three training.
- Patients identified for the stroke pathway did not always receive care and treatment in line with national guidance or trust policies.
- There was not always sufficient staff with the right qualifications, skills, training and experience to provide care and treatment for children in the urgent and emergency departments and sufficient staff to care for women in maternity services.
- Staff did not always adhere to trust and national infection prevention and control guidance with regards to social distancing and wearing of personal protective equipment in urgent and emergency services.
- Controlled drugs were not always stored, administered and recorded safely. The Trust process for the administration of medicines following Patient Group Directions (PGD’s) had been reviewed and updated but had not been implemented effectively in some locations.
- The escalation plan for caring for patients in the corridor was not always adhered to.
- Women receiving maternity care, who were assessed as at risk of sepsis, did not always receive care and treatment in line with national guidance. Risk assessments were not always completed for women or for patients identified with mental health concerns.
- It was not clear if national early warning scores were always assessed and used to identify any signs of deterioration as they were not always documented in patient records. It was not always clear if all risks to women in labour were assessed, including when risk levels changed from low to high, with a need to escalate care safely.
- Although harm grading guidance was available, we were not assured that all incidents were graded appropriately to reflect the level of harm.
- Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The trust controlled infection risk well.
- In surgery there was enough staff to care for patients and keep them safe.
- Current policies were not always available for staff to access during care and treatment of patients.
- The trust did not always submit information for audits, including national audits, and not all services were included in the audit programme.
- The trust did not always manage patient pain effectively including reassessing pain scores in line with trust policy.
- There was not always effective multidisciplinary working in the trust to benefit patient care, treatment and outcomes.
- Staff provided good care and treatment, gave patients enough to eat and drink. 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. Key services were available seven days a week.
- The trust did not always maintain patients’ privacy and dignity, specifically when needing to be cared for in a corridor in the urgent and emergency department.
- Staff treated patients with compassion and kindness and took account of their individual needs and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The trust did not always manage the flow of patients, in the urgent and emergency care department with patient spending long periods waiting for an in-patient bed.
- The length of stay for patients receiving care for trauma and orthopaedics was longer than the national average.
- The trust planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
- Although the trust had an overall vision and strategies, not all services had their own vision and strategy.
- Trust governance processes were not robust or always effective. Risks were not always identified correctly with appropriate mitigations put in place.
- Most staff felt respected, supported and valued. 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 trust engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
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.