You are here

Provider: United Lincolnshire Hospitals NHS Trust Requires improvement

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 3 July 2018

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

  • We rated two of the four locations as good overall, one as requires improvement and one as inadequate.
  • We rated the overall trust key questions of safe, effective, responsive and well led as requires improvement and caring as good.
  • In rating the trust, we took into account the ratings of core services not inspected this time.
  • Our decisions on overall ratings take into account, for example the relative size of service and we use our professional judgement to reach a fair and balanced rating.
  • We rated well-led of the trust overall as requires improvement.
  • We saw many improvements across many core services since our last inspection.
  • There was an improved patient safety culture within the trust.
  • Morale across the trust was mixed however the morale had improved since our last inspection.
  • We saw good MDT working across many core services.
Inspection areas

Safe

Requires improvement

Updated 3 July 2018

Our rating of safe improved. We rated it as requires improvement because:

  • There were periods of understaffing or inappropriate skill mix, which was not always addressed quickly. There was a heavy reliance on agency, bank and locum staff.
  • Risks to patients who use services were not always assessed, monitored and managed on a day-to-day basis.
  • Medicines were not always managed consistently and safely. Medicines were not always stored correctly, and disposed of safely.
  • When something went wrong, there was not always a timely or thorough review or investigation.
  • Lessons learned were not always communicated widely to support improvement in other areas where relevant, as well as services that are directly affected.

Effective

Requires improvement

Updated 3 July 2018

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

  • Care and treatment did not always reflect current evidence-based guidance, standards, best practice and technologies.
  • Implementation of evidence-based guidance was variable.
  • Some outcomes for patient who use services were below expectations compared with similar services. The outcomes of care and treatment were not always monitored regularly or robustly. Participation in external audits and benchmarking was limited in some core services.
  • Staff were not always supported to deliver effective care and treatment through meaningful and timely supervision and appraisal. We saw appraisal levels in most core services were low.

Caring

Good

Updated 3 July 2018

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

  • Feedback from patient who used the service and those who are close to them was mostly positive about the way staff treated them.
  • Patients were mostly treated with dignity, respect and kindness during all interactions with staff and relationships with staff are positive.
  • Patients mostly felt supported and say staff cared about them.

Responsive

Requires improvement

Updated 3 July 2018

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

  • Services were not delivered in a way that focused on people’s holistic needs. A reduction in children’s beds had resulted in paediatric surgery being cancelled on the Pilgrim site. Children now had to travel to Lincoln Hospital for surgery and were likely to experience a delay in receiving treatment due to limited bed capacity at Lincoln Hospital.
  • There had been no capacity and demand modelling undertaken to offer assurance to the board that eight beds on the children’s ward at Pilgrim Hospital would be sufficient to meet the needs of the population.
  • Patients could not always access care and treatment in a timely way. Waiting times in the emergency department and the national referral to treatment standards for surgery and outpatient services were worse than the England average and did not meet the national standard.
  • We saw in a number of core services patients’ individual needs had not always been considered. The trusts were not fully compliant with the accessible information standard. In the emergency department at Pilgrim Hospital individual needs of patients living with dementia and extra support or supervision for vulnerable or agitated patients was not always provided.
  • Despite there being an improvement in complaint responses we saw in several core services where the trust was slow to resolve complaints in line with their own target.

Well-led

Requires improvement

Updated 3 July 2018

  • Not all leaders had the capacity to lead effectively.
  • The arrangements for governance and performance management were not fully clear and did not always operate effectively, however the trust had plans in place to address this.
  • Risks, issues and poor performance were not always dealt with appropriately or quickly enough. The risk management approach was applied inconsistently.
  • The information used in reporting, performance management and delivering quality care was not always accurate, valid, reliable, timely or relevant. Leaders and staff did not always receive information to enable them to challenge and improve performance. Information was used mainly for assurance and rarely for improvement.
  • Leader did not have sufficient capacity to focus on continuous learning and improvement at all levels of the organisation.