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Provider: Blackpool Teaching Hospitals NHS Foundation Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 October 2019

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

We rated safe, effective, responsive as requires improvement, and caring as good. We rated six services as requires improvement, one as inadequate, nine of the trust’s services as good and one service as outstanding. We rated caring for community services as outstanding.

We rated well-led for the trust overall as inadequate.

Inspection areas

Safe

Requires improvement

Updated 17 October 2019

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

  • The trust did not always have enough nursing, medical and allied health professional staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. In some services there were high levels of agency and bank staff usage to fill vacancies.
  • Staff did not consistently asses risks to patients, act on them or keep good care records. Records were not always stored securely.
  • Incidents were not consistently reported to identify patterns and trends. Learning from incidents was not effectively shared.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The trust controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

Effective

Requires improvement

Updated 17 October 2019

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

  • Staff did not consistently monitor the effectiveness of care and treatment in some services. They did not always use the findings to make improvements and achieve good outcomes in several hospital based services.
  • Staff did not always assess and monitor patients regularly to see if they were in pain and give pain relief in a timely way.
  • Key services were not always available seven days a week to support timely patient care in surgery and critical care.
  • The trust did not always provide care and treatment based on national guidance and evidence-based practice. Several policies and guidelines in different services required updating. Several key clinical guidelines had not been reviewed including, ‘non-invasive ventilation’; chronic obstructive pulmonary disease’ and ‘stroke’ pathways. Other pathways were not in place.
  • Staff did not always support patients to make informed decisions about their care and treatment. They did not always know how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

However

  • In community services patient outcomes were monitored and improvement work was in place to enhance patient outcomes.
  • Staff gave most patients enough food and drink to meet their needs and improve their health.
  • In community and some hospital services staff supported each other to provide good care.

Caring

Good

Updated 17 October 2019

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.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • Staff supported and involved children, young people and their families to understand their condition and make decisions about their care and treatment. They ensured a family centred approach.

Responsive

Requires improvement

Updated 17 October 2019

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

  • We rated services within Blackpool Victoria Hospital as inadequate for being responsive. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards. For example, urgent (two-week) cancer referral performance had declined; particularly in relation to urgent assessment for suspected breast cancer, which had fallen to unacceptable levels. Since our inspection the trust has taken action to improve the urgent (two-week) cancer referral performance.
  • We found examples where services had not planned to meet patient’s additional needs and where environments were not in line with national guidance.
  • People could not always access the services when they needed them and did not always receive the right care promptly. The four-hour performance target in urgent and emergency care was consistently below national targets with no improvement.
  • The trust’s response to complaints were not always compassionate, fully investigated and reflective of the findings. We were also concerned that the system in place was not timely in line with complaint regulations.

However

  • There were innovative approaches in community services to provide integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
  • People could access community health services when they needed them, and technology was used innovatively to ensure people had timely access to treatment, support and care.

Well-led

Inadequate

Updated 17 October 2019

Our rating of well-led went down. We rated it as inadequate because:

  • We rated well-led for services within Blackpool Victoria Hospital and Fleetwood Hospital as requires improvement. We rated well led at trust level as inadequate.
  • Not all leaders had the knowledge and capacity to lead some of the services and effectively implement change.
  • Leaders did not always operate effective governance processes throughout the service and with the wider hospital. Staff did not always have regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams did not use systems to manage performance effectively. They did not always identify and escalate relevant risks and issues and identify actions to reduce their impact. Risks and issues were not always dealt with quickly enough.
  • Staff did not always understand the service’s vision and values. Staff did not always feel respected, supported and valued. We were concerned about the culture within Blackpool Victoria Hospital. More information can be found within our well-led report.

However

  • We rated well-led within Clifton Hospital and community services as good.
  • In Clifton Hospital and community services staff felt respected, supported and valued. There was strong collaboration and team working and staff were focused on the needs of patients receiving care.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 17 October 2019

Our rating of use of resources went down. We rated it as requires improvement because:

We were concerned around the Trust’s plans to return to financial balance and performance in constitutional operational performance standards.

Combined rating

Combined rating summary

Requires improvement

Updated 17 October 2019

Our rating of combined quality and resources went down. We rated it as requires improvement because:

  • We rated safe, effective, responsive and well-led as requires improvement, and caring as good. We rated six services as requires improvement, one as inadequate, nine of the trust’s services as good and one service as outstanding. We rated caring for community services as outstanding.

  • We rated well-led for the trust overall as inadequate.
Checks on specific services

Community health services for children, young people and families

Good

Updated 17 October 2019

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

  • The service provided mandatory training in key skills to all staff and most staff received and kept up to date with their mandatory training.
  • Staff understood how to protect children, young people and families from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment in the service kept people safe. Staff managed clinical waste well. A large number of the directorates services were delivered in modern high specification primary care centres and children’s centres across the localities of the teams services.
  • Staff in the service completed and updated risk assessments for each child and young person and acted to remove or minimise risks. Staff identified and quickly acted upon children and young people at risk of deterioration.
  • Data provided by the trust showed that the service had less staff than it had planned for. In our interaction with staff we found that the service had 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. Managers regularly reviewed and adjusted staffing levels and skill mix and gave staff a full induction.
  • Staff in the service understood the relevant consent and decision-making requirements of legislation and how this related to young people such as guidance for Mental Capacity Act 2005, Children’s Acts 1989 and 2004, Gillick competence 1985.
  • 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. The directorate reported no incidents classified as never events and no serious incidents in the period from May 2018 to June 2019.
  • The service provided care and treatment based on national guidance and evidence-based practice.
  • Staff teams understood the needs of local people and had introduced systems so that staff deployment met the need of high and low population areas.
  • The staff in the service were aware of the diversity of populations and the challenges faced by some of its communities. Staff had access to multi-lingual sources such as translation services to support patient care.
  • The directorates leaders had the skills, knowledge and experience to guide and lead staff. management were respected, seen as supportive and effective in their roles.
  • Leaders in the trust and in the directorate had a vison for children and families’ services which focused on promoting well-being and nurturing. The service planned to move to a more holistic model of care which was connective with other services to promote well-being

However;

  • In a number of teams, patients had long waits to start treatment. Arrangements to admit and treat patients were sometimes not in in line with national standards. Young people and families found it difficult to receiver treatment when they needed it and therefore did not received the right care promptly.
  • Whilst the service provided mandatory training in key skills to all staff and most staff received and kept up to date with their mandatory training. We found that the directorate still had some room for improvement to reach the trust completion target in some of its mandatory courses.
  • It was clear that supervision process needed to be reviewed and adjusted so that a clear chain of evidence concerning discussions about safeguarding occurred. Serious safeguarding concerns were still escalated and shared with the trusts safeguarding team.
  • Whilst records audits showed positive results we found some recording to be patchy in some services with elements of care planning missing.

Community end of life care

Good

Updated 17 October 2019

We rated it as good because:

  • Since our last inspection the service continued to be provided by an integrated partnership between the trust and Trinity Hospice. There were enough staff to care for patients and keep them safe. Staff assessed risk to patients and acted on them. They managed medicines well.
  • The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it.
  • The service was planned, organised and delivered well. Care was delivered by competent practitioners who considered the needs of all patients and families in their care.
  • Since our last inspection the end of life care service’s vision and strategy had been set out for 2017-2020. The service had an action plan to monitor and deliver the vision and strategy working with external partners and the involvement of staff.
  • Staff provided a range of treatment and care for patients based on national guidance and best practice.

However:

  • Training in end of life care was not mandatory for all staff.
  • There was no non-executive director at board level for end of life care.

Community health sexual health services

Good

Updated 17 October 2019

Our rating of this service stayed the same. 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 provided good care and treatment. 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. Staff felt respected, supported and valued. 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.

Community dental services

Good

Updated 17 October 2019

Our rating of this service stayed the same. 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.
  • 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. Staff felt respected, supported and valued. 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:

  • Audits of the decontamination process were only carried out annually.
  • Medical emergency medicines and equipment were not taken on domiciliary visits. This had not been formally risk assessed.
  • Waiting times for a paediatric general anaesthetic in the south region were excessive.

Community health services for adults

Outstanding

Updated 17 October 2019

Community adult services was last inspected in November 2017 and was rated overall as outstanding.

Our rating of this service stayed the same. We rated it as outstanding because:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan and deliver care in a way to ensure flexibility, choice and continuity of care.
  • There were innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs.
  • People could access community health services for adults when they needed them, and technology was used innovatively to ensure people have timely access to treatment, support and care.
  • People were respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by dedicated staff.
  • Staff were motivated and passionate in providing care that is kind and promotes dignity.
  • Patients felt cared for and valued their relationship with staff and their personal preferences and needs were always reflected in the care they received.
  • Staff found innovative ways to enable people to manage their own health and care when they could and to maintain independence as much as possible.
  • Staff of different kinds were committed to work collaboratively within their service but also with external organisations to benefit patients and provide good and effective care.
  • Staff consistently supported people to live healthier lives, including identifying those who need extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they used every contact with people to do so.
  • The leadership, governance and culture promoted the delivery of high-quality person-centred care.
  • Leaders had the skills and abilities to run the service and were visible, approachable and supportive for patients and staff.

However:

  • Not all staff had received all relevant training in safeguarding children.
  • There were limited opportunities for staff to engage and share good practice or better ways of working across different localities.

Specialist community mental health services for children and young people

Requires improvement

Updated 17 October 2019

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

  • Staff did not always develop holistic, recovery-oriented care plans in collaboration with patients, families and carers. Staff did not engage in clinical audit to evaluate the quality of care they provided.
  • Children who did not require urgent care waited too long to start treatment. The criteria for referral to the service excluded children and young people who would have benefitted from care.
  • Governance systems and processes did not always ensure that the quality and safety of the services provided was accurately assessed, monitored or improved. The service did not provide us with valid data about waiting times. The trust did not accurately identify which staff were eligible for some mandatory training topics, meaning that compliance figures were incorrect. Information on risk was not always easy to find in patients’ care records and staff did not document whether they had offered patients a copy of their care plan.

However:

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. Patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff provided a range of treatments that were informed by best-practice guidance. The team included the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service was easy to access for children who met the referral criteria.
  • The service was well led and the governance processes ensured that most of the procedures relating to the work of the service ran smoothly.

Reference: Community health (sexual health services) not found

Good

Updated 22 March 2018

We had not previously inspected this service. We rated it as good because:

  • Whilst the service did not reach its mandatory training target, we saw strong levels of compliance.
  • The service had robust systems and processes in place to learn from incidents and effectively share learning and improve practices. Incidents were low.
  • We found safeguarding policies and procedures were in place and arrangements were in place for assessing patients’ need.
  • The service evidenced a multi-agency approach to engaging with clients.
  • Staff used national assessment and clinical guidelines which were based on national best practice.
  • Clinical sites and waiting areas were clean and safe.
  • We found the staffing levels of services were sufficient to meet the needs of patients.
  • The service met the needs of its population including individuals who were vulnerable.
  • The service was based on best practice contributing to local and national audits.
  • The service was well managed and managers were proactive in making disparate teams a collective.