Blackpool Teaching Hospitals NHS Foundation Trust is situated on the west coast of Lancashire and operates within a regional health economy catchment area that spans Lancashire and South Cumbria and supports a population of 1.6 million. The trust provides a range of acute services to the 330,000 population of the Fylde coast health economy and the estimated 11 million visitors to the seaside town of Blackpool. Since April 2012, the trust also provides a wide range of community health services to the 445,000 residents of Blackpool, Fylde, Wyre and North Lancashire. The Trust also hosts the National artificial eye service, which provides services across England.
The trust provides a full range of hospital services and community health services. These include adult and children’s services such as health visiting, community nursing, sexual health services and family planning and palliative care. The trust provides tertiary cardiac, haematology and adult cystic fibrosis services to 1.5 million population catchment area covering Lancashire and South Cumbria.
At our last inspection in October 2019, we rated safe, effective and responsive as requires improvement, caring as good and well-led for the trust overall as inadequate.
The trust had experienced significant challenges over the past 18 months due to the COVID-19 pandemic. There was significant redeployment of staff at the trust during that period to support staff in critical areas.
We carried out this unannounced inspection, from the 14 September to the 20 October 2021, of Blackpool Teaching Hospitals NHS Trust. We inspected core services at the Blackpool Victoria Hospital including urgent and emergency care, medical care, critical care and surgical care services because of continuing concerns about the quality and safety of these services. We also inspected the well-led key question for the trust overall. We rated urgent and emergency services as inadequate and surgery, medical care and critical care as requires improvement. We rated well-led for the trust overall as requires improvement.
Following this inspection, due to the concerns we had identified at Blackpool Victoria Hospital, we wrote to the trust asking for urgent action to be taken to ensure safe care and treatment.
Details for the summary for each core service inspected can be found later within the report, a summary of the trust wide well led is below.
We rated well led as requires improvement at Blackpool Victoria Hospital because:
- There were several new appointments to the board but the plans they had developed had not yet had time to evidence their impact or sustainability. Not all leaders had the capacity to lead effectively. Not all senior leaders were visible or approachable in the organisation. Leaders were not always fully sighted with what was happening on the front line. They did not always identify their priorities and did not always develop plans to manage these in an effective and timely way.
- The trust did not have a clear vision. Although the trust had not developed a new five year vision and strategy because of COVID-19, they had taken a pragmatic approach by putting the one-year overarching strategy in place within the organisation and had started to develop a five year one; however, there were several strategies that were out of date.
- Not all staff felt supported, respected and valued by their local leaders. There was a lack of supportive inclusion for staff with protected characteristics. The trust was working towards an open culture where patients, their families and staff could raise concerns without fear. However, not all staff felt secure to raise concerns. The trust had work to do in relation to promoting equality, diversity and inclusion in daily work.
- The arrangements for governance were not clear and did not always operate effectively. Not all staff in leadership roles were clear about their roles and accountabilities. Processes were not always effective and completed in a timely manner.
- Risks, issues and poor performance were not always dealt with appropriately or quickly enough. There were systems to manage performance; however, these were not used efficiently. The risk management approach was applied inconsistently and was not linked effectively into planning processes. Significant risks were not always identified or escalated appropriately and there were insufficient processes to identify actions to reduce their impact.
- The information that was used to monitor performance or to make decisions was inaccurate, and unreliable or not relevant. There was inadequate access to and challenge of performance by leaders and staff. The trust was delayed in implementing its digital strategy and had no implementation date at the time of our inspection.
- There was minimal engagement with people who used services, staff, and the public. There was a limited approach to sharing and obtaining the views of staff. There was insufficient attention to appropriately engage with people, including those with protected equality characteristics. Feedback was not always reported or acted upon in a timely way.
- Senior leaders demonstrated the necessary knowledge, capability and integrity. They worked well as an executive team and with leadership teams across the trust.
- The trust did have three key ambitions for what it wanted to achieve within a one-year strategy. The strategy was focused on sustainability of services and aligned to local plans within the wider health economy.
- All staff we met were focused on the needs of patients receiving high quality and compassionate care.
- The trust had sourced an external organisation to review and report on governance processes throughout the trust.
- The trust was beginning to invest in continuous learning and improvement within the organisation, however there was still work to be done through the appropriate use of external accreditation and participation in research. There was knowledge of improvement methods and the skills to implement improvement was beginning to be shared among the organisation.
We rated one of the trust’s 14 services as inadequate overall and three as requires improvement. In rating the trust, we took into account the current ratings of the 10 services not inspected this time.
How we carried out the inspection
During our inspection we spoke with a variety of staff including consultants, doctors, therapists, nurses, healthcare support workers, pharmacists, patient experience, domestic staff and administrators and the trust’s board. During the inspection we also spoke with patients and relatives. We visited numerous clinical areas across the hospital site. We reviewed patient records, national data and other information provided by the trust.
We held several staff focus groups with representatives from all over the trust to enable staff who were not on duty during the inspection to speak to inspectors. The focus groups included junior and senior staff from pharmacy, junior and senior nursing staff, junior doctors and consultants, allied health professionals, staff representing equality diversity and inclusion, a separate focus group for staff from a black, Asian and minority ethnic backgrounds. We also had focus groups for the non-executive directors and governors.
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.