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Provider: Lancashire Teaching Hospitals NHS Foundation Trust Requires improvement

On 17 October 2018 , we published a report on how well Lancashire Teaching Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires improvement  
  • Combined rating: Requires improvement  

Read more about use of resources ratings

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 17 October 2018

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

  • We rated safe, effective, responsive and well-led as requires improvement, and caring as good. We rated two of the trust’s eight services as requires improvement and four services as good. In rating the trust, we took into account the current ratings of the two services not inspected this time.
  • We rated well-led for the trust overall as requires improvement.
  • Our ratings for Royal Preston Hospital and Chorley and South Ribble Hospital were both requires improvement which was the same as the last inspection
  • Our ratings for urgent and emergency services and medical care, at both hospitals, were requires improvement which was the same as the last inspection.
  • Our ratings for surgery and services for children and young people at Royal Preston Hospital were good which was an improvement from the last inspection. Our rating for surgery at Chorley and South Ribble Hospital was good which was the same as the last inspection.
  • We previously inspected maternity jointly with gynaecology and outpatients jointly with diagnostic imaging so we cannot compare our previous ratings. We rated maternity and outpatients good at both hospitals.
Inspection areas

Safe

Requires improvement

Updated 17 October 2018

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

  • The trust had made improvements to compliance with mandatory training, life support training and safeguarding training since the last inspection but compliance in some areas such as urgent and emergency care was still below the trust’s targets.
  • The trust did not always have enough staffing in every area to keep people safe. While there had been improvements since the last inspection some areas such as the medical core service did not always have enough staff. The emergency departments did not have enough paediatric nursing staff.
  • Some of the areas used for escalation were unsuitable. The trust did not have appropriate areas for patients in the emergency departments with mental health needs, although there were work plans in place to address this.
  • The trust was not doing everything it could to assess and respond to the risk for patients using the emergency departments. Patients did not always receive timely triage and risks to children using Chorley and South Ribble Hospital had not been fully mitigated. However, data provided since our inspection showed an improving performance trend.
  • The trust was not always managing medicines well. There were different issues with medicines management at the trust. Patient group directions were not properly managed and there was no trust wide policy.
  • Patient records were not always completed in line with best practice and stored securely.

However:

  • The trust was managing infection control well. Most of the areas we visited were visibly clean.
  • The trust was carrying out appropriate risk assessments for most patients and had processes for identifying when a patient deteriorated and take action.
  • The hospital was managing safety incidents well in most areas.

Effective

Requires improvement

Updated 17 October 2018

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

  • While the number of staff who had received an annual appraisal had improved since the last inspection, in areas it was not at the trust target.
  • Staff lacked understanding and awareness of the Mental Capacity Act and the Deprivation of Liberty Safeguards in areas of the hospital. Patients who lacked capacity had do not attempt cardio pulmonary resuscitation orders in place without a capacity assessment or best interest meeting.
  • Policies were not always reviewed and updated to ensure that they were in line with latest national guidelines and best practice.

However:

  • While policies were not all up-to-date, care was provided in line with national guidelines and best practice and services were participating and carrying out local audits to improve practice.
  • Patients’ care and treatment outcomes were monitored and compared with similar services, with results used to assist development
  • Staff gave patients enough food and drink to meet their needs and improve their health. In general, pain relief was given to patients when they needed it.
  • Staff worked well together as a team to benefit patients and seven-day services were available to patients.

Caring

Good

Updated 17 October 2018

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

  • Staff throughout the trust were kind, compassion and caring to patients, their carers and family members.
  • Patients were generally involved in decisions about their care and given emotional support when they needed it.

However:

  • Patients’ privacy and dignity patients was not always protected. In the medicine division handovers took place at the bedside where patient details could be heard by other people on the ward.

Responsive

Requires improvement

Updated 17 October 2018

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

  • The access and flow of patients was an issue for the trust which was demonstrated by the hospital not meeting national performance targets and performing worse than the England average for its performance. There were a high number of bed moves at night.

However:

  • The trust planned and provided services to meet the needs of its service users. Services were provided to reflect the needs of the local population.
  • Staff were responsive to people’s individual needs. We saw good examples of how the service had adapted and improved services to support people with additional needs.
  • The trust treated complaints and concerns seriously, investigated them and shared the lessons learnt in a variety of formats.

Well-led

Requires improvement

Updated 17 October 2018

Our rating of well-led stayed the same. We rated it as requires improvement because:

  • Urgent and emergency services had not met most of the national targets and performance in a range of internal trust targets, such as training, safeguarding, and staff appraisals was below trust target. Although recruitment was underway and improvement work had been started to improve performance.
  • Medical services did not have a clear strategy for the service. Staff in different areas were not always were aware of the wider trust vision and strategy
  • Governance and the management structures had recently been reviewed in the medical division and were yet to be fully embedded. In other areas governance structures were working effectively.
  • Urgent and emergency services and medicine had not always managed risks, issues and performance well. Risks were not always escalated appropriately and the services were sometimes slow to implement changes to mitigate risks.

However:

  • Staff were positive about the local, divisional and trust wide leadership, this included in areas with new leaders or that had faced staffing and demand pressures.
  • There was a positive culture and staff were proud to work at the trust and were positive about the future. Staff were always open and honest and committed to working for the trust.
  • In general, the service collected, analysed, managed and used information to support all its activities, using secure electronic systems.
  • The service engaged with patients, staff, and the public and local organisations to plan and manage appropriate services. Within core services and trust wide there were many initiatives to engage with people.
  • Staff were committed to making improvements, although some of these processes were yet to be embedded. Staff were positive about the focus on continuous improvement and initiatives such as the safety triangulation accreditation review process.