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Provider: Lancashire Teaching Hospitals NHS Foundation Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 November 2019

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

  • We rated safe, effective and responsive as requires improvement; and caring and well led as good. At Royal Preston Hospital we rated two of the four services inspected as requires improvement and two as good. At Chorley and South Ribble Hospital we rated both core services inspected as good. In rating the trust, we took into account the current ratings of the services not inspected this time.
  • We rated well-led for the trust overall as good.
  • Our rating for Royal Preston Hospital was requires improvement overall which was the same as the last inspection. Our rating for Chorley and South Ribble Hospital was good which was an improvement from the last inspection when it was rated requires improvement.
  • Our ratings for urgent and emergency care and medicine at Royal Preston Hospital were requires improvement which were the same at the last inspection, although the ratings for effective and well led improved for urgent and emergency care.
  • Our rating for critical care at Royal Preston Hospital was good which was an improvement from the last inspection when we rated it as requires improvement.
  • Our rating for surgery at Royal Preston Hospital was good which was from the same as the last inspection when we rated it as good. Our ratings for effective went from good to requires improvement and our rating for responsive went from requires improvement to good.
  • Our ratings for urgent and emergency care and medicine at Chorley and South Ribble Hospital were both good which was an improvement from the last inspection when they were both rated requires improvement.

Inspection areas

Safe

Requires improvement

Updated 7 November 2019

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

  • The trust did not always have enough substantive staff with the right qualifications, skills, training and experience to meet national staffing standards and provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and were recruiting to vacancies at the time of our inspection.
  • In critical care, at Royal Preston Hospital, the design, maintenance and use of facilities and premises did not enable staff to always keep people safe and staff did not always use equipment and control measures to protect patients, themselves and others from infection. The trust was building new facilities at the time of the inspection.
  • In urgent and emergency care, at Royal Preston Hospital, patients at risk of deterioration within the waiting area were not always identified or acted upon.
  • In medical care, records were not always stored securely. At Chorley and South Ribble Hospital staff did not always document the time medicines had been administered.
  • In surgery, At Royal Preston Hospital, risk assessments for blood clots, and for patients at risk of self harm were not always completed. We found medicines management systems processes were not always being used effectively.

However,

  • Staff had training in key skills, understood how to protect patients from abuse, and managed safety well.
  • The trust generally controlled infection risk well. Staff in most areas assessed risks to patients, acted on them and kept good care records. Staff generally managed medicines well.
  • The trust managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

Effective

Requires improvement

Updated 7 November 2019

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

  • At Royal Preston Hospital staff did not always support patients to make informed decisions about their care and treatment. Patients who lacked capacity were not always supported to make decisions around there care and treatment.
  • In medical care we saw that where mental capacity assessments had been completed, the use of physical restrictions or restraint was indicated without rationale.
  • Not all services at Chorley and South Ribble Hospital were available seven days a week.

However,

  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.
  • Managers monitored the effectiveness of the services and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and had access to good information.

Caring

Good

Updated 7 November 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, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

Responsive

Requires improvement

Updated 7 November 2019

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

  • Patients could not always access services when they needed it. Patients waiting for emergency treatment had to wait longer than national standards and in medical care patients waiting for planned care had to wait longer than the England average.
  • At Royal Preston Hospital there were regular theatre overruns. Although there had been some improvements, cancelled operations were above the England average.

However,

  • 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.

Well-led

Good

Updated 7 November 2019

Our rating of well-led improved. We rated it as good because:

  • 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 generally felt respected, supported and valued. 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.

However,

  • In medical care at Royal Preston Hospital the service had not improved in all of the areas we identified in the last inspection and did not always shared good practice. In surgery we identified new issues at this inspection.
  • Services across the trust had not always worked together to improve patient flow out of the emergency department at Royal Preston Hospital.
  • Some staff within medical care felt that leadership changes had slowed progress and development in the service.

Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 17 October 2018

Combined rating

Combined rating summary

Requires improvement