Updated 24 November 2023
Lancashire Teaching Hospitals NHS Foundation Trust is an acute trust providing services to the Preston and Chorley areas and a range of specialist services to people in Lancashire and South Cumbria. The trust delivers services from three core sites, Royal Preston Hospital, Chorley & South Ribble Hospital and the Specialist Mobility and Rehabilitation Centre. It is also a major trauma centre. The trust serves a population of 395,000 people and provides regional specialist care to 1.8 million people.
The trust is situated in an area where 20% of the population are 10% most deprived nationally, up to 25% of children and 20% of over 65s are living in poverty. There are high levels of long-term conditions including mental health, cardiovascular disease, asthma, and dementia. By 2035 the over 75s will double. 17% of people in Pennine Lancashire are from a black minority ethnic background.
The trust employs over 8,800 staff and has 900 beds across 2 sites. It has an income of 738 million.
We carried out this unannounced inspection as part of our continual checks on the safety and quality of healthcare services at the trust. We inspected urgent and emergency care at Royal Preston Hospital and Chorley and South Ribble Hospital, and medicine, and surgery at Royal Preston Hospital.
A focussed inspection of maternity services was also undertaken as part of the CQC national maternity inspection programme which looked at the safe and well led questions.
We also inspected the well-led key question for the trust overall.
Where we did not inspect services, using our rating principles the ratings for these services have been aggregated from the inspection in 2019.
No Use of Resources review was undertaken as part of the 2023 inspection.
Our rating of services stayed the same. We rated them as requires improvement because:
- We rated safe, effective, responsive and well led as requires improvement and caring as good.
- We rated surgery at Preston and urgent and emergency care and maternity at Chorley as good. We rated urgent and emergency care, medicine and maternity at Preston as requires improvement. In rating the trust, we took into account the current ratings of the 9 services not inspected this time.
Leaders showed adequate experience, knowledge, and skills to run the service. They mostly understood and managed the priorities and issues the service faced, however during some , interviews leaders could not clearly or consistently articulate certain business details.
Some staff felt leaders were less visible in services where there were greater pressures.
Leaders and teams used systems to manage performance. There was progress with performance but there was still much to do to address elective recovery and delivery of the financial plan.
The trust had processes to escalate relevant risks and identified actions to reduce their impact. However, during our inspection of urgent and emergency care we issued a letter of concern about the management of mental health patients. The trust responded quickly to the concerns raised and monitoring is continuing to ensure there is continued sustainability in mitigation of ongoing risks. Performance since the inspection has been submitted to the CQC fortnightly and shows assurance about the actions that were taken to address these issues.
Also, following our inspection of maternity and a review of trust data, we issued a letter of intent under section 31 of the Health and Social care Act 2008 to the trust who provided the required assurances. No regulatory action was required as a result.
The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
Most staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The trust supported staff to develop their skills and take on more senior roles. Mandatory training for medical staff needed improvement.
Leaders operated effective governance processes, throughout the service and with partner organisations. Staff were clear about their roles and accountabilities. External assurance continued to develop governance processes throughout the trust and with partner organisations.
The service collected reliable data and analysed it.
Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
The trust had a good understanding of quality improvement methods and the skills to use them.
How we carried out the inspection
During our inspection we spoke with a variety of staff including nurses, doctors, therapists, healthcare support workers, pharmacists, patient experience staff, domestic staff, administrators, and the trust’s board. During the inspection we also spoke with patients and relatives. We visited clinical areas across the hospital sites. We reviewed patient records, national data and other information provided by the trust.
We held several staff focus groups with representatives from across the trust to enable staff who were not on duty during the inspection to speak to inspectors.
The inspection was overseen by Sarah Dronsfield deputy director and included an operations manager, inspectors, and specialist advisers. An executive reviewer supported our inspection of well-led for the trust overall. Executive reviewers are senior healthcare managers who support our inspections of the leadership of trusts. Specialist advisers are experts in their field who we do not directly employ.
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.