East Lancashire Hospitals NHS Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure patients' care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive assessment of each patient in a timely manner. All the records we looked at included a range of assessments which had been completed in a timely manner following admission. These covered patients’ care and rehabilitation needs and a range of risks relating to their care.

Staff developed care plans that met the needs identified during assessment. Although care plans were brief and showed minimal evidence of patient involvement (a tick box to confirm the patient’s consent had been obtained), there were care plans in place on the electronic record system in relation to all identified needs for the patients whose records we reviewed. Care plans were recovery-oriented - for example, people had plans for rehabilitation therapies, nutrition, pressure area care, falls prevention and any specific long-term conditions they had. However, there was limited information in the plans to show how they were individualised due to how brief they were. Staff told us that the care plans supported them to deliver care which met people’s needs.

Staff updated care plans when necessary. All the records we looked at showed evidence of patients' care plans being reviewed and updated to ensure they were an up-to-date reflection of the individual’s care needs. The ward managers we spoke with told us that staff were expected to review and update care plans regularly and there was a system of records audits in place which included checks of when care plans had last been reviewed.

The service planned and delivered patients' care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The trust implemented national guidance including National Institute of Health and Clinical Excellence (NICE) guidance and had an action plan in place to ensure that national Getting It Right First Time (GIRFT) recommendations relevant to the Medicine for Older People directorate (which included the community inpatient wards) were implemented where appropriate. Examples of NICE guidance recently implemented within the trust included guidance on sepsis management and antimicrobial prescribing for urinary tract infections. Ward managers described how updated policies and patient safety alerts were shared with the teams via team meetings and emails, and staff confirmed receiving these updates.

At handover meetings, staff routinely referred to the psychological and emotional needs of patients, their relatives and carers. The information shared at the handover we observed included a range of relevant information about each individual’s care. Records of previous handovers confirmed that this took place consistently.

Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and best practice. The trust used the nationally recognised Abbey pain scale to support staff in accurately assessing people’s pain, including when they were not able to clearly communicate their needs verbally and records showed that pain scores were being completed regularly. The patients we spoke with did not raise any concerns about delays in receiving pain relief once they had requested this and records showed patients were receiving regular and/or ‘as required’ doses of pain relief such as paracetamol where this was appropriate.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. The staff we spoke with confirmed they were supported through induction and ongoing mandatory and role specific training to deliver care which met the needs of the patients on their ward. Training records showed a high level of compliance with almost all modules across all the wards.Patients and relatives told us that staff were usually able to meet the needs of the patients, however some patients told us there could be delays in staff responding to their buzzers.The template document we saw for staff’s annual performance review included a section where the staff member’s training and development needs could be reviewed. Staff told us that they had time and capacity to keep their training and continuing professional development up to date.

Managers made sure staff attended team meetings or had access to full notes when they could not attend. We saw minutes of recent team meetings from all the wards and managers and staff confirmed that these took place and that they received a copy of the minutes by email if they were not on shift on the day of the meeting. Managers identified poor staff performance promptly and supported staff to improve. Poor staff performance resulting in disciplinary action was rare (4 instances across all wards in the 12 months preceding our inspection). Ward managers told us that the preferred approach was to support staff to improve through supervision (although also acknowledged that there was not a formal programme of 1:1 supervision sessions in place for staff at the time we inspected).

The service worked well across teams and services to support patients. Staff made sure patients only needed to tell their story once by sharing their assessment of needs when they moved between different services.

The trust had a written standard operating procedure for inter-disciplinary team working in the adult community inpatient service, which was last reviewed and updated in September 2024. Each ward had a system of multidisciplinary team (MDT) meetings which took place at least weekly where each patient’s progress was reviewed. Some of the MDTs included a Complex Case Manager who was responsible for liaising with other agencies in relation to the patient’s ongoing health and social care needs following their discharge from the ward. Patients and their relatives told us that they were kept well informed of the plans for their discharge and ongoing care.

Staff referred patients for mental health assessments when they showed signs of mental ill health such as depression or anxiety. All patients received a mental health assessment on admission which included screening for symptoms of depression and anxiety. Ward managers told us that staff had access to psychiatric liaison teams where this was required due to concerns about an individual’s mental state. Patients who had experienced low mood during their admission told us they had been able to see a mental health professional.

Patients had their care pathway reviewed by relevant consultants. All the MDT meetings were attended by either a consultant physician or a GP who led each patient’s care pathway throughout their admission. Staff confirmed that they were able to access a doctor promptly when needed, including at night and at weekends.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives – for example, through participation in an ‘active hospital’ scheme designed to promote regular movement during their hospital admission and healthy eating advice alongside nutritious menu options. Patients were prescribed nicotine replacement therapy if they expressed a desire to quit smoking during their admission. The service had information promoting healthy lifestyles and outlining the support available to patients displayed on noticeboards on all the wards we visited. Ward activities helped promote a healthy lifestyle for patients including craft activities to promote psychological wellbeing, cooking activities, breakfast clubs and exercise groups.

Staff made sure patients had enough to eat and drink, including those with specialist nutrition and hydration needs. Noticeboards in the ward kitchens clearly identified for staff when patients needed thickened fluids and/or softened food due to choking risks or other swallowing needs. Ward managers told us that patients were weighed once a week and we saw in the care records that people had care plans in place to support their nutrition and/or hydration needs where particular risks in these areas had been identified. Where food and fluid charts were being completed to monitor people’s dietary and fluid intake, these were complete and up to date. The trust used the nationally recognised Malnutrition Universal Screening Tool (MUST) at the point of admission to assess patients for risk of malnutrition. Records showed that specialist support from staff, such as dietitians and speech and language therapists, was available for patients who needed it and ward managers at each site told us that staff were able to access specialist support without any significant delay.

The service routinely monitored patients’ care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients themselves.

Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. The trust’s audit calendar included a range of monthly checks including staff compliance with Aseptic Non-Touch Technique (ANTT) and hand hygiene procedures, completion of National Early Warning Score (NEWS) 2 documentation, cannula and catheter care and falls prevention measures. The reports from these checks highlighted where compliance was below the expected threshold and action was taken in response to any shortfalls, to improve care outcomes for patients. The service also participated in relevant national clinical audits, identifying a lead clinician for each audit it was taking part in and monitoring the progress of and outcomes from these.

Managers shared and made sure staff understood information from the audits. Minutes of governance meetings and ward-level staff meetings showed that the findings of audits were discussed and shared on an ongoing basis. The trust also carried out yearly and monthly Matron’s checks against the CQC standards which were called Nursing Accreditation and Performance Framework (NAPF) reviews, with red, amber and green ratings being given for each of the 5 key questions of safe, effective, caring, responsive and well led. Findings from these were fed back to ward managers and we saw evidence that action was taken to address themes of concern identified from the NAPF assessments – each ward had an ongoing action plan including any improvement areas highlighted by the NAPF assessments, and these were updated regularly. Audit findings and a range of key performance indicators, such as mortality data, pressure ulcer incidence and significant patient safety incidents, were also discussed at the relevant sub-committee of the trust board and we saw reports and meeting minutes which confirmed this.

A range of key performance indicators were reviewed at quarterly divisional performance meetings, most recently for the Community and Intermediate Care Division in January 2025.These meetings included a review of quality and safety data such as incidents, complaints and audit findings, patient flow data such as length of stay, bed occupancy and delayed discharges, workforce planning data, an update on ongoing quality improvement projects and a review of the divisional risk register.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment. Where patients did not have the capacity to consent to their care then appropriate safeguards were in place which complied with the Mental Capacity Act 2005.

The trust had a written consent policy which was approved by the Patient Safety and Risk Assurance committee in January 2023. This set out detailed guidance for staff in relation to their responsibilities to ensure patients gave informed consent to their care and treatment. There was also a separate Mental Capacity Act policy which was approved by the Safeguarding Committee in December 2023, to give clear guidance to staff on their duty to comply with the Mental Capacity Act for patients who lacked the capacity to consent to any aspects of their care.

Staff took all practical steps to enable patients to make their own decisions. We observed staff asking for consent before providing care to patients during our time on the wards and the patients we spoke with told us that staff sought their permission while supporting them. Records showed that patients' consent had been obtained in relation to their care plans, although there was limited evidence to show how this consent was fully informed, as the record was just a tick box confirming the patient had agreed to the plan.

When there were concerns in relation to a patient’s capacity to consent to their care, staff assessed and recorded capacity to consent appropriately. This was done on a decision-specific basis, for example in relation to plans for where the patient would live on discharge from the ward. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history and involving their family carers where appropriate. The outcomes of best interests decision-making meetings were documented in the care records.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. The staff we spoke with about compliance with the Mental Capacity Act were able to give examples of when an assessment of capacity would be appropriate. Staff received and kept up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards – this formed part of the mandatory safeguarding training undertaken by all staff. On all wards 90% of staff or more were up to date with this training, with the exception of level 3 training for eligible staff on ward 19 (86%) and Albion Mill (63%). The staff we spoke with could describe and knew how to access the Mental Capacity Act policy and get accurate advice on Mental Capacity Act and Deprivation of Liberty Safeguards.

Managers monitored compliance with the Mental Capacity Act and Deprivation of Liberty Safeguards and made changes to practice when necessary. A quarterly Mental Capacity Act compliance audit was carried out. The report from the most recent audit (2024/25 Quarter 3) showed variable levels of compliance with the audit standards, for example 98% of mental capacity assessments included evidence of impairment of the mind but only 23% included documentation of the needs and wishes of the patients during the process of making decisions in their best interests where they did not have the capacity to consent themselves. A rolling action plan was created following each audit to address the shortfalls identified. Most of the actions from the Quarter 3 audit had been completed at the time we inspected.

Staff implemented Deprivation of Liberty Safeguards (DoLS) in line with legislative requirements. Ward managers told us that DoLS authorisations had been applied for and obtained for all patients lacking the capacity to consent to their admission to the ward. Data on DoLS applications was tracked over time and showed an increase in applications in the months preceding our inspection. The trust stated this was due to improvements in staff awareness of when an application for a DoLS authorisation was required as a result of lessons learned from audits.