East Lancashire Hospitals NHS Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

The service was in breach of regulation in relation to the provision of person-centred care (Regulation 9).

This service scored 62 (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 did not always make sure patients were at the centre of their care and treatment choices and they did not always work in partnership with patients, to decide how to respond to any relevant changes in patients' needs.

We did not find sufficient evidence that patients' individual views and preferences were taken into account in the planning and delivery of their care. The patients and relatives we spoke with were not aware of the contents of their care plans, although they did say that staff sought consent on an ongoing basis before providing relevant aspects of their nursing and therapeutic care. The records did not show how patients were involved in their care as the only record of patient agreement with the care plans was a tick box.

The electronic care plans on all wards were brief and lacked detailed information about how patients were being cared for to meet their assessed care needs. For example, one patient had a falls care plan which just stated “provide bed rails” without any detail to guide staff on how this aspect of the individual’s care should be managed. Patients had anticipated discharge dates on the records but did not always have discharge care plans. Two patients on one ward had been identified as having swallowing needs but did not have a care plan on their records relating to this (although the correct plan for their diet and fluids was clearly displayed on a noticeboard in the patient kitchen, which reduced any risk arising from this).

There was minimal documentation on the care records in relation to patients’ views to evidence patient involvement and informed consent to their care and treatment. We observed a staff nurse telling a patient about his lowered blood oxygen levels by saying “the numbers are deranged” which is likely to have been difficult for the patient to understand. Five patients said they had not been given information they would have liked, for example about who was in charge of the ward, the plans for their discharge, how to make a complaint or about what medicines they were taking and why. However, we saw that patients did have access to a rehabilitation booklet which included the plans for their physiotherapy and occupational therapy, when they were receiving this.

During our observations of care we usually saw that staff were meeting patients' needs in a person-centred way. However, we did see some examples of patients' needs not being met, for example a drink being provided in a cup which the patient could not lift and a patient not having regular access to clean clothes due to not having any family to support them with their laundry.

The service understood the diverse health and care needs of patients and their local communities, so care was joined-up, flexible and supported choice and continuity.

The trust planned and organised services so they met the changing needs of the local population. There was a model of care for the community inpatient service and other key trust strategies, such as the overarching dementia strategy, which were planned and delivered in partnership with local and national stakeholders within the NHS and more widely.

Staff knew about and understood the standards for mixed sex accommodation and knew when to report a potential breach. All patients were accommodated in either private rooms or single sex bays. Staff could access emergency mental health support 24 hours a day 7 days a week for patients with mental health problems, learning disabilities and dementia.

Facilities and premises were appropriate for the services being delivered and staff made reasonable adjustments to support accessibility where required, for example provision of walking aids to support patients mobilising independently around the ward and to enable them to leave the ward with family visitors. Staff supported patients living with dementia and learning disabilities by using documents such as patient passports and the use of the ‘Forget Me Not’ dementia support scheme. All clinical staff received training in meeting the needs of patients with learning disabilities and/or autism and dementia as part of their ‘essential to job role’ training modules.

The service had access to information leaflets available in languages spoken by the patients and local community. Managers made sure staff, and patients, loved ones and carers, could get help from interpreters for languages other than English, including British Sign Language. Staff and family carers told us that patients whose first language was not English were able to access interpreters. Patients were given a choice of food and drink to meet their cultural and religious preferences. The patients and visitors we spoke with from minoritised communities told us that they were happy with how their cultural needs had been met.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed, including NHS incident reporting systems and CQC.

The service was working towards full compliance with the Accessible Information Standard (AIS). The trust had an AIS working group and the progress of this piece of work was monitored by sub-committees of the trust board including the Patient Experience Committee and the Health Inequalities Committee.

Staff ensured that patients could obtain information on the care provided, ward facilities, how to complain and other relevant topics. Information was included in the patient leaflets, the trust’s website and on noticeboards displayed on all the wards we visited. Written information could be made available in accessible formats such as large print and Braille and in languages other than English on request. However, some patients and relatives told us that they had not received some information which would have been helpful to them, for example about their medicines, the facilities available on the ward or the trust’s complaints process. The ward noticeboards had a poster displayed giving the contact details of the trust’s Customer Relations Team. However, this did not make it clear that this was the correct avenue for patients or relatives to follow if they wished to complain or raise concerns about their care.

Staff ensured carers and families were regularly updated about the patient’s progress. Most of the family carers we spoke with told us that they felt well informed about how their relative was progressing in relation to their rehabilitation and recovery.

The service did not always make it easy for patients to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve patients in decisions about their care or tell them what had changed as a result.

Most of the patients and family carers we spoke with told us that they had not been asked for any feedback about their experience of the hospital. However, some relatives said they had completed an NHS Friends and Family Test (FFT) questionnaire and we saw that the trust collated and analysed FFT feedback and complied summary reports for each ward. The trust confirmed that patients and relatives were routinely asked to complete the FFT questionnaire at the point of discharge. We also saw evidence that improvements were made in response to patient and relative feedback – examples included changes to the menu options and activities available on Hartley ward and an increase in the variety of food available for people on a modified diet on Ribblesdale ward.

Patients and relatives mostly told us that they had not been given any information about how to raise concerns about the care provided or how to make a formal complaint. Although this information was available on the trust’s website and in the written information available for patients about the wards, we found that staff were not usually highlighting this information to people using the service to make sure they knew how to raise concerns if they were unhappy with any aspect of their care.

Rates of complaints were low, with only 7 complaints across all wards in the 12 months preceding our inspection. Of these, 3 were partially upheld and 4 were not upheld. No particular ward was a significant outlier in relation to the complaints the trust had received about the community care wards. The trust also monitored compliments received from patients and families and there were 9 of these across all wards in the 12 months preceding our inspection. Complaints were acknowledged and progressed in a timely manner. There were no formal complaints about the intermediate care service which had not been acknowledged or responded to at the time we inspected.

The staff and managers we spoke with were aware of how to handle complaints from patients and relatives and we saw no evidence that patients would be at risk of discrimination or harassment if they complained about their care. However, we were not always fully assured that complaints were being investigated by staff who were independent of the individual’s clinical care. Complaints were a standing agenda item at the management meetings and ward-level staff meetings across the community inpatient service. This included consideration of any trends or themes of concern arising from complaints and other sources of feedback, such as online reviews.

The trust’s Patient Experience Group (PEG) met every two months and reviewed a range of patient experience data including FFT and other surveys, PLACE inspections and patient views gathered during audits and internal quality inspections. This included identification of any themes or trends of concern arising from patient and relative feedback. The minutes of the January 2025 PEG meeting showed overall positive feedback having been gathered from patients across the community inpatient service in the two months preceding our inspection. The PEG produced an exception report to highlight any issues of concern to the trust board following each meeting.

The service made sure that patients could access the care, support and treatment they needed when they needed it.

Managers monitored waiting times and made sure patients could access services when they needed them and received treatment within agreed timeframes and national targets. The trust confirmed that most patients were allocated a bed within 2 days of the clinical decision for them to transfer to community care. Waiting times data was available for the Rakehead Centre, which confirmed an average waiting time of 2 days for admission in the 12 months prior to our inspection.

Managers and staff worked to make sure patients did not stay longer than they needed to. Each patient’s progress towards discharge and the arrangements which needed to be in place to enable this was discussed at the weekly multidisciplinary team meetings on each ward, with input from medical, nursing and therapies staff and a Complex Case Manager where necessary. Admission and discharge data was monitored, including rates of delayed discharges and discharge processes were a standing agenda item at the regular ‘Share to Care’ all staff meetings on each ward. Ward managers confirmed that staff did not move patients between wards at night.

Staff planned patients’ discharge carefully, particularly for those with complex mental health and social care needs. During the multidisciplinary team meeting we observed, the progress of each patient towards discharge and any arrangements which needed to be made for community support in relation to this were discussed. A Complex Case Manager was present at the meeting who took the lead on any discussions which needed to take place with community teams and other stakeholders to support people being discharged from the ward as soon as possible. All patients had their anticipated discharge date recorded on their records.

Patient flow data including length of stay, bed occupancy and discharge rates was reviewed at quarterly divisional meetings to enable the trust to maintain oversight of any concerning themes or trends in relation to access to the service.

Staff and leaders actively listened to information about patients who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The trust had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. This was a standard part of the process for development and review of all trust policies and procedures.

The standard initial admission assessment of patients’ needs and the risks relating to their care enabled staff to capture a range of data about each patient’s individual needs, including any protected characteristics, and the patients we spoke with told us that they had not experienced any discrimination or barriers to accessing the service or during their experience of receiving care on the ward.

Staff were trained in equality, diversity, inclusion and human rights. This formed part of the core mandatory training undertaken by all staff and, at the time we inspected, all of the community inpatient wards were over 95% compliant with this training module. The staff we spoke with were able to give examples of how they would support patients with protected characteristics to avoid subjecting them to discrimination.

Patients were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment and their future. Where a decision had been made not to attempt to resuscitate a patient in the event of a cardiac arrest (DNACPR) this was clearly documented on patients' records and highlighted to staff during handover and on the Patient Status at a Glance (PSAG) boards in the nursing offices and on the front page of the patient’s electronic records.

Care for patients who were nearing the end of their life was managed and communicated in a sensitive and dignified way. Ward managers told us that, if someone on the ward needed end of life care, this would be care planned and there would be close working with the patient’s family to ensure they could spend as much time as they needed with their loved one.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of patients with complex needs. There were Complex Case Managers on the multidisciplinary teams who took the lead on communicating with other providers and teams within the trust to ensure care pathways for patients with complex needs were well managed.