The Care Quality Commission (CQC) has rated the services provided by University Hospitals of Morecambe Bay NHS Foundation Trust as Requires Improvement overall following inspections in November and December 2018. Previously it was rated Good.
The trust was rated as Requires Improvement for being safe, responsive and well-led and Good for being effective and caring.
A team of CQC inspectors assessed three core services: urgent and emergency care, surgery and medicine. They also looked specifically at management and leadership to answer the key question: Is the trust well-led?
While the overall rating for Royal Lancaster Infirmary has fallen to Requires Improvement, Furness General Hospital and Westmorland General Hospital remain rated as Good overall.
CQC has also published the trust’s Use of Resources (UoR) report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Inadequate for using its resources productively. The combined rating for the trust, taking into account CQC’s inspection for the quality of services and NHSI’s assessment of Use of Resources, is Requires Improvement.
Full details of the ratings, including ratings for each individual service are given in the report published online at: https://www.cqc.org.uk/provider/RTX
The Chief Inspector of Hospitals, Professor Ted Baker, said: “It is disappointing to see this trust return to a rating of Requires Improvement, although I note the staff are doing everything they can to care for patients in a respectful and compassionate manner, often working under significant pressure.
“Inspectors did see some outstanding practice including the improvements in working arrangements in Westmorland’s cardiac unit, the helpful visual and technological advances at Royal Lancaster and the supportive culture in Furness General.
“That being said, it is concerning that the three hospitals’ urgent and emergency services were presenting significant challenges and some of the quality improvements across the trust have not been sustained. The trust has worked very hard in recent years to bring its performance up to standard and it needs to do that again now.
“We will be monitoring the trust’s performance closely. We will return to the trust in due course to report on our findings.”
In Royal Lancaster’s urgent and emergency service, inspectors found nurse staffing levels and the service’s ability to monitor patients was not always effective. At busy times staff found meeting patients’ needs challenging and regular checks on patients were not always evidenced. Inspectors found that the leadership team were not always following up on areas of concern with with robust actions, staff appeared unaware of what improvements were needed.
Inspectors did report that other areas of the hospital had effective systems to identify and reduce risks to patient safety and processes were in place to consider the needs of local people. Staff were seen to be supportive and delivered care with compassion and kindness. There was good team working throughout the hospital and staff had the right mix of skills to care for patients.
Across Furness General Hospital nurse staffing was improved and leadership teams were visible and approachable, providing good oversight of their areas. Staff reported that the culture in the hospital was positive and staff were involved in developing the service delivery alongside patient feedback and local community groups. Risks were being identified and reviewed, staff were well updated through leadership meetings and newsletters.
But in the urgent and emergency service consultant cover was limited and it was not meeting some performance targets. On occasion the service had also experienced pressures and lengthy delays in quickly admitting patients arriving by ambulance. Inspectors found that action plans lacked detail and the outcome of quality improvements was not being monitored well.
In Westmorland General Hospital inspectors saw that the care being provided was largely good across its services and staff were well supported in delivering high quality care. There was a focus on continuous learning and staff were involved in collaborative working to drive improvements. Inspectors also noted that staff morale was high, and complaints were low.
However, in its urgent treatment centre inspectors were concerned that patients whose health risked deterioration may have gone unidentified because the waiting area was not well monitored. Staff were not being regularly appraised in their roles and their training was not up to date, as a result some staff were managing certain conditions which could expose some patients to risk. Inspectors did note that the service had only recently transferred to the trust and therefore still developing new ways of working to ensure patients were safe.
UHMBT Chief Executive Aaron Cummins said he welcomed the report and, in particular, the view of the CQC that colleagues across the Bay continue to provide caring and effective services to our patients despite significant pressures.
“The inspection was carried out between October and December 2018, with the unannounced, site-based element conducted for our urgent care and surgical services only in December. The observation of inspectors gives a fair reflection of how our organisation was performing in those areas over that period,” said Aaron.
“This is the first time the Trust has experienced the new CQC & NHS Improvement (NHS I) combined inspection regime, examining our hospital services, conducting a Well-Led Review and a Use of Resources Review (which highlights the Trust’s financial performance) simultaneously. This comprehensive assessment highlights both areas of good practice and areas we know we need to continue to improve.”
“These areas include improving the care and experience for our patients in our Emergency Departments (particularly when under pressure), improving our adherence to policies and procedures relating to documentation and checking equipment, continued improvement in recruiting additional staff and delivering improvements in our productivity and efficiency.”
“Despite the pressures the health system is under, we are all disappointed with some of the observations made as part of the inspection and I know we will all work hard to ensure we respond to the issues raised in the report quickly and that those improvements are sustained.”
Aaron also commented on some of the challenges the Trust is facing, particularly in relation to the Use of Resources assessment which NHS I rated as inadequate, contributing to the overall Trust rating.
“As a result of the current financial challenges (both local and national) our hospitals have not been sufficiently invested in over recent decades, resulting in buildings which are inefficient, overly costly to run and in some parts just not good enough for our patients or staff to have a consistently positive experience.
“Our colleagues make the very best of it – we’ve seen some phenomenal results of improvements in services delivered without any additional funding, done by working innovatively in partnership with our commissioners and other providers, such as GPs and community teams to reduce demand through schemes like our Patient Initiated Follow Up initiative, improved staffing through our nurse apprenticeship
scheme or delivering our annual cost improvement plans each year; but to deliver further improvements and the efficiencies required over this next period we are looking to secure much needed capital investment.
“The Trust also has a number of challenges in improving its productivity and efficiency given its geography (covering 1,000 square miles) and the need to run three hospital sites to ensure the local population has the access it needs to essential health services. That said, there is now clear evidence of areas we can be more productive in – such as our operating theatres and outpatient clinics – which we are committed to delivering and improving services as a result.”
Aaron went on to commend the Trust’s colleagues: “I am proud to see that across the board, every area of the Trust has been rated as “Good” for the care provided for our patients. This has been the highest priority for the Trust on its improvement journey to this point and will continue to be as we seek to improve further and address the issues highlighted in the report. It was also great to see some areas of outstanding practice highlighted.”
- The introduction of a mobile ‘phone App for patients with arrhythmia, that enables them to record their cardiac rhythm as and when symptoms occurred; and a nurse led cardioversion service which frees up consultant time at the Cardiac Centre at Westmorland General Hospital
- Patients’ meals ordered electronically using a new system meaning people have more time to choose what they want to eat, and waste is reduced.
- In surgery the CQC observed positive, caring and kind interactions between staff and patients and staff caring for patients with compassion.
- Royal Lancaster Infirmary’s Ward 37 and Furness General Hospital’s Ward 9 have both achieved the end of life care Gold Standard Framework accreditation, in addition to Wards 23 (RLI) and the Acute Medical Unit at
- Medical Care was well-led and rated as Outstanding. The Trust’s work with patients, staff, the public and local organisations to plan and manage care was particularly singled out. It was also noted that that the culture had changed beyond recognition over the last five years with high staff morale.
Turning to the comments made regarding the Urgent Treatment Centre at Westmorland General Hospital, Aaron said: “The Urgent Treatment Centre transferred to the management of the Trust on April 1 2018, and since then we have made a number of improvements which have enhanced the clinical care we provide.”
- Point of care testing, avoiding having to send blood samples to Lancaster for testing – speeding up the treatment for patients
- Investment in additional clinical staff
- Investment in x-ray equipment and radiology service operating times – allowing access to higher quality, faster images over a longer period of time.
- The staff appraisal and mandatory training target of 95% has now been achieved
- Patient Safety Incident reporting has increased and the UTC is now in our top ten departments for reporting incidents within its first year of being part of the Trust.
Aaron said: “The Trust is planning to spend the coming weeks discussing the final reports and the observations of inspectors with colleagues across our services and with partners across the Bay to ensure we are all sighted on the improvements we need to make. This is in addition to the actions already identified and completed or in progress following the initial feedback and the draft reports received.
“Our colleagues in Morecambe Bay have a track record of improvement by listening to feedback and using that feedback to work together to improve the services we provide for our patients. Our challenge is to ensure that those improvements are sustained, even in periods of pressure and I’m confident our teams will be able to do that again.”
MP Tim Farron said: “It’s of course very disappointing that our local hospitals trust has gone from being rated Good to being rated as Requires Improvement.
“It’s essential that the Trust immediately look to address the concerns raised by the CQC, but I have every faith that they will do this and turn things around.
“While the overall rating is disappointing, it’s important to recognise that ‘Care’ has been rated good with the CQC finding that staff treat patients with ‘compassion’ and ‘kindness’ – which is testament to the brilliant job that our local doctors and nurses do.”