Chief Inspector of Hospitals finds improvement needed at Lancashire Teaching Hospitals NHS Foundation Trust

England’s Chief Inspector of Hospitals has told Lancashire Teaching Hospitals NHS Foundation Trust’s that it must improve its services to patients following an inspection by the Care Quality Commission.

CQC carried out an announced inspection of eight core services at the trust, visiting Royal Preston Hospital and Chorley and South Ribble Hospital in September 2016.

Overall the trust has again been rated Requires Improvement, although caring was rated as Good.

Read the full reports including ratings for all of the provider’s core services.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said: "When we previously inspected Lancashire Teaching Hospitals NHS Foundation Trust in July 2014 we found a number of areas that required improvement.

"It is disappointing to report that the significant concerns we identified then around patient flow and pressure within the accident and emergency departments remain unresolved, and in some areas that the quality of patient care has declined further.

"Once again we found that patients were waiting too long in A&E, and a high number were placed in areas that weren't the most appropriate for their needs due to capacity issues.

"Additionally, the problems with capacity and patient flow through the hospital led to the cancellation of planned operations due to bed shortages, patients unnecessarily being moved wards during their stay, and the use of areas such as theatre recovery to house patients instead of wards, at times of high pressure.

"We remain concerned about the staffing levels at the trust, particularly within maternity, children’s and neonatal services. There are also significant challenges with medical staffing at the trust, although there are plans in place to improve recruitment in this area.

"The trust is working against a backdrop of pressure on all of its services and, I am anxious to see them continue to monitor and improve staffing levels, patients flow and patient discharge. The trust board is fully aware of our concerns. We will continue to monitor the trust and check on its progress. This will include further inspections."

CQC’s inspection has identified 72 areas where the trust must make improvements, including:

• The trust must improve the access and flow of patients through the hospitals.
• The governance processes for the organisation must be reviewed and improved.
• The process and practice for the escalation of the deteriorating patient must be reviewed and embedded across the organisation.
• Staffing levels must be reviewed and improved to ensure safe care and treatment, particularly within maternity, children’s and neonatal services.
• The trust must improve performance, especially in relation to the four hour target in A&E to avoid long waits for patients.
• The trust must take appropriate action to reduce the number of cancelled operations and the number of patients whose operations were cancelled and were not treated within the 28 days.

Inspectors also identified several areas of outstanding practice, including:

• The trust had launched a sleep improvement programme in critical care. Disturbed sleep in critical care patients is associated with delirium, in which patients become confused, restless, and experience hallucinations which can delay their recovery. The trust now offer eye masks and earplugs to patients, as well dimming lights, and minimising sounds by turning down the volume on medical equipment, anticipating scheduled alarms for equipment maintenance and encouraging staff to talk away from the bedside. An initial study showed that these small changes had caused a 50% reduction in patient delirium.
• In dermatology a computerised diary system enabled a block booking for 12 weeks worth of care for patients in one go rather than them having to make individual appointments. This had improved patient flow through the department and also helped to improve auditing treatment.

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