All inspections: Blackpool Victoria Hospital

Community & mental health inspection reports for Blackpool Victoria Hospital can be found at Blackpool Teaching Hospitals NHS Foundation Trust.

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Blackpool Teaching Hospitals NHS Foundation trust is situated on the west coast of Lancashire and operates within a regional health economy catchment area that spans Lancashire and South Cumbria and supports a population of 1.6 million. The trust provides a range of acute services to the 330,000 population of the Fylde coast health economy and the estimated 11 million visitors to the seaside town of Blackpool. The maternity unit delivers approximately 3,000 babies every year.

We only inspected maternity services at Blackpool Victoria Hospital and rerated this core service. This was an unannounced comprehensive inspection of Blackpool Victoria Hospital maternity services .

As a result of re-rating this core service, the ratings for the hospital location changed slightly with the safe domain changing from requires improvement to inadequate. The overall rating for the hospital location remained the same.

This inspection was partly undertaken due to the concerns raised over how the service was managing with low staffing to ensure women and babies received safe care and treatment.

The maternity services had been inspected previously; this included a comprehensive inspection carried out in 2019. The maternity services were previously rated as good overall, with all key questions rated as good.

After our inspection we sent the trust a Section 31 Letter of Intent of the Health and Social Care Act 2008. We wrote to the trust describing the serious concerns found during our inspection and requested an action plan of how the service was going to improve maternity care. Our concerns included:

There were ineffective processes to manage and mitigate the risks in relation to the lack of enough suitably qualified midwifery staff to care for women. This was creating and contributing to significant risks to women receiving timely and appropriate care and treatment exposing them to the risk of harm.
There was a lack of robust systems and processes to safely store medicines within maternity services which could expose women and babies to the risk of harm.
There was insufficient process to ensure staff had access to in date and safely checked equipment which exposed women and babies to a potential risk of harm.
There were insufficient processes in place to assess the risk of and prevent and control the spread of infections Women and babies were exposed to an increased risk of infection.
There was not effective systems and processes to ensure incidents were reported, reviewed, and investigated appropriately to ensure lessons were identified and shared with teams.

Following us formally raising these concerns with the trust they submitted an action plan on 11 July 2022. The trust included actions to enhance the maternity workforce and access for agency midwives. The trust had reviewed the induction of labour policy that defined delays in induction of labour as those waiting more than four hours. The trust had implemented a written risk assessment for patients waiting for induction of labour and delays over four hours must be reported. Delays in induction of labour would be reported to the trusts board as a monthly report. The trust had agreed that medicines in maternity theatres would be secured with keypad locking devices. The trust had checked equipment to ensure they were fit for use and were checked appropriately and the policies available for use in the department were the correct versions. We will monitor compliance of the action plan through ongoing engagement with the trust.

Details for the summary for the maternity core service inspected can be found later within the report.

Blackpool Teaching Hospitals NHS Foundation Trust is situated on the west coast of Lancashire and operates within a regional health economy catchment area that spans Lancashire and South Cumbria and supports a population of 1.6 million.

The trust provides a range of acute services to the 330,000 population of the Fylde Coast health economy and the estimated 11 million visitors to the seaside town of Blackpool. Since April 2012, the trust also provides a wide range of community health services to the 445,000 residents of Blackpool, Fylde, Wyre and North Lancashire. The Trust also hosts the National artificial eye service, which provides services across England.

The trust provides a full range of hospital services and community health services. These include adult and children’s services such as health visiting, community nursing, sexual health services and family planning and palliative care. The trust provides tertiary cardiac, haematology and adult cystic fibrosis services to 1.5 million population catchment area covering Lancashire and South Cumbria.

At our last inspection in October 2021, we rated safe, effective and well led as requires improvement, caring as good and responsive for the trust overall as inadequate.

The trust had experienced significant challenges over the past 2 years due to the COVID-19 pandemic. There was significant redeployment of staff at the trust during that period to support staff in critical areas.

We carried out this unannounced inspection, from the 19 and 20 April 2022, of Blackpool Teaching Hospitals NHS Trust.

We undertook a comprehensive inspection of Medical Care Core Services, and focused inspection of Urgent and Emergency Care Core Services at Blackpool Victoria Hospital. We also undertook a focused inspection of Surgical Core Service to follow up on the section 29A warning notice issued on 25 October 2021.

We re-rated medical care core service and our rating of safe went down to inadequate and well led came up to requires improvement. We inspected but did not rate the urgent and emergency care and surgery core services.

Details for the summary for each core service inspected can be found later within the report.

A summary of CQC findings on urgent and emergency care services in Lancashire and South Cumbria.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Lancashire and South Cumbria below:

Lancashire and South Cumbria.

Provision of urgent and emergency care in Lancashire and South Cumbria was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, integrated urgent care, acute, mental health, ambulance services and adult social care. Staff felt tired and continued to work under sustained pressure across health and social care.

We found demand on urgent care services had increased. Whilst feedback on these services was mostly positive, we found patients were accessing these services instead of seeing their GP. Local stakeholders were aware that people were opting to attend urgent care services and were engaging with local communities to explore the reasons for this.

The NHS 111 service which covered all of the North West area, including Lancashire and South Cumbria, were experiencing significant staffing challenges across the whole area. During the COVID-19 pandemic, the service had recruited people from the travel industry. As these staff members returned to their previous roles, turnover was high and recruitment was particularly challenging. Service leaders worked well with system partners to ensure the local Directory of Services was up to date and working effectively to signpost people to appropriate services. However, due to a combination of high demand and staffing issues people experienced significant delays in accessing the 111 service. Following initial assessment, and if further information or clinical advice was required, people would receive a call back by a clinician at the NHS 111 service or from the clinical assessment service, delivered by out-of-hours providers. The NHS 111 service would benefit from a wide range of clinicians to be available such as dental, GP and pharmacists to negate the need for onward referral to other service providers. People who called 999 for an ambulance experienced significant delays. Ambulance crews also experienced long handover delays at most Emergency Departments. Crews also found it challenging managing different handover arrangements. Some emergency departments in Lancashire and South Cumbria struggled to manage ambulance handover delays effectively which significantly impacted on the ambulance service’s ability to manage the risk in the community. The ambulance service proactively managed escalation processes which focused on a system wide response when services were under additional pressure.

We saw significant delays for people accessing care and treatment in emergency departments. Delays in triage and initial treatment put people at risk of harm. We visited mental health services delivered from the Emergency Department and found these to be well run and meeting people’s needs. However, patients experienced delays in the Emergency Department as accessing mental health inpatient services remained a significant challenge. This often resulted in people being cared for in out of area placements.

We found discharge wasn’t always planned from the point of admission which exacerbated in the poor patient flow seen across services. Discharge was also impacted on by capacity in social care services and the ability to meet people’s needs in the community. We also found some patients were admitted from the Emergency Department because they couldn’t get discharged back into their own home at night. Increased communication is needed between leaders in both health and social care, particularly during times of escalation when Local Authorities were not always engaged in action plans.

How we carried out this inspection

During our inspection, we spoke with a variety of staff including consultants, junior and senior doctors, junior and senior nursing staff, healthcare support workers, pharmacists, divisional director of operations, deputy director of nursing, divisional director and head of department for the emergency department. We visited the emergency department and the same day emergency care unit. We reviewed patient records, national data and other information provided by the trust.

You can find information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

We last inspected the location in June 2019; the urgent and emergency care services, surgical services and critical care services received an overall rating of requires improvement. The medical care core service received an overall rating of inadequate in June 2019.

We carried out a comprehensive inspection of four core services at Blackpool Victoria Hospital’s;

Urgent and emergency care service from 14 to 16 September 2021. We also carried out a focused visit from 11 October 2021 to 12 October 2021 to follow up on concerns identified during the initial inspection.
Medical core service from 14 to 16 September 2021, inspecting 11 medical wards.
Surgical services from 11 to 13 October 2021, inspecting 20 areas including surgical wards, theatres, recovery areas and anaesthetic rooms.
Critical care services from 13 to 14 October 2021, inspecting cardiac intensive care, general intensive care and the high dependency unit.

Prior to our inspection, we considered nationally available performance data and intelligence provided by the trust. We inspected against all five key lines of enquiry. Each of our inspections were unannounced (staff did not know we were coming) to enable us to observe routine activity.

The urgent and emergency care services were part of the division of Integrated Medicine and Patient Flow. The division was formed by the trust in April 2021.

The medical care services, as defined by the CQC, crosses two divisions within Blackpool Victoria Hospital. These were the Integrated Medicine and Patient Flow (IMPF) division and the Tertiary Services division. The two divisions were formed by the trust in April 2021 and both divisions had a separate senior leadership team (SLT).

The surgical services crosses two divisions within Blackpool Victoria Hospital. Surgical services were managed by the division of surgery, anaesthetics, critical care and theatres (SACCT) and the division of tertiary services. The two divisions were formed by the trust in April 2021 and both divisions had a separate senior leadership team (SLT).

The critical care services were led by two separate leadership teams within different divisions which were newly formed in April 2021. The general intensive care unit was led by the surgery, anaesthetics, critical care and theatres (SACCT) divisional leadership triumvirate. Cardiac intensive care was led by the tertiary service’s divisional leadership triumvirate.

We rated urgent and emergency care services as inadequate at Blackpool Victoria Hospital because:

Managers monitored mandatory training but did not always make sure everyone completed it. Not all staff had training or understood how to protect patients from abuse. The service did not control infection risk well. The design, maintenance and use of facilities, premises and equipment did not keep people safe. Staff did not always assess, monitor or manage risks to people who used the services. Opportunities to prevent or minimise harm were missed. Substantial or frequent staff shortages increased risks to people who used the service. Patient records were not easily accessible for all staff and not always kept securely. Incidents were not always investigated in a timely way or appropriately graded. Lessons from incidents were not always shared widely and embedded to prevent reoccurrence of incidents. Monitoring information was not always used to improve patient safety. Patients did not always receive critical medications in a timely way.
Care and treatment did not always reflect current evidence-based guidance, standards and best practice. Care assessments did not always consider the full range of people’s needs. There was a lack of consistency in how people’s mental capacity was assessed and not all decision-making was in line with guidance and legislation. Decision-makers did not always make decisions in the best interests of people who lack the mental capacity to make decisions for themselves, in accordance with legislation.
The service was not always inclusive and did not always take account of patients’ individual needs and preferences. Staff did not always make reasonable adjustments to help patients access services. People were frequently and consistently not able to access services in a timely way for an initial assessment, diagnosis or treatment. People experienced unacceptable waits for some services. It wasn’t always easy for patients to make complaints. When the trust investigated complaints, learning was not always shared with all staff.
Leaders were not always visible in the department and did not always have a clear understanding of the risks, issues and challenges in the service. They did not always act in a timely manner to address them. Staff did not know about the strategy and vision for the trust. Staff did not always feel respected, supported and valued. Leaders did not operate effective governance processes through the service and safety was not a sufficient priority. Actions to reduce the impact of risks were not always effective. The service did not always collect reliable data and analyse it. Staff did not always feel listened to. Leaders did not always effectively share learning.

However:

Staff training rates on how to recognise and report abuse were positive. Staff were trained to use equipment. The induction programme for permanent and agency staff was comprehensive.
Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Key services were available seven days a week.
Staff treated patients with compassion and kindness and helped them understand their conditions. They provided emotional support to patients, families and carers.
Staff had a good understanding of quality improvement methods and had the skills to use them.

We rated Medical care services as requires improvement at Blackpool Victoria Hospital because:

The overall compliance rate for completion of all mandatory training was low. Completion of mandatory safeguarding training, amongst medical staff, was low across the directorate. Risk assessments were not always completed at the required intervals. The service did not always have enough substantive registered and unregistered nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service did not have enough substantive medical staff, managers regularly reviewed and adjusted staffing levels and skill mix. There was a variation in systems used and reliability of those systems, across the trust, which could cause a reduction in the accuracy, monitoring and reliability of record keeping. We found there were some delays in provision of medication and that there were times when medications had not been provided where patients were withdrawing from drugs or alcohol use. The service did not always manage the investigation of patient safety incidents well.
We saw a small number of gaps in food and drink assessment records. Whilst staff monitored the effectiveness of care and treatment. Managers did not regularly appraise staff’s work performance or hold supervision meetings with them to provide support and development. Decisions about patients care and treatment were not always decision specific. The documented reason for assessments for patients who lacked capacity to make their own decisions or were experiencing mental ill health were not always decision specific.
The service did not always plan or provide care in a way that met the needs of local people and the communities served. It did not always work with others in the wider system and local organisations to plan care. People could not always access the service when they needed it. There were issues with flow and the effects of COVID-19 on services, waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
Leaders did not always understand or manage the priorities and issues the service faced. Not all senior leaders were visible and approachable in the service for patients and staff. The vision for the service was not something that the staff were aware of nor had they been engaged in developing. Staff did not all feel respected, supported and valued. The service was working towards an open culture where patients, their families and most staff could raise concerns without fear, however, this was not yet embedded. We were not assured that leaders operated effective governance processes throughout the service. Actions to reduce the impact of relevant risks and issues were not always effective. The service did not collect reliable data and analyse it well. Staff could not always find the data they needed to understand performance, make decisions and/or improvements. The information systems were not all integrated within the core service. Leaders and staff did not always actively and openly engage with patients, staff, the public and local organisations to plan and manage services. There was a lack of engagement with equality groups.

However:

Staff told us they understood how to protect patients from abuse and how to recognise and report abuse, the service worked well with other agencies to do so. The service mostly controlled infection risk well and displayed clear signage to indicate COVID-19 risk areas. Staff used equipment to protect themselves and others from infection and they kept equipment and most of the premises visibly clean. In most areas inspected the design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well. Staff mostly kept detailed records of patients’ care and treatment. Records were mostly clear, up to date, stored securely and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the team and the wider service, however, these were not always completed in a timely manner. When things went wrong, staff apologised and gave patients honest information and suitable support. The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.
The service provided care and treatment based on national guidance and evidence-based practice. Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain. The service mostly made sure staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Key services were available seven days a week to support timely patient care. Staff gave patients practical support and advice to lead healthier lives. Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
The service was mostly inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
Leaders had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and a one-year strategy to turn it into action. Staff were mostly focused on the needs of patients receiving care. Staff were mostly clear about their roles and accountabilities and had some opportunities to meet, discuss and learn from the performance of the service. Leaders and teams used systems to manage performance. They identified and escalated relevant risks and issues. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care. The service collaborated with partner organisations to help improve services for patients. Staff were committed to continually learning and improving services. They understood quality improvement methods and had some skills to use them. Leaders encouraged innovation and participation in research.

We rated Surgical care services as requires improvement at Blackpool Victoria Hospital because:

The service did not provide mandatory training in key skills to all staff. The mandatory training and safeguarding training compliance rates did not meet the trust’s target in all modules. The service did not always take action to prevent surgical site infections. The service did not manage patient safety incidents well. Staff did not recognise and report all incidents and near misses. The service did not consistently share lessons learned with the whole team and the wider service. When things went wrong staff had not always apologised and gave patients honest information and suitable support in a timely manner.
The service made limited adjustments for patients’ religious, cultural and other needs. The service had not used the findings to make improvements. Most clinical audit outcomes were comparable to expected national standards, although the service performed worse than expected for some national audit indicators. Managers had not appraised staff’s work performance and had not held supervision meetings with them to provide support and development. Key services were not all available seven days a week to support timely patient care. Not all staff followed national guidance to gain patients’ consent or knew how to support patients who lacked capacity to make their own decisions and not all staff used agreed personalised measures that limit patients' liberty.
The service was not inclusive and did not take account of patients’ individual needs and preferences. People could not access the service when they needed it and did not receive the right care promptly.
Leaders were not all visible and approachable in the service for patients and staff. The service had a one year strategy but it was not developed with all relevant stakeholders. Staff did not all feel respected, supported and valued. The service did not promote equality and diversity in daily work. Leaders did not operate effective governance processes, throughout the service and with partner organisations. Leaders and teams did not use systems to manage performance effectively. They did not identify and escalate relevant risks and issues and identified actions to reduce their impact. The service did not collect reliable data and analyse it. Staff could not find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. Information systems were not integrated. Data or notifications were not consistently submitted to external organisations as required. Leaders and staff did not actively and openly engage with patients, staff, equality groups, the public and local organisations to plan and manage services. They did not collaborate with partner organisations to help improve services for patients.

However;

Staff had training on how to recognise, report and protect patients from abuse and they knew how to apply it. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration. The service mostly had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment in most areas. The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. Staff collected safety information and shared it with staff, patients and visitors.
The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment and achieved good outcomes for most patients. The service made sure staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Staff gave patients practical support and advice to lead healthier lives. staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who were experiencing mental ill health.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
The service planned and provided care in a way that met the needs of local people and the communities served. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
Leaders had the skills and abilities to run the service. Leaders understood and managed the priorities and issues the service faced. They supported staff to develop their skills and take on more senior roles. The service had a one year vision for what it wanted to achieve and a strategy to turn it into action. Staff were focused on the needs of patients receiving care. The service provided opportunities for career development. Staff at all levels were clear about their roles and accountabilities and did have regular opportunities to meet, discuss and learn from the performance of the service. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care. The information systems were secure. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

We rated Critical care services as requires improvement at Blackpool Victoria Hospital because:

The service had gaps in mandatory training compliance for medical staff but measures were in place to address this and compliance was monitored and improving. Safeguarding training was not meeting expected levels. A new unit was being built to address the recognised limitations of the current unit which did not follow national guidance. Some equipment was not always available. Staff did not always complete admission assessments. Access to mental health support was not readily available. The service did not always have enough medical staff or enough of some allied health professionals, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment. Records were not always clear, accurate or up to date. Staff could not always access records when required in the cardiac intensive care unit.
Managers did not always check to make sure staff followed trust guidance. Patients were not always given enough food and drink to meet their needs or improve their health. Staff did not effectively monitor care and treatment provided within critical care. They could not always demonstrate they used the findings to make improvements and could not always demonstrate achieving good outcomes for patients. Managers did not appraise all staff’s work performance although they held supervision meetings with them to provide support and development. Key services were not always available seven days a week to support timely patient care. Staff did not always support patients to make informed decisions about their care and treatment. They did not follow national guidance to gain patients' consent. Some staff did not know how to support patients who lacked capacity to make their own decisions.
Staff were not always clear of what the strategy for the department was. The service did not promote equality and diversity in daily work. The services were working towards an open culture where patients, their families and staff could raise concerns without fear. Leaders did not operate effective governance processes, throughout the service and with partner organisations. Whilst staff and leaders had opportunities to meet and discuss the performance of the service there was limited evidence of how effective this was. Leaders and teams had identified and escalated relevant risks; however, they did not identify actions to reduce their impact in a timely manner or effectively manage those risks. Leaders and teams did not effectively use systems to manage performance. The service did not always collect reliable data and analyse it. Staff did not always have access to the data they needed, in easily accessible formats, to understand performance, and make decisions and improvements. The information systems were not always integrated. Leaders and staff did not always actively and openly engage with patients, staff, equality groups, the public and local organisations to plan and manage services.

However;

The service had provided mandatory training in all the key skills for most nursing staff. Staff understood how to protect patients from abuse and understood how to report concerns and the service worked well with other agencies to do so. The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. The maintenance and use of facilities, premises and equipment kept people safe and staff managed clinical waste well. We saw that relevant risk assessments were completed for each patient. Staff identified and quickly acted upon patients at risk of deterioration. The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff on the general intensive care unit kept comprehensive and accessible records of patients’ care and treatment. Records were stored securely in both intensive care units. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well. The service used monitoring results to improve safety.
The service provided care and treatment based on national guidance and evidence-based practice. Staff used special feeding and hydration techniques when necessary. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain. The service made sure staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together to provide good care as a team to benefit patients. Staff gave patients practical support and advice to lead healthier lives.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. People could access the service when they needed it and received the right care promptly. The service admitted, treated and discharged patients in line with national standards. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
The new leadership team had the skills and abilities to run the service. They understood and were starting to manage the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. The service had a one-year strategy in place which was focused on sustainability of services. Leaders understood and knew how to apply the strategy and monitor progress. Staff mostly felt respected, supported and valued. They were focused on the needs of patients receiving care and provided opportunities for career development. Staff at all levels were clear about their roles and accountabilities. They had plans to cope with unexpected events. Leaders contributed to decision-making to help avoid financial pressures compromising the quality of care. There was a developing focus on continuous learning and improvement. There was some knowledge of improvement methods and the skills to use them.

How we carried out the inspection

We spoke with 172 staff across a range of disciplines including junior and senior registered nurses, ward managers, matrons, bed managers, advanced nurse practitioners, pharmacy technicians, pharmacists, physiotherapists, occupational therapists, operating department practitioners, theatre manager, junior doctors, locum doctors, middle grade doctors, consultants, unregistered nursing staff including emergency department assistants, ward clerks, housekeepers, administrative staff, domestic staff, discharge co-ordinators, clinical service managers, specialist cancer nurses and the lead cancer nurse. We also spoke with paramedics who had conveyed patients to the emergency department and the ambulance liaison officer.

Between our inspections, we held several staff focus groups with representatives from all over the trust to enable staff who were not on duty during the inspection to speak to inspectors. The focus groups included nursing staff, allied health professionals, hospital governors and junior medical staff and consultants.

We reviewed 85 patient records, including nursing records, medical records, risk assessments, prescription charts, do not attempt cardiopulmonary respiratory (DNACPR), and mental capacity and Deprivation of Liberty Safeguards (DoLS).

We observed patient care, treatment and support being delivered including infection and control management. We spoke with 48 patients, relatives and care givers. We were limited to the number of relatives and care givers who were present in the hospital due to the COVID-19 pandemic. However, we reviewed comments from patient feedback cards.

During our medical care service inspection, we used Talking Mats technology to interact with ten patients who struggled to communicate verbally.

During the inspection we attended a bed meeting, a clinical command meeting, and trust level staffing and flow meetings. We observed seven staff handovers, four ward safety huddles, one morning theatre team brief and one staff meeting.

On this inspection we were limited to the wards we could visit due to the COVID-19 infection risk. We visited;

Medical wards which included the acute medical unit (AMU), the ambulatory emergency care unit (AECU -Ward 18), the stroke unit (wards 32-33), the gastroenterology and endoscopy unit, wards C, 3, 6, 12, 23, 24, 37 and 38.
Urgent and emergency care team visited the accident and emergency department including the paediatric emergency department and the ambulatory emergency care unit.
The inspection team for surgery visited ward 14 – ear nose and throat surgery, ophthalmic and surgical high care, ward 15a – general surgery and urology, ward 15b - general surgery, ward 16 - elective orthopaedic, ward 35 – trauma and orthopaedic, ward 38 – cardiac, ward 39 – cardiac, Lancashire suite – a six bedded private cardiac ward, surgical admission unit, surgical assessment unit (SAU), same day emergency care (SDEC) unit, pre-op assessment unit, ophthalmic surgical unit, day surgery unit, cardiac day surgery unit, discharge lounge, several theatres, the recovery areas and anaesthetic rooms.
The critical care team visited general intensive care unit, cardiac intensive care unit and the high dependency unit.

We carried out a focused inspection of Blackpool Victoria Hospital on 11 January 2021. This included an inspection of the urgent and emergency care service at Blackpool Victoria Hospital as part of our winter pressures programme.

We considered nationally available performance data and data and intelligence provided by the trust. We inspected against the safe, responsive and well-led key questions; we inspected key lines of enquiry relevant to the winter pressures programme.

We also carried out a focused inspection of medical care because we had concerns about the quality of services.

The focused inspection of medical care covered elements of three key questions; is the service safe, effective and responsive.

We did not inspect all the key lines of enquiry or domains and therefore have insufficient evidence to rate the services.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website:

https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection

Our rating of services stayed the same. We rated it them as requires improvement because:

We rated safe, effective, responsive and well-led as requires improvement. We rated caring as good.
The rating for medical care, surgery and critical care went down. The rating for urgent and emergency care, maternity and services for children and young people stayed the same. Because we previously inspected outpatients with diagnostic services and end of life care jointly with community end of life care, we cannot compare our new ratings directly with previous ratings. The rating for outpatients was requires improvement. The rating for end of life care was good.
The overall rating for community services was good. The rating for community health services for adults, community inpatient services, services for children and young people, sexual health services and dental services stayed the same. The rating for child and adolescent mental health services went down. Because we previously inspected community end of life care services jointly with acute end of life care, we cannot compare our new ratings directly with previous ratings. The rating for community end of life care was good.

Blackpool Teaching Hospitals NHS Foundation Trust was established in December 2007 and serves a population of around 440,000 residents and around 11 million tourists and transient visitors seasonally. The trust has an acute hospital, Blackpool Victoria Hospital, two community hospitals, three elderly rehabilitation hospitals, a national eye treatment centre and a child development centre. The trust employs over 7000 staff, has an annual turnover of over £410 million and has 830 beds across all sites. The trust sees over 250,000 outpatients, 56,000 day cases and 91,000 emergency admissions annually.

This was an unannounced, focused inspection to review the safety of the emergency department as part of a focussed winter inspection programme. It took place between 1pm and 10pm on Monday 7 January 2019.

We did not inspect the whole core service therefore there are no ratings associated with this inspection. Our key findings were:

Our key findings were:

The emergency department (ED) did not have space and capacity to cope with the number of patients and their relatives who presented there. We observed patients sitting on the floor of the waiting room and trolleys, beds and equipment blocking corridors and exit routes, which limited the standard of care.
The paediatric ED was not compliant with staffing levels set by the Royal College of Paediatrics and Child Health (RCPCH).
There were significant delays in most aspects of the service, including triage delays of over three hours. We found delays in transferring patients awaiting a mental health bed of over 17 hours whilst awaiting review by the mental health provider, which was separate to the trust.
Flow to the rest of the hospital did not meet demand and there was very limited input from acute medical physicians. This reflected our discussions with nine members of medical staff, during which they said there was a culture in which specialty teams did not work well together for the improvement of patient experience.
Patients were accommodated in corridors for extensive periods during our inspection. This included elderly patients and those with severe dementia and staff did not always meet their individual needs. Use of corridors was part of the trust’s surge plans during periods of exceptional demand.
Overnight medical cover was restricted to one doctor with higher specialist training at grade ST4 (specialist trainee) with one or two doctors at basic specialty trainee level (ST3). This caused lengthy delays to assessment and all staff we spoke with told us it resulted in additional pressure.
Provision for mental health patients was lacking and the trust had limited influence to improve the service provided to their patients.
We saw isolated examples of very poor, unkind care in the acute medical unit during a violent incident.
Staff described increasing levels of threatening behaviour, aggression and violence towards them from patients and relatives.
There were senior decision-makers present in the resuscitation area and in the rapid assessment and treatment (RAT) area who managed patients appropriately.
There was effective clinical collaboration between the consultant in charge and the nurse in charge and it was notable that staff systematically did their best in challenging circumstances.
Staff demonstrated resilience and compassion when trying to help patients who had waited significant periods of time in the ED for a mental health review. This included when they faced aggression and verbal abuse.
The patient and staff safety team had wide-ranging responsibilities and provided considerable support, including in safeguarding and child protection circumstances.
The trust had a range of developing strategies to improve access, flow and capacity. These were in the early stages of development at the time of our inspection and we saw limited impact of them to date. Staff provided evidence the improvement works had resulted in faster treatment and an improved experience for some patients, particularly those who arrived by ambulance.

We told the trust they must:

Further improve performance in the national 15-minute triage recommendation.
Improve standards of care, including triage, time to assessment and time to mental health review, for patients with mental health needs.
Ensure the paediatric ED is compliant with RCPCH staffing level standards.
Review the availability of medical staffing in ED overnight.

In addition, the trust should:

Improve governance processes and clinical governance oversight of the number of refused referrals to the urgent care centre through the streaming process.
Improve the management of the waiting area in the main ED to ensure patients who are vulnerable are not put at risk by patients who pose a threat to their safety.
Continue to work in partnership with the mental health provider and other providers to review the tools used to assess and improve the mental health pathway.
Ensure staff working in the acute medical unit have the training and supervision to provide a caring and compassionate service.
Effectively manage crowding in all areas of the ED.
Review the flow of patients through the paediatric ED to reduce the time children spend waiting with adults.
Ensure there is a clear, defined and ratified standard operating procedure for the ambulatory emergency care unit and ensure that staff understand this and adhere to it.
Ensure patients have access to food and fluids during their time in the department.

There were also areas of outstanding practice:

Senior ED staff had introduced more consistent support for staff following an incident, including a ‘support basket’ with items to encourage staff to come together and debrief for 15 minutes. Staff spoke highly of this initiative and said it helped them to focus again on patient care after a stressful period or incident.
The trust had facilitated the implementation of a ‘synergy car’ service for patients who called 999 with urgent mental health needs. The service was staffed by a police officer, mental health crisis worker and a paramedic. In its first week of operation the synergy service had prevented seven unnecessary ED attendances and 17 attendances for patients detained under section 136 of the Mental Health Act.
Although ED nurses lacked formal training in the management of mental health conditions, they demonstrated exceptional resilience and compassion when faced with patients who were clearly deteriorating. This included an ED nurse who remained kind and compassionate despite a patient screaming in their face after being in the department for 17 hours.

Professor Edward Baker

Chief Inspector of Hospitals

Our rating of services stayed the same. We rated them as requires improvement because:

Although surgical and medical services had improved, urgent and emergency care services required improvement.
The emergency department had consistently failed to meet the Royal College of Emergency Medicine recommendation that the time patients should wait from time of arrival to being triaged (having an initial assessment undertaken) is no more than 15 minutes. This is important as it is a system that emergency departments use to make sure that the patients who may need immediate treatment are prioritised.
The emergency department and medical care services did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. This was because the planned establishment for nursing and medical staffing had not always been met.
The service had not always planned services in a way that met the needs of local people. The emergency department faced challenges to make sure that that the environment matched the needs of patients. We observed some patients were cared for in corridors.
People could not always access the service when they needed it. The emergency department had consistently failed to meet the four hour standard for admission, transfer or discharge.
Patient outcomes for urgent and emergency care continued to be poor and information submitted to the Royal College of Emergency Medicine showed that results were worse than the national average in most areas.
The service did not provide a suitable environment for high risk mental health patients within the emergency department. This was because the department did not have a designated area, which for example, was free of ligature points.
The service did not always ensure that each mandatory training area was completed to the trust target for the identified staff within the emergency department. Information provided indicated compliance with training was lower for medical staff.
Staff within the emergency department did not always have the correct level of training to prevent patients from abuse. Safeguarding training was not always provided in line with the Intercollegiate Document, 2014.
The service did not always manage medicines well. Controlled drugs were not always checked appropriately and patients’ own medicines were not reconciled in line with trust policy within the emergency department. The review dates for medicines were not consistently documented and there was a lack of adherence to the medicines self-administration policy within the medical wards.
The service had not always made sure that staff were competent in their roles and up to date competency records were not always available. This was because not all new staff within the emergency department had completed mandatory training before taking on the role and only 55% of nursing staff were up to date with annual appraisals.
The emergency department had a vision for what it wanted to achieve. However, not all of the aims had workable plans in place.

However,

Staff of different kinds worked together as a team to benefit patients. We observed positive examples of collaborative working.
Staff understood their role and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff continued to care for patients with compassion.
The service took account of patients’ individual needs.
Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

Blackpool Victoria Hospital is the largest acute hospital of the Blackpool Teaching Hospitals NHS Foundation Trust. It treats more than 80,000 daycase and inpatients and more than 200,000 outpatients from across Blackpool, Fylde and Wyre every year. The Urgent care service is one of the busiest in the country with more than 80,000 attendances every year in the emergency department. The hospital has 767 beds and employs more than 3,000 members of staff. It provides a wide range of services from Maternity to Care of the Elderly, and from Cancer Services to Heart Surgery.

The trust was one of the trusts identified for Professor Sir Bruce Keogh’s review of trusts in 2013 as the trust had a significantly higher than expected mortality rate from April 2012 to March 2013. CQC inspected the trust in January 2014 and found overall the hospital required improvement. Intensive/ critical care; children and young people and end of life services were rated as Good. Accident and Emergency; Medical care; Surgery and Outpatients services required improvement and Maternity and Family planning services were rated as inadequate.

This inspection was a follow up and was conducted on 21 and 22 September 2015. We only reviewed Maternity services, to review progress against the inadequate rating, we did not review the gynaecology service. We also reviewed the Urgent care services as continued intelligence had raised concerns with regards to the department. We also looked at the governance and risk management support for the services we inspected. We did not undertake an unannounced inspection as the team were confident they had gathered sufficient evidence at the announced inspection. We will apply ratings to the maternity and urgent care services but these will not affect the hospital overall rating of requires improvement.

Our key findings were as follows:

In urgent care services we found some areas had improved since the last inspection however, the results of national CEM audits showed that there were improvements to be made in a number of areas where they were in the bottom 25% of participating trusts nationally. Plans were in place to improve and these were having an effect and were regularly monitored. However, the time to mental health assessment remained a concern with many patients waiting over four hours for assessment although the trust was working with external partners providing mental health services to address this.

We also found that systems for checking essential equipment continued to require improvement since the last inspection when this was raised. The hospital managers took mitigating action before we left the site. However, there were some basic equipment shortages which were having a minimal effect on patients but are worthy of the hospitals attention.

We also noted an induction loop system to help hearing aid users was not working at the time of our inspection. Staff did not always utilise the language support for patient whose first language was not English and were satisfied for a relative to translate.

Leadership of the service had been improved through the employment of a matron with sole responsibility for the A&E department. The new matron however, had only been in post for two months. We noted that nurse appraisal rates were below the expected and the frequency of departmental meetings was very low. Although the team meetings had been reintroduced it was too early to understand the efficacy of them or the matrons role on the culture and understanding of risk and improvement in the department. However, there was a strong multidisciplinary team in the department and staff were positive and proud of the work they did.

The organisational vision and values had been cascaded but there was a lack of documented service level strategy although the direction of travel was planned with eight key actions highlighted by the A&E leadership team. A t rust wide strategic review was underway at the time of the re inspection. There was a current A&E strategy, developed in December 2014, which was under review at the time of the inspection. The current work underway in developing a trust wide strategy would inform the future A&E strategy.

The lead consultant and senior managers were aware of their challenges and there were escalation processes in place for dealing with additional demand.

The layout of the department continued to hinder the flow of patients, bed management ensured capacity was monitored and managed but when the department became busy patients waited on trolleys in the walkway whilst waiting for a cubicle. The service had escalation processes in place. The 4 hour wait standard was not always met but it was better than the England average. The percentage of patients leaving the department before being seen was slightly higher than the England average however the re-admission rate and percentage of patients waiting 4 to12 hours before being admitted were similar to the England average.

The separate, newly refurbished children’s department was not as busy as the adult side. Patient flow was good and it was rare for patients not to be treated within the four hour target. However, the average time each patient spent in the emergency department was above the England average between April 2013 to March 2015.

Staffing levels for both doctors and nurses had improved although bank and agency staff continued to be utilised. The emergency department was visibly clean. Patients nutrition and hydration needs had been assessed and patients had food and drinks where appropriate. Staff followed infection prevention protocols. There was a good skill mix of competent staff for both adult and paediatric patients. We saw effective collaboration and communication among all members of the multidisciplinary team and services were set up to run 7 days a week. Compliance with mandatory training did not yet meet the trust’s target but was on track to meet it by year end. Risks and complaints were managed well and there was evidence of learning from them. The trust was investing in the senior staff through leadership training and coaching. Staff were positive and proud of the work they did.

Patients described a positive experience and we observed staff treating patients with compassion, respect and dignity. The department Friends and Family test scores were consistently above the national average.

In maternity services the last inspection had identified areas which were inadequate and others that required improvement and an action plan had been developed to address these which has been monitored regularly. At this inspection we found improvements had been made in the number of incidents being reported and the number of post-partum haemorrhages had reduced at the trust. Staffing levels in maternity services were being safely managed and a new midwifery staffing model had been introduced which had impacted positively on the department.

We found that women using maternity services had a high regard for staff and clinical teams, who were caring and treated patients with dignity and respect. There was a good incident reporting culture and systems were in place to ensure lessons were learned. Policies and procedures were up to date and in line with NICE guidance. The outcomes for patients were in line with the England average on most of the compared measures. Where they were worse this had been investigated and actions taken. There was a good system to triage patients who were admitted to the unit. Patients were offered choice of place for delivery and were included in the decision making for their care. There was good inclusion of the patients and systems for engagement with patients and staff were in place.

However, not all areas of the maternity unit or equipment met with infection prevention and control guidance. The systems for checking the maintenance of equipment and its readiness for use in an emergency were not robust. Training compliance in some key areas including skills and knowledge in emergency situations did not yet meet the trust’s target.

We saw the following area of outstanding practice:

The trust was actively trying to support breastfeeding and there was a network of experienced breast feeding mothers called star buddies, who supported new mothers wanting to breastfeed. The star buddies were mostly volunteers and attended antenatal classes to provide information and advice, as well as meeting women on the maternity ward. There was a monthly rota in place covering seven days and five nights of the week. The women we spoke to were impressed with this service and had found it helpful.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the hospital must:

Improve the outcomes for patients through the improvements demonstrated through the national CEM audits in particular, reduce the number of patients attending urgent care services waiting for mental health assessment for over four hours.

In addition the hospital should:

Maintain all equipment in both urgent care and maternity is checked as per the policy and kept clean within the infection prevention and control guidance for each specific item.
Consider improving the monitoring of the impact of actions taken as a result of incident investigations in maternity services.
Maintain training for all staff working in the maternity department with basic life support, blood transfusion and CTG training by the year end.

Address the insufficient supply of basic equipment e.g. thermometers in A&E.
Review the computer equipment in ‘minors’ area of A&E to ensure consistent recording of patients’ treatment.
Try to improve patient confidentiality at the reception.
improve staff utilisation of translation support when dealing with patients in A&E who require communication support.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Blackpool Teaching Hospitals NHS Foundation Trust operates from three sites:

Blackpool Victoria, which is the main hospital site and the focus of much of its work.
Clifton Hospital, which currently has four wards, mainly for elderly care and rehabilitation (with one outpatient clinic).
Fleetwood Hospital.

This report relates to the acute core services at the Victoria Hospital site.

Blackpool Victoria is a large acute hospital that treats more than 80,000 day-case and inpatients and more than 200,000 outpatients from across Blackpool, Fylde and Wyre every year. Its Emergency Department sees more than 80,000 attendances every year. The hospital has 767 beds and employs more than 3,000 members of staff. It provides a range of services from maternity to care of the elderly, and from cancer services to heart surgery.

Blackpool Victoria is one of four hospitals in the North West that provides specialist cardiac services and serves heart patients from Lancashire and south Cumbria.

We found that the trust had undertaken work on improving clinical pathways. This was engaging clinicians, and these were well used. This was having a positive impact on the mortality data that was being measured. Some pathways (e.g. heart failure) require further work.

The hospital’s reporting of incidents was poor in some areas where some staff did not report near misses, and some staff reported incidents on behalf of others. This means that the hospital and trust could potentially miss out on valuable learning and therefore improve services.

The quality of patients’ clinical records was poor; handwriting was sometimes illegible and often difficult to read. Accessing information was challenging because of the filing of case notes. This may delay access to important clinical information and impact on continuity of care. Delays in access to case notes is already a challenge, particularly in outpatients.

We saw good participation in clinical audit and use of the data from this. This is an important way for the trust to develop its clinical services.

The trust has a higher than expected rate of primary postpartum haemorrhage (significant bleeding after childbirth). There is also a high rate of hysterectomy in these patients. This is under investigation by the trust.

We observed good caring by all levels of clinical and medical staff, and high levels of patient satisfaction for the way that staff delivered treatment and care.

The trust had made improvements to its services following feedback from its patients (e.g. ward 12) although some areas, such as stroke services, still required additional action. It had also improved facilities for patients in children’s and maternity services.

Many people we spoke to did not know how to share feedback or complaints with the trust. This is a valuable opportunity to develop services that is being lost to the trust.

This inspection was carried out to follow up on compliance actions made at the previous inspection in June 2013. These related to systems in place to manage and respond to complaints and concerns. During the previous inspection we found that complaints were not always dealt with in the trusts own timescales. People did not always feel their concerns or complaints were managed satisfactorily.

The Trust provided the Care Quality Commission with an action plan to address the non- compliance issues. They told us they were reviewing the trusts operation procedures for complaints. This included timescales and communication with people raising complaints.

Two inspectors, a specialist advisor (a professional with specialist experience in hospital governance) and an expert by experience (a person who has personal experience of the services being provided), visited Victoria Hospital unannounced on 26th November 2013.

We looked at what systems had been put in place to improve the management of complaints. We visited three departments within the hospital to speak with staff and look at what information was available to patients to raise concerns or complaints, we also carried out a random selection of telephone interviews with people who had raised concerns and complaints with the Trust in order to determine what that experience was like for those people. Most people told us they had been informed of timescales in the response to their complaints. Some people told us the timescales were not always met. One person told us, 'They did let me know about the timescales, they didn't meet them but they did let me know this would be the case and why'.

Staff members we spoke with told us they were aware of the hospitals complaints processes and some gave examples of how they had directed people to the appropriate contact. This included P.A.L.S (Patients and Liaison Service) who provide confidential advice and support in health related matters.

We carried out this review in response to concerns centred on issues we had been made aware of from the Trust and also members of the public. The concerns centred around three areas inlcuding, consent to care and treatment, communication and complaints. This responsive inspection took account of the three areas and the content reflects the evidence found in respect of the Trusts compliance with those regulations.

As part of the inspection process we spoke with a number of patients on the wards. We also spoke with relatives in order to gain the views of people who experienced services including planned, emergency surgery and treatment.

Patients we spoke with told us they were given the opportunity to make informed choices about their care and treatment. They told us staff respected their preferences and decisions. One person told us, 'I had everything explained to me including the benefits and risks. I had the time to discuss this with my wife. The nurse also spent time with us. It gave me more confidence to make a decision'. Another person told us, 'I had all the information I needed to be able to give my consent to my operation'. Two other patients we spoke with told us they had been provided with the information they required to make an informed choice to consent to care and treatment.

Patients told us they had been looked after well and had confidence in the service offered. One person said "everyone is very kind and caring"; "nothing is too much trouble for them". One person said the "staff know what they are doing". Another added that the various staff had "explained everything" and all "knew what each other were doing".

The staff told us they enjoyed working in their particular departments, and they felt supported, both by their colleagues and the senior management team.

We saw the trust had made changes to the way complaints and concerns were being handled and managed. Patients we spoke with in the cardiology centre were satisfied with information they had been provided with and told us they felt comfortable in raising issues with senior staff if they were not satisfied with their care or treatment. Information received by the Care Quality Commission highlighted a number of concerns regarding the way the trust managed complaints and concerns. This included complaints not being responded to in the trusts own timescales. People felt they did not know what action had been taken to improve areas within the context of their individual concerns.

We saw that the trust had a number of internal and external audit systems in place to monitor the quality of the service provided. We were reassured that they responded appropriately when they were given information of concern. They reviewed their own processes as a result of concerns raised and made amendments to their systems if required.

We carried out this inspection to follow up areas of non compliance found during a Dignity and Nutrition Inspection (DANI) on 1st August 2012. In addition we looked at how hospital discharges were being managed and how patients privacy and dignity was being respected.

People we spoke with told us they were satisfied with the care and treatment they had received. They told us they were supported and staff were respectful. Comments included, 'I had everything explained to me, staff were very supportive'. Also, 'I was anxious about going home as I live alone. They have got carers coming in for the first few weeks. I am happy with what they have done for me'.

We saw there were systems in place for patients to receive a planned discharge. Records we looked at had been completed and other professionals and external agencies had been involved in the planning for patient discharge.

Patients requiring clinical assessment and intervention for nutrition had records in place to manage this process. Where patients were 'nil by mouth', there was evidence of clinical decision making as to how this would be managed. In one instance we saw a patient had been assessed for 'nil by mouth', on admission. Improvements had been made to record nutritional assessment for patients. The Malnutrition Universal Screening Tool (MUST) had been completed in all instances where there had been a need for the patient

People told us what it was like to be a patient in Blackpool Victoria Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older patients' in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by two Care Quality Commission (CQC) inspectors joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

To carry out the inspection, we identified two wards, where there were a percentage of

older patients, in order to focus the dignity and nutrition inspection (DANI). As part of the inspection process we spoke with a number of patients and visitors on both wards. We also spoke with members of the executive management board for Blackpool Teaching Hospital Trust. A range of staff members were spoken with on both wards throughout the site inspection. We did this to gain the views of patients who received care and treatment and people who visited the hospital or worked there.

Patients we spoke with were positive about the care and treatment they were receiving. They told us they liked the food in hospital and told us there was 'plenty of choice,' available to them. Comments included, 'It's a busy ward all the staff seem to be involved in meal times, it's really organised.' Also, 'I can't always manage my food, but the staff are around to help.' A visitor told us, 'My wife never had a good appetite, but they go out of their way to try and encourage her with food.'

Patients told us they liked the way staff made them feel at ease if they were receiving treatment, or were talking to the doctor. They told us they felt staff respected their privacy and dignity. Comments included, 'Nurse speaks ever so softly when she is asking if I want the bathroom, it's nice because you don't want everyone to hear.' Also, 'When I need some treatment or the doctor comes to talk to me they always pull the curtains around the bed,' and, 'I like my own room it's more private, the nurses always knock even though I always have the door open, I like to see what's going on.' We saw evidence of these practices occurring during the observations we made on both wards.

In addition to gaining the views of patients who used the hospital services, we asked other agencies including Local Involvement Network (LINkS) about Blackpool Victoria Hospital. They told us they had been involved in a recent patient experience meeting, which included visiting a ward. They told us comments received from patients had been positive. Patients spoken with were very satisfied with the choice of food and the quality of meals available to them.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

We did not visit the provider as part of our inspection and there were no comments received from people in receipt of their service. We looked at all the information we hold about the provider and asked them to send us information confirming how they had achieved compliance with consent to care and treatment. They sent us comprehensive evidence of the action they had taken in ensuring staff have undertaken training in Mental Capacity Act (MCA). This evidence demonstrated staff at all levels have received training to gain the necessary knowledge and skills to act in peoples best interests and to act in accordance with the consent of people, in relation to their care and treatment. Action taken to gain compliance included, identification of a dedicated lead in Mental Capacity Act (MCA) training. Evidence of a comprehensive training programme, evidence of access to e-learning, regular reviews on the impact of training and regular board updates.

Patients we spoke with during our inspection were very positive about the information they had received prior to under going surgery. All confirmed they had received information about what to expect during their stay in hospital and about the treatment they were to receive.

Patients told us that they felt fully informed about their care and treatment and that all

doctors had taken the time to answer any questions they had. Patients said that their pre-operative assessment and physical examinations were carried out in private and helped them understand the surgical procedure they were being admitted to hospital for and were positive about their experiences.

Patients said that the new building was relaxing and clean but some did not like the lay out of the four bedded bays. However patients told us there was insufficient natural light in the bay and the lighting provided was insufficient that in the for the bathroom there were no electric shaver points.

Patients said that staff were available when needed and had a relaxed and professional

approach to their jobs which put them at ease. They told us that they were supported by staff who were helpful and recognised if they had anxieties about their treatment. They confirmed that staff helped them understand their treatment and allay their anxieties.

Patients said that staff were attentive and were readily available to provide care and

support when needed.

"Everybody has been brilliant; they have told me everything I wanted to know"

"I thought the information I had was good".

"The leaflets were helpful, but then the staff explained everything I needed to know".

"They went through all the forms again so I understood what was happening and I had

already agreed to have the operation. They treat you really well in that way and I knew what to expect"

"The wards are new and clean ' it's very comfortable in here."

"The staff are excellent; they do speak to people in a respectful way".

"Night staff are friendlier, the day staff seem to be a bit rushed to spend too long a time with you"

"The nurses have explained everything and carried out the procedure very well, they are all very caring".

Blackpool Victoria Hospital

All Inspections

Other CQC inspections of services

21 June 2022 and 22 June 2022

During an inspection looking at part of the service

19 and 20 May 2022

During an inspection looking at part of the service

14 Sept to 20 Oct 2021

During a routine inspection

11 January 2021

During an inspection looking at part of the service

03 June to 07 June 2019

During a routine inspection

7 January 2019

During an inspection looking at part of the service

15 Nov to 14 Dec 2017

During a routine inspection

21,22 September 2015

During an inspection looking at part of the service

Professor Sir Mike Richards

15 January 2014

During an inspection

15-16 January 2014

During a routine inspection

26 November 2013

During an inspection looking at part of the service

11 June 2013

During an inspection in response to concerns

19 March 2013

During an inspection looking at part of the service

1 August 2012

During a themed inspection looking at Dignity and Nutrition

21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

24 April 2012

During an inspection looking at part of the service

26 September 2011

During an inspection in response to concerns