Chief Inspector of Hospitals finds that Lancashire Teaching Hospitals NHS Foundation Trust requires improvement

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of services provided by Lancashire Teaching Hospitals NHS Foundation Trust.

Overall Lancashire Teaching Hospitals NHS Foundation Trust has been judged as requiring improvement. The Care Quality Commission has found that the trust provided services that were effective, caring and well led, however improvements were needed in the safety, responsiveness and leadership of some services.

The trust runs two hospitals; Royal Preston Hospital, and Chorley and South Ribble Hospital. The full reports on the trust and on each site can be found here.

The trust was inspected by CQC in July under its new inspection regime.  The inspection team, which included doctors, nurses, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent three days at the trust.  The team also returned unannounced at a later date to the Royal Preston Hospital.

Inspectors found that both hospitals were clean and well maintained, and robust infection control practices were adhered to by staff. Staff communicated with and supported people in a compassionate way, and patients and their families spoke positively of the care they had received.

However, pressures on bed capacity within the hospital were affecting patient care and experience. Some patients were being treated on wards that were not specific to their condition, or best suited to their needs. Patients were often moved many times before being placed in an appropriate setting and surgical patients were also affected because operations were cancelled if inpatient beds were not available.

Patients were often in hospital longer than they needed to be. Discharge processes were slow and fragmented and delays in discharge were compounded by the lack of intermediate care provision in the local area. The trust was taking action to improve discharge processes and was working with commissioners and the local authority to improve discharge support in the community.

Inspectors also identified staffing issues. There was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain safe staffing levels. The trust was actively recruiting nurses and had increased its staffing levels, however this remained an ongoing challenge.

Inspectors identified a number of areas of outstanding practice, including:

• The trust was committed to becoming a dementia-friendly environment. The proactive elderly care team helped staff to identify and assess the needs of older people. and worked with intermediate care services to ensure the safe discharge of older people and those with dementia.
• The alcohol liaison service had been nominated for a national Nursing Standards award and staff spoke highly of the service and the positive contributions they had made in supporting patients with alcohol-related conditions and their families.
• The end of life team coordinated rapid response for discharge to the preferred place of care. There was a multidisciplinary approach to discharge planning that involved the hospital and the community staff working towards a rapid but safe discharge for patients.
• Ultrasound-guided blocks were used in A&E for patients with neck of femur injuries, which provided quicker pain relief.

Inspectors found a number of areas where the trust must improve:

• There must be enough suitably skilled and experienced staff to meet the needs of all patients at all times.
• Medical staffing must be appropriate at the location, including medical trainees, long-term locums, middle-grade doctors and consultants.
• Staff should receive advanced paediatric life support and moving and handling training.
• Action must be taken to improve patient flow throughout the hospital to reduce the number of patient bed moves and their length of stay, particularly in the medical division.
• Admission and referral pathways to the High Dependency Unit must be  clearly communicated and understood by all staff so that patients receive timely and responsive care and treatment.

CQC's Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"When we inspected the services run by Lancashire Teaching Hospitals NHS Foundation Trust, we found that – across the board – staff were working hard to deliver compassionate care to patients. We were particularly impressed by the trust’s approach to dementia care and the coordination of discharge for patients requiring end of life care in the local community.

"However, we also found that improvements were required in several areas. Pressures on bed capacity within the hospital meant that some patients were being cared for on wards that were not suited to meeting their needs. It had also led to patients being moved from ward to ward, sometimes during the night. This issue must be addressed to ensure that patients' needs are met at all times.

"The trust must also continue the work to improve discharge processes and tackle staff shortages. I know that the senior managers have acknowledged the importance of these challenges. I believe that trust has considerable potential to improve their services along these lines, and I will watch their progress with interest."

Ends.

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