England's Chief Inspector of Hospitals has told Liverpool Community Health NHS Trust that it must make further improvements to services following its latest inspection by the Care Quality Commission.
When CQC inspected in May 2014 the trust was rated as Requires Improvement overall. The trust was told it must make improvements in respect of a number of areas, including, staffing levels, waiting times and a culture in some services which was negative and on occasion intimidating.
Following the latest inspection in February 2016, the trust is still rated Requires Improvement. The full report is available on this website.
Inspectors were satisfied that the trust had sought to address the findings of the last inspection, and that improvements had been made. However, progress to make the necessary changes was often slow and some services still required further improvement.
Inspectors found there was well established multidisciplinary team working which focused on the best outcomes for patients and their families. Community services for children, young people and families and the health visiting and school nursing teams worked closely together to support children as they developed through their early years and into primary and secondary education. Health visitors supported local GP practices to help provide a more integrated service
Staffing had improved in community services since the last inspection but there were still concerns in some areas of community adult services. Team leaders in the community services for children, young people and families’ had responsibility for a large number of staff. Inspectors also noted high levels of sickness in some teams.
Although waiting times in the services for adults and children, young people and families’ had improved but in other areas, performance was worse than at the last inspection. Demand was so high for the paediatric speech therapy service that the trust had suspended the waiting list last year.
Inspectors were pleased to report an improvement in culture in the community inpatient service, which, at the last two inspections, was found to be very negative. All staff were clear that huge efforts had been made to change and support the delivery of intermediate care services.
Previously inspectors had found that the staff culture in some services was negative and on occasion some people found it intimidating. At this inspection inspectors found there had been significant improvements in culture across the organisation, although the percentage of staff that had experienced harassment or bullying was worse than the national average.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“It is positive to see that there has been an improvement in all areas of the inpatient services operated by the trust. This service was previously rated as requires improvement and was rated good in all areas at this inspection. It is also positive to see that there has been a significant improvement in the number of staff across most community services. I note that there has been a net increase of 57 district nurses since our last inspection – but there are still gaps in some areas.
“When we last inspected Liverpool Community Health NHS Trust we clearly identified a number of areas for improvement. It is disappointing to find that some of the issues had still not been resolved at the time of this inspection.
“I am pleased to report that patients are not waiting so long for wheelchairs, I am concerned that generally progress on waiting times has been far too slow. In addition, some waiting times, such as those in the children’s speech and language therapy service, have actually got worse since the last inspection and give cause for some concern, which I know that the trust has been trying to address.
“I am still concerned that too many patients have been developing serious pressure ulcers and although we have seen some improvement, it is clear that there is much to do if Liverpool Community Health NHS Trust is to provide the level of service which its patients are entitled to expect. We will continue to monitor performance and we will return in due course to check on the trust’s progress.”
There was an area where inspectors identified outstanding practice:
The school nursing service had responded at short notice to a requirement to carry out a flu vaccination programme, which involved immunising 18,000 children in 200 schools over a four week period.
CQC has told the trust it must draw up a plan to address the issues found during the inspection. Inspectors will return to check that the required improvements have been made.
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It is positive to see that there has been an improvement in all areas of the inpatient services operated by the trust.
Professor Sir Mike Richards, Chief Inspector of Hospitals