CQC issues two warning notices to University Hospitals of Morecambe Bay NHS Foundation Trust following investigation visits

6 March 2012

The Care Quality Commission (CQC) has issued two formal warnings to University Hospitals of Morecambe Bay saying it must do more to improve standards of care or face further action.

Debbie Westhead, North West Regional Lead for the Care Quality Commission said: “As part of our investigation into emergency care, our inspectors found failings in the way that patients are monitored at the Royal Lancaster Infirmary and Furness General. We also noted that patients are not always afforded privacy and dignity and are placed on mixed sex accommodation in the clinical decisions unit at the Royal Lancaster Infirmary.

“We have served these warning notices because these are matters the trust needs to put right without delay.”

When patients are not being monitored appropriately, there is a greater risk that their condition will worsen. For example, a patient had their first vital sign observations undertaken on admission in the emergency unit, then the next set of observations were completed two hours and twenty minutes later when they were transferred to the surgical assessment unit. A senior nurse said they would expect half hourly observations to be undertaken due to the condition this patient presented with. This patient did not have appropriate monitoring of their condition.

Records showed – and our observations confirmed – that the trust was failing to follow Department of Health guidance in relation to mixed sex accommodation. This means that the trust is failing to respect the dignity and privacy of patients.

It is also important that a patient’s care is based on the assessed needs of that patient, and our inspectors observed care that was not centred on the patient as an individual. For example, inspectors observed an elderly patient who kept removing their bedclothes and exposing themselves to the ward. No nursing staff were available to help ensure the privacy and dignity of this patient was maintained. Additionally, the safety of this patient was put at risk due to lack of equipment. We noted that bed rails had been placed on the bed. The patient kept putting their legs through the bars as protective cushions had not been fitted to the rail.

The trust has told us it has taken steps to tackle these problems, but we will be back to check that any improvements are being sustained.

The CQC investigation focussing on the emergency care pathway is looking in-depth at the care patients receive when they arrive at the hospital for emergency care, and what happens to them subsequently. These warning notices were served following inspections carried out as part of the investigation. We will publish a detailed report of the investigation in due course.

Ends

Notes to Editors

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

The warning notices find that University Hospitals Morecambe Bay NHS Foundation Trust is in breach of:

Regulation 9 (1) (a) (b), which states:

Care and welfare of service users
(1) The registered person must take proper steps to ensure that each service user is protected against the risks of receiving care or treatment that is inappropriate or unsafe, by means of—
(a) the carrying out of an assessment of the needs of the service user;
and
(b) the planning and delivery of care and, where appropriate, treatment
in such a way as to—
(i) meet the service user’s individual needs,
(ii) ensure the welfare and safety of the service user,
(iii) reflect, where appropriate, published research evidence and guidance issued by the appropriate professional and expert bodies as to good practice in relation to such care and treatment, and
(iv) avoid unlawful discrimination including, where applicable, by providing for the making of reasonable adjustments in service provision to meet the service user’s individual needs.
(2) The registered person must have procedures in place for dealing with emergencies which are reasonably expected to arise from time to time and which would, if they arose, affect, or be likely to affect, the provision of services, in order to mitigate the risks arising from such emergencies to service users.

Regulation 17(1) (a), which states:
Respecting and involving service users
(1) The registered person must, so far as reasonably practicable, make suitable
arrangements to ensure—
(a) the dignity, privacy and independence of service users; and
(b) that service users are enabled to make, or participate in making, decisions relating to their care or treatment.
(2) For the purposes of paragraph (1), the registered person must—
(a) treat service users with consideration and respect;
(b) provide service users with appropriate information and support in relation to their care or treatment;
(c) encourage service users, or those acting on their behalf, to—
(i) understand the care or treatment choices available to the service user, and discuss with an appropriate health care professional, or other appropriate person, the balance of risks and benefits involved in any particular course of care or treatment, and
(ii) express their views as to what is important to them in relation to the care or treatment;
(d) where necessary, assist service users, or those acting on their behalf, to express the views referred to in sub-paragraph (c)(ii) and, so far as appropriate and reasonably practicable, accommodate those views;
(e) where appropriate, provide opportunities for service users to manage their own care or treatment;
(f) where appropriate, involve service users in decisions relating to the way in which the regulated activity is carried on in so far as it relates to their care or treatment;
(g) provide appropriate opportunities, encouragement and support to service users in relation to promoting their autonomy, independence and community involvement; and
(h) take care to ensure that care and treatment is provided to service users with due regard to their age, sex, religious persuasion, sexual orientation, racial origin, cultural and linguistic background and any disability they may have.