CQC publishes findings from inspection at Blackpool Victoria Hospital

The Care Quality Commission (CQC) has told Blackpool Teaching Hospitals NHS Foundation Trust that it must make some improvements in its urgent and emergency care department (UEC) and its medical care services at Blackpool Victoria Hospital.

The unannounced, focused inspection of the UEC department took place in January as part of CQC’s winter pressures programme. Inspectors looked at whether the service was safe, responsive and well-led. As inspectors did not inspect all key areas, the overall rating of Requires Improvement remains from the last inspection in October 2019.

CQC also carried out a focused, unannounced inspection of the medical care services which included the acute medical unit (AMU), the stroke unit, and wards 10 and 12 at Blackpool Victoria Hospital. This was in response to concerns from staff and patients about the safety and quality of the services. Inspectors looked at whether the service was safe, effective and responsive. This service was not rated, therefore the rating of Inadequate remains from the previous inspection in October 2019.

Following the inspection of both services, CQC has told the trust to take action due to concerns around the potential risk of harm to patients. This included addressing issues around patient flow through the departments. Also, in the medical care services there was insufficient numbers of qualified medical staff and a lack of patient involvement in their care.

CQC’s deputy chief inspector for the north, Ann Ford, said:

“Whilst we recognise the pressures that the trust was under during the pandemic at the time we inspected, CQC has a responsibility to follow up on concerns that were received from staff and people using these services.

“When inspectors visited Blackpool Victoria Hospital, they found areas where immediate improvements were needed to ensure people could access the appropriate service in a prompt and timely way. This was not always happening, because patient flow through the hospital was a challenge.

“We also found there was not sufficient numbers of qualified, competent and experienced medical staff in the medical care services. The trust must ensure that this is improved to keep patients safe from avoidable harm and to provide the right care and treatment they deserve.

“However, inspectors did also see some examples of good practice. There was effective senior leadership of doctors and nurses. Junior doctors informed us that they felt supported and that consultants were open and easy to speak to.

“Inspectors found that the atmosphere, while busy, was calm and staff were aware of their roles and what they needed to do. A senior nurse told us that there was strong support from their manager and there had been massive leaps in patient care and patient safety following the appointment of the relatively new executive team.

“The trust has made a number of improvements since our last inspection and knows what further improvements need to be made and embedded. We will continue to monitor services closely and return to check on progress.”

CQC inspection team identified the following actions the trust must take to improve:

Emergency department

• The flow of patients through the emergency department and the hospital so that patients are assessed, treated, admitted and discharged in a safe, timely manner.

Medical care

• Ensure that patient records are complete, legible and kept securely at all times, so that they are up to date, clear and only accessed by those authorised to do so.
• Medical staffing is sufficient to meet the needs of patients and ensure actual staffing meets with, or is close to, the planned numbers. They should continue work to improve the recruitment and retention of medical staffing to reduce vacancies.
• Make sure that when a patient is unable to consent to their care and treatment staff follow trust policy and the requirements of the Mental Capacity Act 2005. Patients and/or their families should be involved in decisions made about their care and treatment.
• Continue to progress work and focus on making improvements to flow through the hospital, so that patients receive appropriate care and treatment in the right place when they need it and that discharges happen safely in line with national standards.

Outstanding practice

The inspection team also found some outstanding practice which included:

• There was an advanced paramedic who worked with the mental health liaison team to deflect admissions from the department to other services. Patients who requested an ambulance would be contacted by phone or visited by this team. This had been effective in reducing admissions to the department and shown a reduction in section 136 admissions to mental health services.
• The trust had developed strong processes in the emergency department to support safeguarding including the safeguarding navigator role and an independent domestic violence advisor. They had won an award for their work for victims of rape who attended their department.
• Due to the national issue of Deprivation of Liberty Safeguards (DoLS) authorisations not being reviewed by the local authority in a timely way, the trust had implemented a DoLS assurance process where patients were reviewed every seven days. This allowed for professional challenge between colleagues over whether the application was still required, to ensure any deprivation of a patient’s liberty was kept to a minimum.

Read the full inspection report