CQC publishes report of investigation into University Hospitals of Morecambe Bay NHS Foundation Trust

13 July 2012

The Care Quality Commission (CQC) today publishes its full investigation report into University Hospitals of Morecambe Bay NHS Foundation Trust.

The investigation into the delivery of emergency care services by the trust identified a number of key concerns with the provision of patient care that go beyond emergency care. We began the investigation on 17 January 2012, and evidence gathering took place from January to March 2012.

However, CQC has noted that recent changes to the management of the trust have resulted in positive actions to address many of the issues highlighted in this report – although the impact of these changes has yet to be tested by CQC.

The overriding concern at the time was an apparent dislocation between senior managers and senior clinicians and a lack of leadership to address practices that adversely affect the quality of care patients receive at the trust.

We found that despite action taken by the trust in response to earlier concerns and recommendations made in earlier reviews, patients remained at risk of poor care, particularly those in accident and emergency and other parts of the hospital that provided urgent care.

During the course of, and as a result of, the investigation we issued warning notices to the trust in relation to the use of mixed sex accommodation and failings in the way that patients were monitored.

Other key findings of the report include:

• The trust’s systems and processes for clinical governance, including the systems for monitoring the effectiveness of these systems in the provision and delivery of assurance to the Board, have been subject to recent review and remain under review. However, until new systems and processes for identifying, assessing and managing risk have been embedded, concerns remain regarding inconsistent incident reporting practices; lack of learning from incidents and poor use of performance information to drive change.
• Little evidence of the whole trust working together to drive change and improvements in care.
• Despite being part of the same trust, The Royal Lancaster Infirmary and Furness General Hospital have retained their own identities and distinct cultures, with only limited plans in place for cross-site working and standardisation of practices.
• Where areas of improvement had been identified, the trust had been slow to respond. This was demonstrated by long waits in accident in emergency; frequent internal transfers of patients to wards outside the specialty to which they had been admitted; failure to adequately monitor patients; inconsistency in the medical review of patients; unnecessary delays to the discharge of patients; lack of regard to the privacy and dignity of patients through the accommodation of male and female patients together in one ward.
• An apparent ‘shared helplessness’ among staff with little ownership by the emergency department staff of the system of patient management. There was evidence that key decisions related to patient care within the emergency care pathway had been made without consultation with the emergency department senior management team. For example, the decision to admit all stable GP admissions to the emergency department, whichresulted in an ever increasing volume of patients attending the emergency department and longer waits for patients within the department.
• Staffing levels across some parts of the trust were inadequate.
• There were concerns about the trust’s ability to effectively manage the quality of service delivery.

Amanda Sherlock, CQC Director of Operations, said: ‘This investigation allowed us to take an in-depth look at the care patients received as they entered the hospitals for emergency care and at what happened to them subsequently.

‘The standards of care we found were not good enough, with people waiting too long to be seen, too few staff on duty, patients not being monitored properly and patients being accommodated in mixed sex wards, or sometimes in wards not appropriate to their condition.

‘A clear message from our investigation is that the trust needs firm leadership and robust governance systems to make sure everyone pulls in the same direction. It is especially important for clinicians and managers to work together

‘The new leadership of the trust appears to be responding positively to our concerns. They need to maintain this impetus and, importantly, ensure that improvements are sustained.’

Progress reported by the trust

During the course of the investigation the trust reported that action had been taken to address the areas of concern raised within this report and to concerns identified following previous reviews.

These include: Stopping the use of the Clinical Decision Unit at the Royal Lancaster Infirmary for the overflow from the medical and surgical assessment units; Introduction of spot checks in respect of observations and record keeping; all staff have been reminded of their responsibility in respect of privacy and dignity and a programme of work to review and improve the emergency care pathway as a whole has been established.

There have also been significant changes to the membership of the Trust Board, as an interim Chair, interim Chief Executive, interim Medical Director and Chief Operating Officer were all appointed during the course of this investigation. In addition, the trust also announced appointments to clinical leadership and senior management positions to help drive improvement. Although at the time of writing the report, this recruitment had not been completed.

The trust must ensure that the recommendations from this investigation are incorporated into the existing improvement programme. Any action should include how it will show evidence of positive impact on the quality of service and outcomes for people, and provide quality assurance for commissioners. Details of the action taken and changes in practice should be submitted to CQC, Monitor, stakeholders and partner agencies, and made available to people who use its services.

CQC will conduct a formal review of how the trust has addressed the recommendations in this report in six months.

Ends

For further information please contact the CQC press office on 0207 448 9401 or the CQC Regional Communications Team - Kirstin Hannaford 0191 233 3629; David Fryer 07901 514 220 or.

Out of hours, call 07917 232 143.

Notes to editors

Evidence gathering took place from January to March 2012. Both hospital sites were inspected, during which we spoke to patients about their experiences and observed care being delivered. We interviewed more than 200 hospital staff in private and spoke to staff from eight different external stakeholders. We received further information from more than 100 people who had used the trust’s services, through interviews and written submissions. MPs and local councillors submitted their views and the views of the constituents they represent.

The investigation team was lead by a compliance manager who was independent of the compliance team who usually led on the trust. The investigation team comprised of compliance inspectors; specialist advisors from emergency care; a former chief executive; analysts; regional intelligence and evidence officers and business support staff including staff from our National customer service centre.