CQC publishes review of standards at United Lincolnshire Hospital NHS Trust

A report published by the Care Quality Commission (CQC) today (Tuesday) said United Lincolnshire Hospitals NHS Trust must take action to ensure it meets all essential standards of quality and safety.

The regulator has asked the trust to set out the action it will take to improve in relation to: safeguarding people from abuse; respecting and involving people who use services; management of medicines; and supporting workers.

Today’s report details the findings of CQC’s review of the trust’s compliance with the new quality and safety standards, which came into effect from 1 April. The review involved analysis of information from the trust and an unannounced inspection at Lincoln County Hospital on 10 June 2010, to directly observe care given to patients.

Inspectors talked to patients, carers, a range of medical and nursing staff as well as the Local Involvement Network, primary care trust and strategic health authority.

During its inspection, CQC saw examples of people receiving good quality care, and the patients it spoke to were positive about their experience. It found:

• Patients knew who to contact about their care needs and what to do if their needs were not being met.
• Staff knew what action to take if a patient’s condition deteriorated.
• There are adequate staffing levels to meet the needs of patients.
• Staff enjoy their work and are committed to enabling patients to achieve good outcomes.

As part of its review, CQC looked at planning for surgical procedures. Surgeons interviewed by CQC stated that they were involved in the formation of operating theatre schedules, which take account of the competency of the surgeons. They also said junior doctors were appropriately supervised in theatre, and inspectors observed good team work among theatre staff.

However, CQC found evidence that the trust is not fully meeting four standards relating to: safeguarding people from abuse; respecting and involving people who use services; management of medicines; and supporting workers. 

The regulator said the breaches do not present immediate risks to the safety of people who use services and that formal enforcement action is not necessary at this time. However, it has required the trust to take action to address its concerns. If progress is not made, it will consider taking enforcement action.

The trust must take action to address the following four standards:

Respecting and involving people who use services:

• Sometimes patients waited up to four hours in the theatre recovery area following their surgical procedure because of a high demand for beds on wards. There are no toilets in the area and patients are required to use a bed pan. This could compromise patients’ dignity.
• The needs of patients with a learning disability were not fully understood by all staff.
• Patients cannot always identify staff, as sometimes staff did not introduce themselves or clearly display their name badges.

Safeguarding people from abuse:

• Not all staff were clear about what to do if they suspect a patient is being abused, and not all have received training on the protection of vulnerable adults.

Management of medicines:

• Some staff left medication at patients’ bedsides and did not always give them assistance to take it when needed.

Supporting workers:

• Not all staff had individual supervision or an appraisal with their line manager, and bank nursing staff are not clear about opportunities for training, development, appraisal and supervision.  

The trust must submit an action plan to CQC, outlining how it will address these remaining concerns in order to meet the standards.  

Andrea Gordon, CQC regional director, said: “During our inspection of Lincoln County Hospital we were pleased to see examples of people receiving really good quality care, and staff were dedicated to making sure patients’ needs are met.

“It is true that we found evidence to show the trust is not meeting four standards, however, we want to reassure the public that we do not believe there are immediate risks to patient safety.

“But compliance with standards is not optional. Patients should be able to expect a certain level of care wherever they receive treatment. The trust must take swift action to address our concerns.

“The trust must now provide us with an action plan stating the action they will take. We will be monitoring progress closely and will not hesitate to take action and use our powers to drive improvement where necessary.

“We would like to thank the staff, patients and carers who took the time to speak with us. We turn up unannounced, so it’s not always easy or convenient for people, especially busy staff and ill patients. This input is invaluable.”

CQC also wrote to the trust in May requiring improvements in areas such as supporting staff, supporting people to understand the care they receive and handling of complaints.  The trust has provided action plans and is demonstrating improvements in these areas.

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

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. Our aim is to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people’s own homes, or anywhere else that care is provided. We also seek to protect the interests of people whose rights are restricted under the Mental Health Act. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

We are introducing a new registration system that brings the NHS, independent healthcare and adult social care under a single set of essential standards of quality and safety for the first time. Registration is a legal licence to operate. We register health and adult social care services if they meet essential standards and we continuously monitor them to make sure they continue to do so as part of a dynamic system of regulation which places the views and experiences of people who use services at its centre.