CQC recommends a return to special measures for Northern Lincolnshire and Goole NHS Foundation Trust

England's Chief Inspector of Hospitals has recommended that Northern Lincolnshire and Goole NHS Foundation Trust should return to special measures following the Care Quality Commission’s latest inspection of its services.

The inspection included Scunthorpe General Hospital and Diana Princess of Wales Hospital and a follow up inspection of community services. Goole Hospital was not inspected as it was rated as Good in October 2015. Overall the trust has been rated as Inadequate, although caring has been rated as Good.

Inspectors found significant concerns in urgent and emergency care, outpatients and maternity services. The trust had made some improvements in staffing although this remained challenging.

The trust was one of 11 NHS trusts placed into special measures by Sir Bruce Keogh in July 2013 as part of his review of high mortality rates.  The trust exited the special measures regime in April 2014 following improvements at the time.

On the latest inspection, in October to December 2016, CQC found deterioration across a number of services resulting in the trust being rated inadequate overall.

Ellen Armistead, Deputy Chief Inspector of Hospitals at CQC, said:

“Having seen improvements to patient care previously, we are disappointed that our latest inspection of Northern Lincolnshire and Goole NHS Foundation Trust found these improvements had not been sustained and there had been an overall deterioration in quality and patient safety."

“For this reason, we have recommended that the trust should re-enter special measures so that the trust can receive the necessary leadership support it needs to deliver a robust improvement plan. The focus of the improvement plan will be to ensure that patients receive safe, high quality and compassionate care at all times."

“In particular, we would like to see significant improvements to the quality and safety of patient care, leadership and managerial oversight of quality and performance and effective implementation of the existing governance arrangements consistently across all of the services. Further improvement is required to ensure the trust is able to effectively manage risk, and cope with patient demand and flow across its services in a timely and sustainable way."

“Community services, critical care and end of life care had made improvements at this inspection."

“We will continue to monitor the trust and will return to check on the progress it must make. NHS Improvement will be working closely with the trust to ensure full support is available to make the improvements needed.” 

Inspectors found there were ongoing delays in patients being able to access treatment and care, with growing numbers of patients having to wait for longer than necessary for their outpatient appointments or inpatient treatments. Although there were some improvements in outpatient processes since the last inspection there has not been sufficient progress.

In urgent & emergency care there had been no significant improvement to patient flow in both hospital departments. Inspectors found poor infection control practices at Scunthorpe General Hospital. They were not assured that patients were being monitored appropriately or that they were receiving appropriate nursing care in either of the urgent and emergency care departments.

In maternity services there were concerns regarding midwifery staffing levels and the service could not provide assurance that teams learned from incidents.

CQC found poor leadership and oversight in a number of services and at a senior level within the trust. Leaders had not managed to deliver the required improvements robustly or effectively. There was lack of managerial oversight of quality and performance indicators and lack of credible recovery plans in place to address the concerns.

However inspectors some improvement across community services at Scunthorpe and in critical care and end of life care services at both Scunthorpe General Hospital and Diana Princess of Wales Hospital. Community services were rated as Good overall and both critical care and end of life care services were rated as good. There had been some improvements in staffing at this inspection.

Areas of poor practice, where CQC has told the trust to make improvements include:

• The trust must continue to take action to reduce the numbers of cancelled clinics within Outpatients and also work to reduce the backlog of patients in this area.
• The trust must also continue to work with partners to address referral to treatment times and improve capacity and demand planning to ensure services meet the needs of the local population.
• In the emergency department, the trust must ensure that patients are assessed for pain relief; and appropriate action is taken if it is needed. This should also be recorded within the patients’ notes.
• Ambulance staff should be able to promptly register and handover patients on arrival at the emergency department.
• The trust must take steps to ensure that appropriate numbers of suitably qualified and experienced midwifery staff and medical staff are available to meet the needs of women in maternity.
• The trust must ensure that appropriate numbers of staff are available in line with national guidance specifically within surgery, medicine, and maternity. They must also ensure the right staff are available to meet the needs of children and young people on both the paediatric wards and in the emergency department.
• The trust must monitor and address mixed sex accommodation breaches.

The inspection also identified some areas of positive practice:

• A Skype service run by the infant feeding co-ordinator was offered by the trust to support mothers who were breast-feeding mothers in their own homes.
• The trust had a dedicated member of staff to manage interpretation and translation services, including British Sign Language.
• The trust’s podiatry services had developed training sessions for patients to care for their own feet. Patients were discharged if this was successful and waiting lists had fallen as a result.

Full reports, including ratings for all of the provider’s core services, are available on our website.

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For further information please contact CQC Regional Engagement Officer Kerri James by email kerri.james@cqc.org.uk or by phone on 07464 92 9966. 

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