England's Chief Inspector of Hospitals has recommended that United Hospitals Lincolnshire NHS Trust should remain in special measures following the Care Quality Commission’s latest inspection.
Although the inspection highlighted much progress at the trust, it is felt that the trust should remain in special measures so it can receive the support it needs to make further improvements.
The inspection included visits to Lincoln County Hospital, Pilgrim Hospital, County Hospital, Louth, and Grantham and District Hospital and took place from 15 February to 12 April 2018. As a result, the trust’s overall rating has improved from Inadequate to Requires Improvement.
The trust’s ratings for whether its services are safe and well-led have also changed from Inadequate to Requires Improvement. Meanwhile, the trust remains rated Requires Improvement for whether its services are effective and responsive and Good for whether its services are caring.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“While we saw a number of improvements to patient care across United Hospitals Lincolnshire NHS Trust, we feel the trust would benefit from remaining in special measures. This is so that it can receive support it needs to maintain and embed the changes it has already made and to make further sustainable improvements so that people can receive the service they should be able to expect.
“During our inspection we found staff were caring and committed to helping patients, but we were disappointed to find that insufficient improvement had been made at Pilgrim Hospital in Boston since our last inspection in October 2016, and our overall rating of the hospital remains Inadequate.
“Pilgrim Hospital’s urgent and emergency care was of significant concern, and we have rated it as Inadequate in all the key questions we ask when inspecting – is the service safe, effective, caring and well-led. Services for young people at Pilgrim Hospital are also rated Inadequate overall and it is clear that much work is needed.
“However, we also found a number of examples of outstanding practice at the trust. Most notably these were found in urgent and emergency care and medicine, including older persons care and outpatients. Staff in these services are to be commended for their hard work.
“The trust leadership knows what it needs to do to make the necessary improvements and we will continue to monitor the trust. This will include further inspections”
CQC has told the trust to make a number of improvements. This includes that the quality of data must be improved to provide assurance to the board, there must be effective governance processes around procedures to ensure locum staff are suitable to work in the organisation and to assure the board of the quality and delivery of surgical care for children.
The trust must also ensure there are effective arrangements for identifying, recording, and managing risks and issues, and taking mitigating action, and it must take immediate action to address the significant levels of violence and abuse experienced by staff.
Additionally, the trust must ensure it is fully compliant with the duty of candour in relation to incidents and that appropriate checks on prospective and current staff are carried out.
The inspection also identified areas of outstanding practice. This included the emergency department at Lincoln County Hospital which had developed a quality improvement project with an acronym on a sticker known as ‘Trueman Show’. This helped staff identify and diagnose aortic dissections and ensured patients received appropriate care and treatment in a timely way.
Housekeeping and domestic staff on Lancaster ward showed inspectors how they tracked individual nutritional needs according to a red, amber, green risk system which helped them to plan each meal service depending on people’s specific requirements. Following feedback from patients, staff on the same ward provided finger food for patients with dementia. This meant they could have a snack at any time on the ward, which reduced the risk of malnutrition.
Meanwhile, the stroke ward at Pilgrim Hospital in Boston arranged for a long-term patient to carry out their wedding ceremony on the unit. And the hospital’s laundry staff offered a free service to cancer patients to tailor bras to ensure they fitted women’s specific measurements after breast surgery.
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While we saw a number of improvements to patient care across United Hospitals Lincolnshire NHS Trust, we feel the trust would benefit from remaining in special measures
Professor Ted Baker, Chief Inspector of Hospitals