The Care Quality Commission (CQC) has rated the services provided by Royal Liverpool and Broadgreen University Hospitals NHS Trust as Requires Improvement overall following inspections in January and February 2019. Previously it was rated as Good.
The trust was rated Outstanding for being caring and Good for being safe and effective. However, responsive and well-led were rated Requires Improvement.
A team of CQC inspectors looked at three core services at the Royal Liverpool site (Royal Liverpool Hospital): urgent and emergency care, surgery and medical care including older people’s services. Inspectors visited the trust’s community and dental services for the first time. They also looked specifically at management and leadership to answer the key question: Is the trust well-led?
The trust’s Dental Hospital was rated Outstanding. Community services were rated Good overall, but overall rating for the Royal Liverpool fell to Requires Improvement. Broadgreen Hospital was not inspected, its Good rating remains unchanged.
CQC has also published the trust’s Use of Resources (UoR) report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Requires Improvement for using its resources productively. The combined rating for the trust, taking into account CQC’s inspection for the quality of services and NHSI’s assessment of Use of Resources, is Requires Improvement.
Full details of the ratings, including ratings for each individual service are given in the report published online at: www.cqc.org.uk/provider/RQ6
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“We saw some excellent practice and care being provided by the trust in the community and dental services, clearly making a positive difference to people’s lives. But during our visit to the Royal Liverpool we found a number of concerns, particularly in urgent and emergency and medical care services. We saw a lack of appropriately skilled and experienced staff, delays in discharges in some areas of the hospital, and areas and equipment that required important maintenance.
“We also found issues with managing demand and how quality improvements would be made. However, patients were cared for with dignity and respect, and staff were compassionate when delivering treatment.
“I pay tribute to the trust for improving their rating for caring from Good to Outstanding. This recognises all the hard work in challenging circumstances; the time staff spend with people through treating people with compassion, kindness and dignity, by going that extra mile.”
There was effective leadership across the trust’s community and dental services with a focus on continuous improvement. In both services, people’s needs were sought and accommodated where possible to ensure they had a positive and personal experience. People were fully involved in their care and praised the services for the care provided. Both services, and the trust overall, were rated Outstanding for being caring.
Outstanding practice was seen in community health services for adults: the HIV team worked with a local charity to help patients access additional pain relief when they needed it, and the community respiratory team combined staff expertise and developed a care model to help people manage their conditions at home and avoid hospital stays.
When visiting the Royal Liverpool, inspectors saw staff treating people with compassion and providing emotive support, taking time to discuss their needs and involving them in their care decisions. Patient feedback was consistently positive.
However, inspectors reported not enough appropriately experienced and trained staff were consistently available in the urgent and emergency service. Nursing and medical staff vacancy rates were high and patients that risked deterioration were not being regularly monitored.
Arrangements for managing demand did not always operate effectively. Some staff in medical services did not understand how or when to assess whether a patient had capacity to make decisions about their care. Decisions were not always documented, meaning that it was unclear if they had been fully assessed. Some areas that contained hazardous substances were left unlocked and accessible to patients.
Managers in medical care were not always made aware of poor performance, so that timely improvements could be made. Leaders in both urgent and emergency and medical care services envisioned quality improvements, however, inspectors did not find evidence of actionable plans in medical care.
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