The Care Quality Commission (CQC) has published a report following an inspection at North Cumbria Integrated Care NHS Foundation Trust in June and July.
CQC looked at how well-led the trust is as well as emergency and urgent care and medical care services as part of its continual checks on the safety and quality of healthcare services.
Inspectors also looked at the emergency and urgent care and medical care services at Cumberland Infirmary and West Cumberland Hospital. Following the inspection:
- Cumberland Infirmary - the emergency and urgent care services were again rated as requires improvement overall. Its rating for being safe improved from inadequate to requires improvement. Effective, responsive and well-led were again rated as requires improvement and caring remains rated as good.
The medical care services were again rated as requires improvement overall. Effective and responsive have declined from good to requires improvement. The ratings for being safe and well-led remain rated as requires improvement and it remains rated as good for being caring.
- West Cumberland Hospital - the emergency and urgent care services were again rated as requires improvement overall which is the same for how safe, effective and responsive it was. How well-led the service was improved from requires improvement good and caring was again rated as good.
The medical care services were again rated as requires improvement overall. Effective and responsive declined from good to requires improvement. The ratings for being safe and well-led remain rated as requires improvement and it remains rated as good for being caring.
Following this inspection, the trust overall remains rated as requires improvement for being well-led. The other areas weren’t inspected, therefore, the trust’s ratings for safe, effective, and responsive also remain as requires improvement and caring remains rated as good. The overall rating for the trust remains as requires improvement.
Linda Hirst, CQC deputy director of operations in the north, said:
When we inspected North Cumbria Integrated Care NHS Foundation Trust, we found a senior leadership team who were still finding their feet after a number of personnel changes, and in an organisation that also been through significant overall change. We found that not all leaders worked effectively together yet, however, they had recognised this and understood there was still significant work to be done and had a development plan in place.
We saw that the services we inspected had largely remained the same as when we last inspected, some areas had made improvements and some still have issues they need to work on.
During the inspection of Cumbria Infirmary, we found significant concerns relating to medicines management. During our visit, we found an unlocked cupboard with controlled drugs inside and a discrepancy in the stock of one of the medicine cabinets which staff weren’t aware of, but addressed immediately when we raised it. These incidents were due to poor oversight and the service not having effective processes or staff following the trust’s own policies, which they were looking to improve.
We found some good practice at West Cumberland Hospital, where we saw that urgent and emergency care service leaders had the skills and abilities to run the service. They were visible and approachable for people using services and staff. We found a good culture where staff continued to be resilient and positive despite the challenging circumstances.
However, it was disappointing to see some of the issues at the hospital’s medical care services. During the inspection we saw rooms containing potentially dangerous items, where doors should have been locked, they were left propped open or unlocked. doors that should have been locked. This was a safety risk as vulnerable people on the wards with the potential for episodes of confusion and delirium had access to these unlocked rooms. There had already been incidents of this happening. We raised our concerns to leaders on the day of inspection.
We also found access to medical care and waiting lists were still an issue and people couldn’t always receive treatment in a timely way. This continues to be a nation-wide challenge.
We will continue to work with the trust and monitor its progress to make sure that trust leaders and services make improvements going forward.
Inspectors found:
- CQC rated four of the trust’s 17 services as requires improvement. In rating the trust, CQC took into account the current ratings of the 13 services not inspected this time.
- The service did not always have enough staff to care for people using services and keep them safe.
- Not all staff had training in key skills, understood how to protect people from abuse, or managed safety well.
- The service did not always control infection risk well.
- Staff did not always assess risks to people, act on them and keep good care records.
- Pain relief was not always given in a timely way and when people needed it.
- The service did not always manage the safe storage of medicines and hazardous cleaning materials.
- The service did not always manage safety incidents well and although there was evidence of learning following safety incidents, there was further work required to manage environmental hazards and associated risks.
- Leaders did not always run services using reliable information systems.
- The trust’s vision and values were developed but did not have clear underpinning strategies.
However:
- Staff treated people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to people, families and carers.
- The service planned care to meet the needs of local people, took account of peoples’ individual needs and made it easy for people to give feedback.