The Care Quality Commission (CQC) has published a report following inspections at Lancashire Teaching Hospitals NHS Foundation Trust in May, June and July.
Unannounced inspections were carried out as part of CQC’s continual checks on the safety and quality of healthcare services at the trust.
Inspections took place at urgent and emergency care at Royal Preston Hospital and Chorley and South Ribble Hospital, as well as medical care, and surgery at Royal Preston Hospital.
A focused inspection of maternity services was also undertaken as part of CQC’s national maternity services inspection programme. The programme aims to provide an up-to-date view of the quality of hospital maternity care across the country, and a better understanding of what is working well to support learning and improvement locally and nationally.
Inspectors also looked at how well-led the trust is overall.
Following these inspections, the following services were rated:
- Urgent and emergency care at Royal Preston Hospital – has again been rated requires improvement overall and for being safe and responsive. Caring and well-led have again been rated as good. Effective has declined from good to requires improvement.
- Urgent and emergency care at Chorley and South Ribble Hospital – the overall rating, as well as effective, caring, responsive and well-led have again been rated as good. Safe has declined from good to requires improvement.
- Medical care at Royal Preston Hospital – overall, safe, effective and responsive have again been rated as requires improvement. Well-led has improved from requires improvement to good. Caring has been re-rated as good.
- Surgery at Royal Preston Hospital – this has again been rated good overall and for being safe, caring and well-led. Effective has improved from requires improvement to good, and responsive has declined from good to requires improvement.
- Maternity services at Royal Preston Hospital – this has declined from being good to requires improvement overall and for being safe. Well-led has again been rated as good.
- Maternity services at Chorley and South Ribble Hospital – overall and well-led were re-rated as good. Safe has declined from good to requires improvement.
Following the inspections of maternity services and a review of trust data, CQC issued a letter of intent to the trust. This requested further information around delays with reporting and grading of incidents. The trust responded quickly to the concerns raised and provided the required assurances.
The overall rating for Lancashire Teaching Hospitals NHS Foundation Trust was again rated requires improvement. Safe, effective and responsive were also again rated requires improvement. Caring was re-rated as good, and well-led has declined from good to requires improvement.
Sheila Grant, CQC deputy director of operations in the north, said:
When we visited Lancashire Teaching Hospitals NHS Foundation Trust, we found leaders showed adequate experience, knowledge and skills to be able to run the trust. However, some staff felt leaders weren’t always visible in services where there were greater pressures, which left some staff feeling unsupported.
Inspectors found the trust had processes in place to escalate relevant risks and identified actions to reduce their impact. However, in urgent and emergency care, there were concerns about the management of people with mental health needs. We raised this with the trust, who responded quickly to our concerns.
At Royal Preston Hospital, there were delays in induction of labour, with no explanation in people’s notes of why this delay happened for over half the people we looked at. The service has now introduced a new system to reduce the delays and improve the standard of care for women and people using the service.
We also found some outstanding practice in both maternity services, as well as in the emergency department at Royal Preston Hospital.
Additionally, last November, the trust opened Finney House (a step-down rehabilitation centre). This is for people who no longer meet the criteria to be in an acute hospital but require support such as rehabilitation before returning into the community. This has reduced the number of people who don’t meet the criteria for being in an acute hospital.
Following these inspections, we reported our findings to the trust. Its leaders know where they need to make improvements.
We will continue to monitor the trust and will return to carry out another inspection, to ensure the necessary improvements have been made so people receive the safe care they deserve.
Inspectors found:
- Most staff felt respected, supported, and valued. They were focused on the needs of people receiving care.
- The service promoted equality and diversity in daily work and provided opportunities for career development. The trust supported staff to develop their skills and take on more senior roles.
- The service collected reliable data and analysed it.
- Leaders and staff actively and openly engaged with people, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for people.
- The trust had a good understanding of quality improvement methods and the skills to use them
- In both maternity services, staff did not consistently report incidents via the appropriate system. After this was raised, leaders took immediate action to ensure all staff reported incidents accurately and in a timely manner to keep people safe.