Archived: North Cumbria University Hospitals NHS Trust

Updated 22 November 2018

North Cumbria University Hospitals NHS Trust was created in 2001 by the merger of Carlisle Hospitals NHS Trust and West Cumberland NHS Trust. It became a University Hospital Trust in September 2008.It is a provider of acute hospital services based at the Cumberland Infirmary in Carlisle (CIC) and the West Cumberland Hospital (WCH) in Whitehaven. It also provides a midwifery-led maternity service at Penrith Community Hospital.

The trust has 590 inpatient beds across these three locations and employs over 4,600 members of staff (over 3,600 whole time equivalent). The trust is not a Foundation Trust. Its main commissioner is Cumbria Clinical Commissioning Group (CCG), which commissions around 85% of its services, with NHS England commissioning a further 13%. The trust serves a population of approximately 320,000 in the west, north and east of Cumbria, in the districts of Allerdale, Carlisle, Copeland, and Eden Valley. It also provides services to parts of Northumberland and Dumfries & Galloway. The community is thus spread over a large geographical area, with 51% of residents living in rural settings. Deprivation levels vary from relatively low to high. Ethnic diversity is low. Rates of homelessness and youth drinking are both significantly higher in north Cumbria than in the rest of England. Over 65s make up a larger proportion of the population than is the national average. The health of people in Cumbria is mixed, with five indicators scoring better and nine indicators worse than the England average; 12 indicators are not significantly different from the England average. Deprivation is similar to the England average and about 11,700 children (14.5%) live in poverty. Life expectancy for men is lower than the England average and life expectancy for women is similar to the England average.

The trust was one of 14 selected for Sir Bruce Keogh’s 2012 review of quality of care and treatment provided by those NHS Trusts and NHS Foundation Trusts that were persistent outliers on mortality indicators (known as The Keogh Review). Following the review, in July 2013, the trust was placed into special measures. The trust was taken out of special measures in March 2017.

Updated 22 November 2018

Our rating of the trust stayed the same. We rated it as requires improvement because:

• We rated safe, effective, responsive and well-led as requires improvement and caring as good.
• We rated six of the trust’s eight services as good and two as requires improvement. In rating the trust, we took into account the current ratings of the three services not inspected this time.

We rated well-led for the trust overall as requires improvement.

• Registered nurse staffing shortfalls and registered nurse vacancies continued on all wards, however, this was most prevalent in the medical care group. Several registered nurse shifts remained unfilled despite escalation processes. Medical staffing cover remained challenging and locum cover was significant. Additional support was not always available for wards with more complex patient needs, such as one to one support due to behavioural problems or aggressive tendencies.
• There had been several serious incidents where patients had suffered harm as a result of missed diagnosis, late escalation of deterioration or delay in receiving treatment. The emergency department had a designated mental health assessment area that did not meet best practice guidance for a safe metal health assessment room. It contained inappropriate equipment and several ligature risks. We raised this during the core service inspection and the department took action to change the room and make it safer when we retuned for the well led inspection. Mental health patients also experienced long waits in the department as they waited to see mental health specialists from the local mental health trust.
• Mandatory training was not always completed by medical or nursing staff in a timely manner and compliance with mandatory training targets was low for both nursing and medical staff.
• Some areas had achieved appraisal target rates, however, staff across the trust reported that the quality of appraisals was poor.
• National and local guidelines were not fully embedded, some departments were not meeting the majority of the audit standards.
• The electronic systems for recording staffing levels and patient acuity was not used consistently throughout the trust.
• Prescribing policies were not followed and on occasions staff had difficulty following controlled drug procedures due to limited staffing. Intravenous fluids were not always secured as per the trusts medicines policy.
• There were a large number of bed moves after 10pm where patients had been moved for non-medical reasons and there remained many medical outliers being cared for on non-medical wards.
• Staff had a variable understanding and awareness of consent issues, the Mental Capacity Act and Deprivation of Liberty Safeguards.
• Staff morale was variable in each area we visited however we did see some areas where it had improved from our previous inspection.
• We were not assured that safeguarding training was delivered in accordance with Adult and Children Safeguarding Levels and Competencies for healthcare, intercollegiate guidance (2016).
• Governance systems varied from ward to ward in terms of quality. We found that staff on several wards did not know what the risk register was and ward managers were were unable to voice what risks were on it.
• Throughout the inspection staff told us that senior leaders lacked visibility in their clinical areas.
• Audits of the WHO surgical safety checklist showed completion of the checklist had been inconsistent and had not been completed for every patient;
• The foundation school had identified concerns about the adequacy of the training and experience of foundation programme doctors within surgery.
• There was a large number of guidelines and procedures within the maternity service which were not in date, although there was an action plan in place to recover this position.

However:

• Staff worked hard to deliver the best care they could for patients. Patients were supported by staff who were kind and compassionate despite being under pressure.
• Patients were positive about the care they received and staff proactively involved patients and their family to consider all aspects of holistic wellbeing.
• Staff confidently reported incidents and the division had made considerable efforts to reduce patient harms from falls and pressure ulcers.
• Ward environments were clean and staff used personal protective equipment appropriately to protect themselves and the patient from infection exposure.
• Patient outcomes in many national audits were good and there had been some reported improvements in others.
• Multidisciplinary team working across the services was integrated, inclusive and progressive.
• The trust had introduced a composite workforce model through the recruitment of trainee advanced clinical practitioners and physician associates to support the medical workforce within surgery;
• Discharges were managed during daily and weekly ward meetings and multidisciplinary team meetings on wards and staff worked with the discharge liaison team;
• Improving referral to treatment times had been set as a priority within the surgical division and at the time of inspection, national data showed referral to treatment times had improved for all surgical specialities;
• Services for children and young people had taken appropriate action in response to issues identified at the previous inspection. There were sufficient medical and nursing staff to ensure children were safe, and appropriate mitigation in place to manage staffing pressures. The service met relevant standards recommended by the Royal College of Paediatrics and Child Health.

Updated 22 November 2018

Updated 22 November 2018