The hard work and dedication of teams across University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) has been recognised in two reports published by the Care Quality Commission (CQC) today - alongside some areas where further work is needed.
In March 2022, a team of inspectors from the Care Quality Commission (CQC) carried out an unannounced inspection of the Trust’s emergency and urgent care (UEC) services at Furness General Hospital (FGH) and the Royal Lancaster Infirmary (RLI). This was as part of a system wide inspection around urgent and emergency care services that took place across Lancashire and South Cumbria Integrated Care System between March and April 2022.
Whilst they were at the Trust, inspectors also inspected medical services at FGH as this was not assessed in the Trust's last inspection.
Some areas of good practice identified in the reports include:
- There have been improvements in relation to the pathway for patients having had a stroke and the treatment and planning of this in the Emergency Department (ED) had increased the service’s ability to respond in a timely manner to patients needing this care
- The management of safety incidents and learning lessons from any that take place
- Staff treated patients with compassion and kindness, respected their privacy and dignity; and provided emotional support to patients, families and carers to minimise their distress
- Staff supported patients to make decisions about their care
- Staff assessed risk to patients, acted on them and kept good care records
There were two areas of outstanding practice reported by inspectors - both in UEC services at the RLI:
- Support to staff through the pandemic was designed to meet their emotional and welfare needs. Innovative practice and opportunities were available for staff to assist them in their well-being
- Staff recruited from overseas and new to the service worked additional to the staff establishment for six months with an individualised induction and a buddy support to make sure that they were appropriately supported in their new roles
Bridget Lees, Executive Chief Nurse, UHMBT, said: “As with all NHS colleagues, our teams have dealt with some incredibly difficult times over the last two years, but despite that, they have managed to make some fundamental changes and improvements to the services we offer to local communities. We are pleased to see that the inspectors witnessed this change themselves and were able to highlight some improvements from the last time they visited us.
“I am especially pleased to see that inspectors witnessed the improvements to our stroke services at both the RLI and FGH. They also reported the compassionate and dignified care our teams offer to patients; how our teams work together and with other agencies when needed to care for patients; and the support given to teams by their colleagues and leaders.”
The report also highlighted areas in all services inspected where further work needs to be done, including:
- Patients waiting longer than anyone would like due to pressures on services
- Not always having enough medical, nursing and support staff with the right qualifications, skills, training and experience
- Working relationships between some departments
- Not always following best practice when prescribing, giving and storing medicines
- Not always following national legislation and guidance for patients lacking capacity
Bridget, said: “We know we aren’t where we need to be in some areas - especially around medicines management, pharmacy support, and continuing to work with partners to improve patient flow so that patients do not wait any longer than necessary to be seen or discharged.
“We were already aware of a number of the areas of improvement highlighted by inspectors, and the report highlights some of the actions that are already in progress to help resolve them, such as investing in more staffing for our EDs and pharmacy teams; our development programme to assist doctors in developing the skills to become consultants; and the work to further understand the experience of our patients and how we can use that to improve services.
“We have more work to do but it’s important that our teams take some time to reflect on these reports - feel proud of what they have achieved and remain focused on what needs to be done now to improve further for the benefit of all who use, and work in, our services.”
Aaron Cummins, Chief Executive, UHMBT, said: “The reports published today show that the hard work of our colleagues is starting to have a real impact on the quality and safety of the services we offer to our patients - especially within our stroke and medicine services. It also acknowledges the compassionate care that our teams offer to patients despite the pressures they are often under. I want to thank all of the teams across the Trust for their unwavering support and dedication to our patients that has led to us making the improvements seen by inspectors.
“However, we know we have more to do so the next step is to carry on doing what we are doing but at a faster pace where possible. To do this, we will continue to work with partners across Lancashire and South Cumbria and as part of the national Recovery Support Programme to focus on those areas that will further improve services for local communities.”
The full CQC inspection reports will be available on the CQC website.
Areas of good practice identified in urgent and emergency care at FGH included:
- Staff held regular and multidisciplinary meetings to discuss patients and improve their care. There was evidence of other disciplines collaboratively working in the department for patient benefit
- The service relieved pressure on other departments when they could treat patients in a day - including the recently opened Same Day Emergency Care (SDEC) unit
- At a local level, staff felt the culture of the department was very open, honest and
- fostered a spirit of teamwork and camaraderie during challenging times
Areas of improvement for urgent and emergency care at FGH included:
- Most sharps bins were left open. Safety was not consistent as one sharps bin in a sluice room was undated and had intravenous tubing sticking out of it
- After using computers to access patient records, some staff log in cards were left in the keyboard terminals and not locked
- Staff did not always follow policy to keep patient care and treatment confidential.
- Three patients told inspectors that thy did not feel their privacy was respected at triage as their information could easily be overheard by other people in the waiting area
Areas of good practice identified in urgent and emergency care at the RLI included:
- Managers debriefed and supported staff after any serious incident. They investigated incident thoroughly and patients and families were involved in these investigations
- Staff were committed to improving the facilities and environment for patients living with dementia, mental health conditions and children. There had been an improvement in children’s facilities and an effective unit was in place for mental health
- Staff felt positive and proud about working for the service. They demonstrated compassion and a prominent level of integrity to making sure that patients received the best care they could
Areas of improvement for urgent and emergency care at the RLI included:
- The design of the waiting area for walk-in patients presented a risk to patients who may deteriorate whilst waiting to be seen
- At times of additional pressure, patients were cared for on corridors. When this occurred, there was a ratio of one nurse to four patients planned for but this could not always be maintained
- Staff reported they did not think the leadership team above a local level were visible to them. Other than visits to the unit, there was limited information as to how the triumvirate leadership team was visible
Areas of good practice identified in medicine at FGH included:
- Staff shared key information to keep patients safe when handing over their care to others
- Outcomes for patients were positive, consistent and met expectations, such as national standards. Managers and staff used the results to improve patients’ outcomes
- Staff who spoke to the inspectors commented on the positive culture throughout the medical wards. They said they felt there was good team working across all clinical staff
Areas of improvement for medicine at FGH included:
- Staff did not always follow systems and processes to prescribe and administer medicines safely
- Capacity in the pharmacy team for medicines reconciliation and clinical review was limited
- There were challenges for the provision of care in the community across the region, which impacted on staff ability to discharge patients