ULHT out of ‘special measures’, but still needs improvement

The United Lincolnshire Hospitals Trust has come out of ‘special measures’, 20 months after a report into care and mortality rates flagged a number of urgent issues.

Overall, the trust’s rating has remained the same: “Requires Improvement”, however a re-inspection by the Care Quality Commission (CQC) between February 2 and 4, 2015 has recognised achievements across the board.

The special measures were put into effect after a report led by Sir Bruce Keogh (The Keogh review) accessed the quality of care within the trust’s hospitals — Lincoln County Hospital, Pilgrim Hospital, Louth Hospital and Grantham Hospital.

In April 2014, the NHS Trust Development Authority made the decision to extend the review’s special measures in order to improve services by the next inspection.

The three day re-inspection by the CQC at the beginning of February found that 83% of the trust’s ratings are now “Good” – 47% more than last year.

Improved results

The CQC inspection team looked at eight service areas across the trust’s four hospitals: A&E, medical care, surgery, critical care, maternity, children and young people, end of life care, and outpatients.

Photo: File/The Lincolnite

Photo: File/The Lincolnite

Most services, and the trust overall, were assessed against five domains: whether they were safe, effective, caring, responsive and well-led.

Against this, the trust received three ‘good’ ratings for questions of whether the service was effective, caring and well-led, and two ‘requires improvement’ ratings for questions of safety and responsiveness.

This is a marked improvement on the 2014 ratings, when four ‘requires improvement’ ratings were given and one ‘good’.

Out of a possible 113 individual ratings, 94 areas were rated as good or outstanding.

The inspection team highlighted the following areas which had been improved since the last inspection in 2014:

  • A&E departments now more responsive to patients and families
  • Better signage for patients whose first language isn’t English
  • Condition of medical records
  • Good progress on infection control
  • Good progress on core learning and appraisals, and evidence of good practice at ward level
  • Good practice in medicines management and fewer prescribing errors
  • Improvements in safety of the outpatient department at Lincoln
  • Increased staffing to help 7 day working
  • Turnaround of quality of care on trauma ward (formerly Stow) at Lincoln

The issues highlighted for further improvement were:

  • Recruitment of staff is still an issue
  • Records relating to risk assessment and care were still not always maintained
  •  The outpatients department at Lincoln County Hospital requires further improvements to the booking system
  • The trust must ensure that there are sufficient qualified staff

The report also noted that in the last year, the trust recorded two ‘never events’ – the term to describe an incident which should never have happened, should the procedure been carried out appropriately.

Lincoln County Hospital. Photo: Steve Smailes for The Lincolnite

Lincoln County Hospital. Photo: Steve Smailes for The Lincolnite

At hospital level, Louth and Grantham Hospitals scored “Good” ratings, whereas Pilgrim Hospital in Boston and Lincoln County Hospital were rated “Requires Improvements”.

Lincoln County Hospital’s Outpatient Department was still rated as “Inadequate”.

One “Outstanding” rating was also given to Lincoln County Hospital for its single sex accommodation in Critical Care.

Staff dedication

Jane Lewington, Trust Chief Executive, said: “I am always so proud of our staff’s dedication and commitment to delivering compassionate and high quality care, but today I am beyond proud.

“The result really boosts morale, but also has a practical impact with our ability to recruit staff.

“We certainly need more doctors and nurses. We’ve allocated a lot of funding over the last two years but we still have a shortage of trained nurses and as we speak we are interviewing the student nurses at the University of Lincoln.

“We do however need to do more than that and we are looking to continue with our international recruitment, as well as trying to encourage nurses who may have left the profession to come back by offering a return to practice course.

“It’s not an issue of funding it’s getting the bodies into the roles. We are trying to get away from reliance on agency staff and secure more of our own permanent staff working on the wards. We’re also identifying clinical apprenticeships.

“One of our continued areas of focus is Outpatients, and that comes down to our booking systems that we operate and the facet that we do have increasing demand.”

Jeffrey Worrall, Portfolio Director at the NHS Trust Development Authority, said: “This is a fantastic achievement for the trust which recognises the intensive work and dedication that staff have put into improving services for their patients.

“With their enthusiasm and inspirational focus, the trust’s teams have used the additional support under special measures to address significant challenges and deliver great improvements to care quality and the patient experience.”

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said the trust has worked hard to achieve the level of change:

“Our inspectors found many improvements had been made and a number of areas of good practice, including the increased engagement between the trust board and medical staff. This is why I have recommended that the trust is now brought out of Special Measures.

“There are however areas where the trust still needs to make improvements and its leadership knows what it must now do to ensure further change takes place and existing improvements are maintained.”

Lincoln MP Karl McCartney added: “Under the last Labour government, we in Lincolnshire had one of the worst patient safety records in the country – that’s why the decision was taken to place United Lincolnshire Hospitals NHS Trust in special measures.

“I know from my many visits to Lincoln County Hospital just how hard our local hospital’s medical staff at all levels, and their managers, have been working to turn things around.

“Although there are still some areas that require further improvement in some areas of the county – such as in Outpatients and ensuring that there are enough experienced and qualified staff – great improvements have been made, which of course I wholeheartedly welcome and commend.”

Concerns

Councillor Mrs Christine Talbot, chairman of the Health Scrutiny Committee for Lincolnshire, says: “I am pleased that the Care Quality Commission has found improvements at ULHT. The Health Scrutiny Committee for Lincolnshire has met with the trust regularly and we are aware that staff have been working hard on the improvements, as well as maintaining delivery of services during another busy winter for the NHS.

“However, I am concerned to see that the overall rating for ULHT remains at ‘requires improvement’. Every resident in the county deserves a safe health service and safety still requires improvement in a number of areas at Lincoln County Hospital, Boston Pilgrim Hospital and in medical care at Grantham Hospital.

“I find the inadequate rating for outpatient services worrying. We know that not enough people with suspected cancer are being treated within the 62 day target following an urgent referral from their GP.

“This is something the Health Scrutiny Committee for Lincolnshire has questioned previously and we will be keeping a very close eye on this despite the trust coming out of special measures.”