ULHT in ‘special measures’ after Keogh care review

United Lincolnshire Hospitals Trust has been placed into “special measures” after a report into care and mortality rates at 14 health trusts.

Out of the 14 trusts, 11 of them, including ULHT, have been placed under special measures by the Health Secretary Jeremy Hunt.

The special measures mean a task force will be placed within ULHT to help improve patient care.

The trust then be reviewed again at a later date. If conditions do not improve, the trust’s chief executive, board of governors and medical directors could all risk losing their roles.

The Keogh review

The measures were put into effect after a report led by Sir Bruce Keogh, in which a panel visited ULHT to access the quality of care within the trust’s three hospitals (Lincoln County Hospital, Pilgrim Hospital and Grantham Hospital).

The visits were part of a nationwide review into 14 NHS trusts with high mortality rates between 2010 and 2012, after the Mid-Staffordshire Hospitals scandal.

The report has noted it found a number of good points about care and they way in which hospitals were managed in Lincolnshire, but also saw a number of issues that needed urgent action.

This included:

• A lack of communication between leadership at board level and leadership at clinical levels
• A lack of clear management dealing with deteriorating patients and patient flow
• A confusing patient complaints system
• A lack of interest in patient experience
• Low staffing levels at certain times of the day
• Workforce planning is poor with no recruitment plans and no plans in place to cover maternity leave, sickness and annual leave
• Quality strategy is not consistently articulated by staff
• In regards to treatment of elderly patients, there was a lack of awareness of the Mental Capacity and Deprivation of Liberty Act 2005. This is in relation to the Trust’s responsibilities in allowing patients to leave wards if deemed capable or wish to do so.
• Poor pain control
• Issues in completing patient DNAR (Do Not Attempt Resuscitation) forms

A number of these issues were considered in urgent need of response by the trust, or something that the trust should start developing an action plan for.

Some issues were more ingrained into certain hospitals over others. For instance, A&E in Boston displayed good examples of the escalation process, but Lincoln A&E did not make use of the ambulance inbound information to plan capacity needs due to “IT issues”.

This was also leading to improper use of certain wards when patients were transferred. The panel saw one example of an elderly orthopaedic patient being transferred to a ward where staff were not familiar with a brace being worn, leading to another move for the patient.

At a bed management meeting in Lincoln County Hospital, there was no discussion regarding capacity required for the next 12 hour period and no evidence of forward planning to ensure capacity planning for overnight.

The trust had a written escalation plan, but this was not used at the meeting, despite not having enough beds available. This led to the outlying of patients — a primary option for the trust.

Staffing within the trust was also a concern for the panel, after witnessing a lack in nurses in all hospitals, meaning patients who require one-on-one care might not be able to receive it.

In one instance, there were three members of staff to cover a ward of 32 patients.

Some members of staff were also working past their shifts to make sure patients received the correct care they needed.

Full acceptance

ULHT has stated it fully accepts the findings within the review on its care within hospitals.

ULHT’s Chief Executive Jane Lewington said: “The safety and quality of patient care is our top priority. We have always seen the review as an opportunity to continue our journey of improvement.

“The review has helped to ensure that our efforts are targeting the changes that will make the most impact on patient care. Therefore we fully accept the findings.

“Patients are the very heart of everything we do, but others are doing better and therefore we need to learn from them.”

The trust is currently working to improve measures it has been flagged up on, with a focus on the level of staffing.

Recently, the trust pledged to spend £7 million on around 200 more nurses to meet with the demands of patients.

Jane Lewington added: “We will be unrelenting in our efforts to improve in the areas which the review panel have identified.

“But it also important that the review has recognised the excellence of much of what we do, and the commitment of so many of our staff.”

Other actions the trust are aiming begin are public listening events, a patient-focussed overhaul of the complaints system with patients and experts in the field involved in the review, and internal campaigns to promote staff awareness of best clinical practice.

David Harding-Price, Secretary of the North Lincolnshire Branch of the Royal College of Nursing, said “We take this review incredibly seriously and nationally the RCN have detailed examples of where we have raised concerns about patient safety in trusts.

“There is an undeniable link between nurse staffing levels and patient mortality and we cannot keep failing to address this issue. Only with the right numbers of nurses, with the right skills, can we ensure patients are looked after with dignity and compassion.”

He added “Sir Bruce Keogh’s review identifies key risk factors and warning signs to show where, and why, some trusts are underperforming including United Lincolnshire Health NHS Trust and the steps that urgently need to be taken to improve standards of patient care and safety.”

In a statement at the beginning of the review, Sir Bruce Keogh said: “We found pockets of excellent practice in all 14 of the trusts reviewed. However, we also found significant scope for improvement, with each needing to address an urgent set of actions in order to raise standards of care.

“These organisations have been trapped in mediocrity, which I am confident can be replaced by a sense of ambition if we give staff the confidence to achieve excellence.

“This is consistent with the ambitions that I know the new clinical commissioning groups have for their local populations and the legal duties they have to secure continuous improvements in the quality of services provided to patients.”

Areas of good care in Lincolnshire included:

• Dedicated, committed and loyal staff
• Monthly mortality reviews with good staff attendance
• The Interim Director of Nursing has provided strong leadership to the nursing team and Matrons at all sites displayed strong leadership
• Many wards displayed safety thermometer data sets
• Plan for every patient on wards
• Evidence of innovation e.g. Red Lid Scheme for Hydration/medication; phlebotomy service at weekends which takes pressure off junior doctors
• Annual patient listening event in Lincoln, and patient experience and stories are part of Trust Board meetings
• Safety and quality dashboards displayed on the wards
• Proactive work around dementia in particular wards

To read the full report, visit The Keogh Mortality Review NHS page.