The Care Quality Commission (CQC) has put United Lincolnshire Hospitals Trust (ULHT) into special measures for a second time after inspectors discovered a catalogue of failings at county hospitals.
The health watchdog’s report, published on Tuesday, April 11, comes just days after Northern Lincolnshire and Goole NHS Foundation Trust became the first trust in the country to re-enter the failure regime for inadequate organisations.
England’s Chief Inspector of Hospitals made the recommendation after inspectors found significant concerns in the safety of emergency services and outpatients’ leadership at Lincoln County Hospital, as well as in medical care and outpatients at Pilgrim Hospital.
The trust’s Chief Executive Jan Sobieraj, who was appointed into the role in September 2015, said he was “disappointed” in the findings, but argued that the trust had made a number of improvements since inspectors’ visits.
The inspection, carried out during visits in October 2016, included Lincoln County Hospital, Pilgrim Hospital and Grantham Hospital’s A&E department.
Overall the trust has been rated as ‘inadequate’. A special measures task force will be placed within ULHT to help improve patient care.
The scores were:
ULHT provides a range of services to 700,000 people in Lincolnshire and was one of 11 NHS trusts placed into special measures by Sir Bruce Keogh in July 2013 as part of his review of high mortality rates.
It exited special measures in February 2015 following improvements at the time and was given a rating of ‘requires improvement’ in March 2015.
The latest inspection found that the trust only met ‘good’ standards in one out of five areas. Services had deteriorated in safety and effectiveness, and standards of leadership at the trust had fallen from ‘good’ to ‘inadequate’.
In particular, inspectors also found:
- Ongoing delays in patients being able to access treatment and care, with growing numbers of patients having to wait too long for their outpatient appointments or inpatient treatments. There were 3,772 follow up outpatient appointments overdue by more than six weeks.
- There were no robust arrangements in place to respond to emergencies and major incidents.
- Patients had been unable to access services in a timely way for an initial assessment, diagnosis or treatment, including when cancer was suspected.
- During 2016 the trust failed to meet the majority of the national standards for the cancer referral to treatment targets.
- Low levels of staff satisfaction coupled with high levels of stress and work overload.
- Some staff told inspectors they did not feel respected, valued or appreciated. Others said they perceived they were being bullied or intimidated.
- Poor leadership and oversight in a number of services and at a senior level within the trust.
- Inspectors were not assured that all incidents were reported or investigated in a timely way.
- Inspectors observed a number of isolated instances at Pilgrim Hospital where staff had not treated patients with dignity, respect and compassion.
- The trust recorded 11,536 incidents between August 1 2015 and July 31 2016 and 72 serious incidents. It also recorded three never events (serious incidents that are wholly preventable).
Inspectors did see improvement across some services. For example, governance arrangements in the maternity service had been strengthened significantly over the past two years.
They also observed good care across several services including services for children and young people, critical care, surgery and urgent and emergency services at Grantham Hospital, all of which were rated ‘good’ overall.
In addition, it was noted that generally staff interacted positively with patients and were treated with kindness.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Having seen improvements to patient care previously, we are disappointed that our latest inspection of United Lincolnshire Hospitals NHS Trust found these improvements had not been sustained and there had been an overall deterioration in quality and patient safety.
“For this reason, we have recommended that the trust should re-enter special measures so that it can receive support at the highest level to deliver all the necessary improvements. The focus of the improvement plan must be to ensure that patients receive safe, high quality and compassionate care at all times.
“In particular, there must be significant improvements in the quality and safety of patient care, leadership and managerial oversight of quality and performance and effective implementation of the existing governance arrangements consistently across all of the services.”
“We are sorry”
ULHT has said it is disappointed with the findings and it is “taking them very seriously”. ULHT Chief Executive Jan Sobieraj added: “We are sorry to our patients as we know this isn’t good enough.”
“The trust has already improved on many of the areas of concern that have been raised by the CQC, and we have started to see significant improvements since the inspection last October.
“Immediate action was taken and many issues raised by the CQC have since been resolved. Further actions are planned to ensure improvements are sustained.”
Jeff Worrall, Delivery and Improvement Director at NHS Improvement, said: “Patients will be reassured that the trust has been rated ‘good’ for caring. Ensuring that improvement is sustainable from this point onwards is our primary focus.
“The trust has already demonstrated once that it can make positive changes. We will be working closely with the team to make sure those changes are lasting ones.
“We have already put an improvement director and programme of support in place in response to the concerns raised and will be working alongside trust staff to address the specific areas outlined in the report.”