"Improvement across all domains" at Southport and Ormskirk Hospital - but MP is unconvinced
Health watchdogs have carried out an unannounced inspection of Southport and Ormskirk Hospitals NHS Trust, after concerns were raised by West Lancashire's MP.
Care Quality Commission (CQC) inspectors made the visit after they received information about patients absconding from wards and that patients and their families had not always been involved in decision making regarding the application of Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR).
MP Rosie Cooper claims it was her that contacted the CQC following an "incredibly serious incident" involving an elderly man being discharged from the hospital by the North West Ambulance Service with only a blanket wrapped around his bottom half.
While inspectors said there have been improvements "across all domains", Mrs Cooper said she was "far from convinced" and accused the Trust and the CQC of "brushing it (the incident) under the carpet".
The Trust says the incident was dealt with "directly" at the time.
The hospital had been rated as "requires improvements" in its last CQC inspection in 2019.
At that time, five of the trust’s core services were rated as good, and three as requires improvement. Particular concerns had been raised over levels of mandatory training for resuscitation, storage of hazardous materials, patients needs not always being assessed for bed rails, some medicines had passed their expiry date, and staff had not completed documentation for Mental Capacity Act, Deprivation of Liberty safeguards and do not attempt cardiopulmonary resuscitation plans appropriately.
In the latest visit, which took place in March, inspectors looked at safety processes in the trust’s medical care services, the wider oversight and management of risk, governance and safety of patients across the service.
Due to Covid-19 restrictions, they were only able to visit five of the eight medical wards, which included the medical emergency assessment unit (EAU), ward 11b the general medical /gastroenterology ward, ward 7a the cardiology including coronary care ward, 14b the respiratory ward and 9a the short stay ward.
A report out today states: "During this inspection on the wards visited there was an improvement across all assessed domains. All the staff we spoke with were friendly and helpful. They spoke positively about the culture and the support and visibility of leadership on the medical wards."
It adds that:
- The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
- Managers regularly reviewed and adjusted staffing levels and skill mix and gave bank and agency staff a full induction. This was an improvement against the requirement notice from the last inspection.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. This was an improvement from the last inspection.
- Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
- The service managed patient safety incidents well. Managers investigated incidents, shared lessons learned with the whole team and the wider service and ensured that actions were implemented and monitored. There were some incidents relating to poor discharges which the trust was taking action to improve.
- Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where staff could raise concerns without fear.
- At the previous inspection, it was found that consultants did not lead daily ward rounds on all wards and consultants were not available on wards at weekends. In the latest inspection, this had improved with consultant ward rounds being held two or three times a week. In addition, multi disciplinary board rounds were held daily on weekdays.
- Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ needs. Staff did not always fully and accurately complete patients’ fluid charts where needed, although this had improved from the last inspection.
- Staff provided emotional support and understood patients' personal needs and had provided contact to families and carers whilst visiting had ceased due to the COVID-19 pandemic.
The report does however note a small number of instances where the family had not been involved in meaningful conversation around the making of important decisions about resuscitation, however, inspectors believed a recent audit demonstrated improvement in this area.
Concerns also remained that staff completed but did not always update risk assessments for each patient. However, falls risk assessments had improved since the last inspection and staff identified and acted upon patients at risk of deterioration.
Inspectors also said that the lack of an electronic patient record (EPR) system meant it was more difficult to holistically review the care of an individual however, the trust has identified this risk. A digital strategy had been implemented with the next planned programme of work being an electronic prescribing system.
Due to the specific focus of the inspection, the overall rating for this service and of Southport and Formby District General Hospital did not change and remains as requires improvement. The trust’s overall rating also remains as requires improvement.
Karen Knapton, CQCs head of hospital inspection said: “I am pleased to report that since the previous inspection in August 2019, we saw a number of improvements had been made on all the wards we visited.
“Concerns that had been raised to our inspectors had also previously been identified by the trust and were being addressed by the leadership team. Staff were positive about the culture, support and visibility of their leadership team.
“Due to the nature of this visit and the time we had to carry out the inspection, we were unable to re-rate the service, however we will return to ensure that further improvements are made and fully embedded.”
Mrs Cooper said: “I am pleased that the Care Quality Commission (CQC) and Southport and Ormskirk Hospitals NHS Trust (S&O) believe there have been improvements to the Trust’s services, but I am far from convinced. The unannounced inspection took place after I contacted the CQC to draw their attention to an incredibly serious incident that I had been made aware of by a whistleblower.
“This incident involved an elderly man being discharged from the Hospital by North West Ambulance Service (NWAS) with only a blanket wrapped around his bottom half. This incident occurred because both S&O and NWAS failed to follow their own processes. They should be deeply ashamed of this, and I had hoped that the CQC would bring this to light and properly hold them accountable.
”Instead, both CQC and S&O seem to be brushing it under the carpet, burying this incident with only the slightest of references to it in the report. How can the Trust be held accountable if the regulator won’t even acknowledge serious failings like this?
“I am also far from assured that Do Not Resuscitate orders are properly consulted on with patients and families not just placed on a patient record without following the proper process. Family members have told me they knew nothing about the DNR that was placed on their loved ones’ record. Across the NHS as a whole, I believe the Police should be involved where the strict guidelines are breached. The public needs confidence in the medical staff treating them.
“Southport & Ormskirk may be improving but it needs to improve more quickly than it is.”
Trust chief executive Trish Armstrong-Child said: “I am really pleased inspectors found significant improvement since their last inspection across all the areas they reviewed. They also noted staff spoke positively about the culture in the hospital and the support and visibility of the leadership teams on the medical wards.
“These improvements are the result of hard work, compassion and commitment from our dedicated nurses, doctors, all other health professionals, and our non-clinical support teams. We are committed to providing the best care possible to all our patients and will continue to build on these improvements to make sure we consistently deliver safe, high quality care for local people.”
In response to Mrs Cooper's comments, a spokesman for the Trust said: “We are extremely sorry that this incident happened which was dealt with directly at the time. The findings of our investigation and learning were shared with CQC inspectors prior to their visit. We are pleased that the CQC looked in detail at discharge arrangements in their latest inspection and gave a balanced view.”