The trust which runs the Royal Preston and Chorley and South Ribble Hospitals has been told by regulators that it ‘requires improvement’ - for the third successive occasion.
The Care Quality Commission (CQC) inspected a range of services at Lancashire Teaching Hospitals NHS Foundation Trust (LTH) over the summer, almost two years after its last visit.
While the two hospitals were once again rated as ‘good’ for being caring, improvement is still needed across the CQC’s four other measures of performance - which rates how ‘safe’, ‘effective’, ‘responsive’ and ‘well-led’ they are. That means there has been no change to any of the trust’s headline ratings or its overall result.
The regulator concluded that the trust had not made “sufficient” improvements since the last inspection and that some of the changes which had been made were not yet “embedded”.
Gail Naylor, Director of Nursing and Midwifery, says LTH is on a “journey of improvement”.
“It’s important to see the narrative behind [the] rating and the report calls out the progress we have made since the last inspection. It’s really positive that our interventions and actions since the last report have managed to move some of our [individual] services from ‘requires improvement’ to ‘good’,” Ms. Naylor said.
Surgery and children’s services at the Royal Preston are among those areas which have improved. 60 percent of the inspection categories at both the Royal Preston and Chorley and South Ribble are now rated as ‘good’.
But the CQC report outlines a mixed picture of the trust’s overall performance.
Inspectors found that there were not always “enough nursing staff available on every ward to meet people’s needs”. And at Chorley and South Ribble Hospital, there were concerns over the numbers of “suitably qualified” nursing staff to cover shifts.
However, the Royal Preston was found to have enough consultants to cover the hospital’s 7-day-a-week rota - and the trust currently has no vacancies in maternity.
Vacancy rates remain above 10 percent in nursing and as high as 30 percent for some junior doctor grades, in spite of investment of more than £6m over the last two years.
Gail Naylor says LTH is not unique in struggling to find staff and is adopting “lots of different approaches to maximise our chances of recruiting to those vacancies”.
“We’re looking at ways we can support the medical workforce, where there are significant doctor vacancies - and developing new roles like physician associates, so nurses can develop their careers [and] support the gaps,” she said
Urgent and Emergency Care
The CQC recognised that there had been improvements in the triage process, but warned that the booking-in of patients and referrals between Accident and Emergency and the Urgent Care Centre at the Royal Preston were not always timely. This contributed to a “deteriorating trend” in performance against targets.
The “layout and construction” of the A&E department in Preston was also highlighted as a potential problem for patient flow, while the emergency unit at Chorley was reminded that all patients should have a first assessment within 15 minutes of their arrival.
Gail Naylor says almost £2m recently awarded to the trust from a Department of Health fund will help it to “do things differently, particularly as we head into winter”.
And the CQC recognised that the planned work will “provide a rapid assessment and treatment service, [better able to] transfer and manage patients”.
In spite of significant improvements in the proportion of staff being up-to-date with their training, the trust is still falling short of a 90 percent target. The figure stood at 88 percent at the end of August.
But the CQC highlighted concern at the Royal Preston, where “compliance with life support training including adult and children’s basic, immediate and advanced life support, was poor”.
“We need to be able to deliver [the basics] reliably,” Gail Naylor admitted. “It’s important to remember that we have over 7,000 staff, so to have all of those staff trained can be a challenge, particularly when we’ve got busy clinical services.
“We’ve seen a significant investment in staffing in the last two years [which] makes it easier to release staff for training and we also use e-learning, “ Ms Naylor added.
The CQC found that patients were too often moved during the night at the Royal Preston and that patient care was “not always centred around need”.
However, inspectors noted safety reviews were carried out on individual wards, that wards were clean and that there was “good practice” for those patients suffering from cognitive impairment.
At Chorley and South Ribble Hospital, which also specialises in older people’s care, inspectors witnessed “staff communicating with patients in ways which respected their dignity, providing support and reassurance. Patients we spoke with were full of praise for the staff and the treatment they received,” the report notes.
STAFF SUCCESS STORIES
Staff at the trust were widely praised throughout the CQC report, with their kindness and compassion noted across the range of services provided by the trust. Inspectors also commented on their concern for patients’ families.
And even in the most challenging departments and situations, staff were found to have a positive attitude. Their contribution to the more encouraging aspects of the trust’s inspection is not lost on Gail Naylor.
“We have got some absolutely amazing staff who go above and beyond every day and it’s really positive to see that reflected in the report - it’s a huge testament to them. It was good to see staff feeding back that they feel this is a good place to work,” she said.
“I’m most proud of the [areas of] outstanding practice that have come directly from our staff.”
Amongst them is the purple socks initiative, which sees some of the trust’s most vulnerable patients done the flamboyant footwear so that they can be more easily spotted by staff if they begin to wonder around their ward.
Other projects singled out for praise include the introduction of equipment to allow remote monitoring of patients suspected of having suffered a stroke while they are en route to hospital and the use of vintage music and wartime speeches to help relax patients with dementia.