Royal Preston Hospital gets an unannounced visit from Care Quality Commission inspectors

Inspectors from the Care Quality Commission (CQC) have completed an unannounced visit to the Royal Preston Hospital.
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A team arrived at the Sharoe Green Lane site on Wednesday and undertook inspections of the emergency department and medicine service over the course of two days.

The Post understands that the assessment was not carried out as a result of any specific risk or concerns having been raised about either area - a so-called “focused inspection” - but neither was it a comprehensive review of the whole facility of the kind that culminates in it being given an overall rating.

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The last occasion that the trust that runs the Royal Preston - Lancashire Teaching Hospitals NHS Foundation Trust (LTH) - was subject to the latter back in 2019, it was rated as “requires improvement” for the fourth time in five years. However, it did achieve a “good” grading in the “caring and “well-led” categories.

It hasn't just been patients arriving at the Royal Preston's A&E in recent days, but inspectors from the Care Quality Commission as wellIt hasn't just been patients arriving at the Royal Preston's A&E in recent days, but inspectors from the Care Quality Commission as well
It hasn't just been patients arriving at the Royal Preston's A&E in recent days, but inspectors from the Care Quality Commission as well

The organisation has been told that a standalone inspection of how well led it is will take place across three days at the end of this month. However, even in conjunction with the outcome of the A&E and medicine service assessments, it will not be enough to generate a new overarching rating for the trust.

The Post approached the CQC to ask for an explanation of the rationale behind this week’s visit to the Royal Preston. The commission is known to prioritise inspections of facilities most recently rated as requiring improvement or being inadequate.

Last year, the Royal Preston’s emergency department was inspected as part of a broader CQC assessment of urgent and emergency care services across Lancashire and South Cumbria. When the resultant report was published in July, the A&E at the Fulwood site was given a “requires improvement” rating because it was found that there were not always enough doctors and nurses to care for patients - although praise was heaped on staff for the way they did look after those in need of their help.

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Papers presented to an LTH board meeting on Thursday revealed that there was a “risk attached” to the delivery of a CQC recommendation from last year’s inspection which ordered the trust to “ensure that medical staffing levels, with the right qualifications and competencies, are safe for the numbers of patients in [A&E]”.

In its latest board report, “the absence of recurrent funding in the [emergency department]” was highlighted as the reason for the risk that the recommendation would not be met. While it was noted that an urgent and emergency care transformation programme aimed to reduce the funding gap, “it will not remove it entirely”, the document warned.

Board members were also told that there was still “not currently a resolution” to a separate recommendation from 2019 that medical staffing levels should be reviewed in order to ensure that they met national standards, which related specifically to a trauma team leader position within the emergency department.

Those recommendations were two of only three that remain wholly outstanding out of the 109 emanating from the CQC inspections undertaken at LTH in 2018, 2019 and last year. The third involved issues with the flow of patients through the hospital system.

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Speaking at the meeting, Hajara Ugradar, the trust’s deputy associate director of risk and assurance, said that 91 CQC recommendations have been fully delivered and progress has been made with a further 15.

“Overall, in spite of a number of challenges over the last five years, including Covid 19, delivery of the previous recommendations support us in evidencing the substantial progress made in the trust’s improvement…[as well as] tangible improvements in our well-led journey, demonstrating some of out strong and sustainable foundations that we put in place over the last few years - and our desire and commitment to continually learn and improve,” Ms. Ugradar said.

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