Grantham A&E rated as good but Lincolnshire hospitals trust goes back into special measures

A&E, Grantham Hospital EMN-160613-154514001 EMN-160613-154514001 EMN-160613-154514001
A&E, Grantham Hospital EMN-160613-154514001 EMN-160613-154514001 EMN-160613-154514001
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The trust which runs the town’s hospital has been put back into special measures, but urgent and emergency services at Grantham have been rated ‘good’ overall following a visit to the A&E unit.

The Care Quality Commission has rated United Lincolnshire Hospitals NHS Trust as ‘inadequate’ overall, just two years after it came out of special measures.

But it says that following a visit to Grantham A&E in october it found it to be good when it came to being effective, caring, responsive and well-led. However, it did say that in the area of safety it ‘required improvement’.

The visit to the A&E unit came soon after the unit was closed overnight by ULHT in order to transfer staff to its hospitals in Lincoln and Boston which were suffering a ‘staffing crisis’.

CQC visited Lincoln and Boston Pilgrim Hospitals as well as Grantham A&E. It did not inspect any other departments at Grantham.

Chief executive of ULHT Jan Sobieraj said the report was disappointing but on the issue of Grantham A&E he told the Journal: “It’s good but we are not resting on our laurels. The CQC came in as a result of concerns from the public over A&E and we need to make sure that serices are safe and responsive and we are pleased to say that they are.”

Mr Sobieraj repeated that ULHT was determind to re-open Grantham A&E 24 hours a day, but ony when staffing levels made it safe to do so. He said that last year the trust only had 12 middle grade doctors available across its three A&E units. The trust now has 18 doctors but says it needs 21 middle grade doctors to allow it to open Grantham A&E over 24 hours.

Mr Sobieraj says it is not appropriate to compare the 2017 report with the CQC’s last report which also put the trust into special measures as the latest inspection did not cover all hospitals, such as Louth and Skegness, and only looked at A&E in Grantham.

But Mr Sobieraj said he was not hiding from the fact that the report was disappointing. He said: “The safety and quality of patient care is our number one priority. We’re disappointed with some of the findings in the report but we are taking them very seriously. 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.

“Following the CQC inspection, many of our services were inspected by the GMC in November. They found a positive patient safety culture at the trust, with learners and educators being encouraged to raise concerns and be open and honest with patients when things go wrong.”

Since the CQC inspection in October, ULHT says it has already made progress made in the last six months including significant improvements in identifying and treating sepsis and bringing in additional senior clinicians and management at Pilgrim hospital. It says it has also improved staff awareness and training around caring for patients with mental health problems and major incident planning. It has launched an anti-bullying campaign and is encouraging staff to raise concerns through official channels.

Jan said: “I want to reassure people that we are working hard to make our services safer and ensure they stay that way. I’m pleased the CQC rated 56 per cent of our services as “good” including surgery at Lincoln and Pilgrim hospitals and critical care at Pilgrim hospital. I want to publicly thank our staff, who the CQC found to be caring and treating patients with kindness and respect. It’s also worth noting that some services weren’t rated and these are generally those that were rated good or outstanding at the last inspection.

“We know we still have more work to do, and we have been very open about the long-term challenges we face in making our services safer and sustainable. Our biggest challenges are around our shortages of permanent staff and we struggle to meet some national quality standards.

“We’re working hard to recruit staff locally, nationally and internationally but the reality is we rely on locum and agency staff, and this sometimes affects the quality of our services. ULHT has a five year plan in place to improve long-term quality and safety of our services - our share of Lincolnshire’s STP – and we’re working hard to quicken the pace of these changes.”

Dean Fathers, chair of ULHT said: “The Trust Board is fully committed to delivering high-quality care for patients. I’d like to echo the CQC’s praise for our caring staff who treat patients with dignity, compassion and respect. We have a very detailed plan in place to address all the areas for improvement raised by the CQC, which have addressed many of the issues already. With the support from NHS Improvement and our partners in Lincolnshire I’m confident we can make long-term improvements for the benefit of all our patients.”

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.”

CQC said it found deterioration across a number of services resulting in the trust being rated inadequate overall. It said an unannounced inspection was also carried out on 19 December at Pilgrim Hospital’s emergency department following information of concern highlighted to the commission.

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 Hospitals Lincolnshire 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.

“Further improvement is required to ensure the trust is able to manage risk effectively, and cope with patient demand and flow across its services in a timely and sustainable way. I note, for example, that there were significant delays in patients receiving their follow up outpatient appointment across several specialities with more than 3,000 appointments being overdue by more than six weeks.

“We raised a number of issues with the trust that needed urgent attention at the time of the inspection. We were impressed with the response by the Chief Nurse who sought opportunities to learn from other trusts to improve patient care.

“We will continue to monitor the trust and will return to check on the progress it must make. NHS Improvement will be working closely with the trust to ensure full support is available to make the improvements needed.”

Inspectors found there were 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. Arrangements to respond to emergencies and major incidents were not sufficiently robust.

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.

In addition, inspectors found low levels of staff satisfaction coupled with high levels of stress and work overload. Some staff told us they did not feel respected, valued or appreciated and many reported they did not feel comfortable raising concerns.

CQC found poor leadership and oversight in a number of services and at a senior level within the trust. There were weaknesses in the governance framework to support the delivery of the trust’s vision and strategy and inspectors were not assured that the board were sufficiently cited on risks. Inspectors were not assured that all incidents were reported or investigated in a timely way.

In addition, whilst it was isolated to a small number of wards at Pilgrim Hospital, inspectors were not assured that all staff understood the trust values because they observed care being delivered that was not respectful or compassionate.

However, inspectors saw improvement across some services. For example, governance arrangements in the maternity service had been strengthened significantly over the past two years. Inspectors 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.