England's chief inspector of hospitals has recommended that United Lincolnshire Hospitals NHS Trust should return to special measures following the Care Quality Commission’s (CQC) latest inspection of its services.
The inspection included Lincoln County Hospital, Pilgrim Hospital and Grantham Hospital. Overall the Trust has been rated as Inadequate although caring has been rated as Good. Inspectors found significant concerns in medical care and outpatients at Pilgrim Hospital.
The Trust 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. The Trust exited the special measures regime in February 2015 following improvements at the time.
CQC found deterioration across a number of services resulting in the Trust being rated inadequate overall following the latest inspection in October 2016. An unannounced inspection was also carried out on 19 December at Pilgrim Hospital’s emergency department following information of concern highlighted to the commission.
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.
“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, while 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.
