The boss of the Royal Preston and Chorley and South Ribble Hospital says patients can be confident that they will be well looked after – in spite of the trust that operates the facilities having once again been rated as ‘requires improvement’ following an inspection by the regulator.Advertisement
It is the fifth consecutive occasion in nine years that Lancashire Teaching Hospitals NHS Foundation Trust (LTH) has been given the grading by the Care Quality Commission (CQC).
The hospitals’ interim chief executive, Faith Button, acknowledged that the outcome was disappointing, but told the Local Democracy Reporting Service (LDRS) that it was “extremely difficult” to move up into the ‘good’ category against the backdrop of issues like the waiting list backlog caused by the pandemic and the pressure on urgent and emergency care services being felt nationwide – irrespective of the “great progress” that she said had been made in tackling both.
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The 194-page report identifies 54 areas for improvement – 18 of which are must-dos that have to be addressed in order for the trust to “comply with its legal obligations”. These include ensuring that there are enough medical staff at the Royal Preston to keep patients safe; that staff across the trust complete mandatory training; and, in the urgent and emergency care departments at both sites, that private patient information is not visible to visitors to the department.
Throughout LTH, all staff were considered by inspectors to be “committed to improving the quality of care and patient experience” and were focused on the needs of those in their care.
The CQC did not assess all areas of the two sites during its unannounced inspection, which was carried out across 10 days over the summer – but it nevertheless came up with an overall rating for LTH, based on refreshed and previous scores, having this time inspected urgent and emergency care at both Preston and Chorley, in addition to medical care and surgery at Preston.
A focused inspection of the maternity units was also undertaken as part of CQC’s national maternity services programme.
Within LTH’s overarching ‘requires improvement’ grade, the same mark was given to the trust’s ‘safe’, ‘effective’, ‘responsive’ and ‘well-led’ domains, with the latter dropping down from good since the last wholesale inspection in 2019. However, the organisation was once again rated good in the ‘caring’ category.
The two individual hospitals were also found to require improvement – a deterioration for the Chorley facility compared to 2019 and the same fate as suffered within the ‘safe’ domain for its urgent and emergency care and maternity services, both of which remain good overall.
At the Royal Preston, urgent and emergency care was found to require improvement overall, a repeat of its 2019 score, with concerns raised including that the design of the department made it “difficult to keep people safe” and that staff “did not always assess risks to patients, act on them or keep care records updated”.
However, staff at the Fulwood site’s A&E facilities “provided good care and treatment”, administered pain relief when patients needed it and treated people “with compassion and kindness, respected their privacy and dignity and helped them understand their conditions”. They were also found to provide emotional support to patients, families and carers.
The overall rating for maternity services at the Royal Preston fell from good to requires improvement, with reasons listed in the report including “long delays in the induction of labour” for some women, compliance with life support training being below trust targets and the fact that “not all staff felt that [they] were listened to by senior leaders when highlighting concerns around staffing”.
Maternity unit staff at Preston, however, “worked well together for the benefit of women and birthing people, understood how to protect women and birthing people from abuse and managed safety well”.
Meanwhile, surgery at the Royal Preston remained rated ‘good’, although within that, it had fallen to requires improvement on the ‘responsive’ measure.
Medical care was still deemed to require improvement, as in 2019, but its ‘well-led’ metric had improved to good.
Faith Button, who is usually LTH’s chief operating officer, but is covering the chief executive role until early next year, when Silas Nicholls arrives from the neighbouring Wrightington, Wigan and Leigh trust, told the LDRS: “For our local population of patients, there is nothing in [the CQC] report that anyone should be concerned about.
“You will be looked after well and treated well at the hospitals – we have really good clinical expertise here.
“But we want to get to ‘good’ – we have got to note what [the inspectors] say and we have got to go through that line by line.
“After our last inspection [in 2019], we were a whisker away from being good and the CQC fed that back to us – there were just a couple of areas we were working on to improve. Obviously, [we then had] the pandemic and the pressure we were under post-pandemic – this year, particularly, [with] the elective backlog, industrial action, pressure on our finances and the emergency front door.
“But we have got a plan: integrating with our community services more, virtual wards [and] the care connection hub – rapid response teams who are able to come out to patients instead of [them] being [brought] to hospital.
“That is the way for acute trusts to try and stem some of the admissions coming into hospital and get the [patient] flow better, so that we can then get to the good which the CQC expect. So there are plans in place,” Ms. Button said.
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