An NHS trust with hospitals in Cumbria has been placed in the new equivalent of special measures.
The University Hospitals of Morecambe Bay NHS Foundation Trust came out of special measures in 2014 and has now been added to NHS England’s Recovery Support Programme.
The new nationally-led programme is used for trusts which need “the highest level of mandated support”. It replaces the programmes of special measures for trusts and CCGs.
Aaron Cummins, Chief Executive, University Hospitals of Morecambe Bay NHS Foundation Trust – which operates hospitals in north Lancashire and south Cumbria, said: “We are committed to providing the best quality care to our patients, including recovering from the additional challenges COVID-19 has posed.
“The Recovery Support Programme provides an opportunity for us all to work together across Morecambe Bay to build better and more sustainable services for those patients for the future.”
It comes as the Care Quality Commission carried an unannounced inspection of emergency and urgent care, maternity and surgical services in April and found:
Stroke pathway
An email outlining the areas of concern and requesting immediate assurances was sent to the Chief executive after providing verbal feedback on May 7. He was asked to urgently review the stroke pathway including, but not limited to:
- Safe and timely thrombolysis of patients;
- Competencies of staff delivering thrombolysis;
- How assured the trust is that there are appropriate staffing levels when caring for acute stroke patients on the wards;
- Understanding the rationale for why acute stoke patients appear to be moved off the stroke ward.
Trust-wide findings
- From interviews, trust documentation and information from other sources it was clear that the leadership team faced a considerable challenge to deliver the required improvements within the trust; there was a lot of change still planned and in progress.
- There was a significant level of external support within the organisation and it was too early to judge whether the board had the capacity and processes to ensure that any changes were maintained once the support ends.
- Whilst the work on systems and processes put in place to manage risk and quality was still ongoing, the CQC was significantly concerned about the timely and effective management of incidents and learning from them.
- The size of the financial deficit and how this would/was colouring and impacting on the operational performance and quality of the organisation was considered.
- It was noted that the trust board talked about difficult issues and challenges. However, from this and documentation reviewed to date, inspectors did not detect a strong sense of pace. This was also apparent in interviews, the CQC said. Inspectors thought there were elements of required change that the trust could have acted upon internally and swiftly.
- The visibility of the chief executive with staff was positively commented on and was commendable. This appeared less so with other executives, the CQC said.
Royal Lancaster Infirmary and Furness General Hospital
- No urgent concerns to escalate were raised regarding surgery. Some issues regarding security of fire doors and security of patient records were identified.
- Urology – the culture was felt to be improving, however; trauma and orthopaedics was not in the same place.
- Urgent and emergency care – adult nurse staffing numbers were showing an improvement. The practice educators were having a positive impact on staff competencies and induction for new starters. Point of care testing for Covid was supporting swift decision-making regarding patient pathway placement. The facilities for patients with mental health needs had improved, however; they were underutilised by staff.
- It was noted there was no paediatric emergency medicine (PEM) consultant at either site.
Royal Lancaster Infirmary
- There were some concerns about controlled drugs administration being fully documented and Patient Group Directions being past their review dates.
- Paediatric – there were concerns about the current security of the waiting and treatment areas which had open access and was shared with the minor injury area. Inspectors were aware of changes ongoing in this area, but that there did not appear to be anything in place to mitigate this risk.
- A concern was raised regarding a patient during the inspection, regarding best interests decisions and recording of capacity.
- Challenges with access and flow were identified and it was not clear if the trust’s escalation plan was always followed. Some long waits with patients “being inappropriately cared for in corridors, including an example of a patient being examined in the corridor”.
- Stroke services – a number of significant concerns to patient safety in the stroke pathway, especially at Royal Lancaster Infirmary, were identified.
Furness General Hospital
- COVID-19 – A number of staff were found not following infection prevention and control guidance, as some had masks that were not covering their nose and staff did not always practice social distancing with each other.
- Maternity – concerns regarding staffing levels in the department and how these were maintained to ensure safe care were identified.
- Training for staff was also below target, but this was starting to improve.
- Inspectors also raised concerns regarding medicines administration and apparent delays in the system meaning there was a risk of medicines being administered twice.
- Stroke service – the clinical team were dedicated and working hard to provide the stroke service. However, a number of significant concerns to patient safety in the stroke pathway were identified.
Westmorland General Hospital
- Concerns were raised by the CQC regarding the mental health room and safety of oxygen cylinders, these were actioned immediately after they were raised with staff.
