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Troubled trust found 'inadequate' and now faces special measures
A HOSPITAL trust labelled ‘inadequate’ in a damning report leaked to the Gazette could be forced to ‘buddy up’ with another trust as it battles for recovery.
The University Hospitals of Morecambe Bay NHS Trust could be put into special measures after acute services were slammed in a draft report by watchdog the Care Quality Commission (CQC).
•Staffing difficulties had put patients at risk of ‘avoidable harm’
•Staff had struggled to access training because they could not leave the wards
•The trust had had more ‘never events’ – events that should not happen – than similar trusts
•There had been problems with outpatient appointments and the availability of patient records
•There had been incidents of poor hand hygiene •Staff felt ‘disengaged and remote’ from the executive team
•Leaders lacked the capacity to manage certain problems in a ‘prompt and timely manner’
Now South Lakes MP Tim Farron has told the Gazette he believes the trust will be recommended for special measures by the CQC, which will be agreed by both NHS England and the watch-dog Monitor, once the report has been finalised.
But he has called for the trust board to remain in place – saying ‘enough heads have rolled’. He believes the trust will enter into a ‘buddy’ system with another trust to aid its recovery.
“The critical thing is special measures will be recommended but I’m not interested in any change at the top or having any scalps,” he said.
“The progress that the chief executive in particular has made means that special measures will be more about monitoring and aiding support by buddying them up with a very good trust.”
The draft, published in May, followed four days of inspections in February, when CQC officials descended on Furness General Hospital (FGH), the Royal Lancaster Infirmary (RLI) and Westmorland General Hospital (WGH), all run by the trust.
Inspectors graded the trust as a whole on five areas and found that just two were ‘good’, while one required improvements and two more were ‘inadequate’.
Overall it was given an ‘inadequate’ rating – the lowest a trust can achieve from the CQC.
Since then bosses at the trust have recruited 130 new nurses, developed different working patterns for staff and executives spend more time on the frontline.
But Furness MP John Woodcock said: "This report will be a real blow for our hospitals after many months in which we hoped the situation was improving.
"A fresh warning that managers are failing patients will raise the spectre of central takeover of the trust by a team that may take a slash and burn approach to the vital services we need to enact government cuts.”
Gail Bundy, regional officer for the Unite union, said the matter was ‘of serious concern’.
“Once the report of the CQC is made public, Unite would call for maximum transparency by the trust on the issues raised and the fullest public debate on what may need to be done,” she said.
And Dr David Earnshaw of Ambleside, who works at WGH as a duty GP, said: ”If it is to be given an inadequate rating then it’s very disappointing because we all thought that when the new board came into place they would get on top of things.
“We thought we would see massive improvements but if it’s inadequate then obviously they haven’t done what they should.”
The report states that the trust has had ‘a long history of turbulence’, including a high turnover of senior staff.
In 2012, chief executive Tony Halsall resigned after months of being urged to step down by MPs and local people, and eight other board members were replaced.
This followed the 2011 launch of a police probe into mother and baby deaths on FGH’s maternity ward.
In February 2012 and October 2013 staffing levels at RLI were criticised, and this was noticed again in the most recent inspection.
“Our inspection found that failure to address the staff issues in the medical wards was adversely affecting the quality of care provided to patients,” said inspectors.
Hygiene levels at FGH were criticised by the CQC in 2012, and this was also raised again this year.
In 2013 the CQC recommended a ‘cultural change programme’ be put in place to promote an identity of a fully-merged trust – but most recently they found staff ‘did not see themselves as part of the wider organisation’.
The report is expected to be officially released within the next fortnight, when the trust could be told by Monitor that it is being put into special measures.
A spokesman for the CQC said the trust has already submitted an action plan for improvements.
“When it’s all agreed we’ll give them the time to put that into place and then a discreet time we go back to reinspect them unan-nounced,” he said.
Now Mr Farron has called for the trust to ‘remedy the situation quickly’.
“I am pressing them to deliver that to reassure local residents,” he said.
“The trust can only recover if there is stability.”
'PATIENTS WERE PUT AT RISK OF SUFFERING AVOIDABLE HARM'
THE CQC report has broken down the overall ‘inadequate’ rating into five individual categories.
Are acute services safe?
INADEQUATE: The report says patients had been placed at ‘the risk of avoidable harm’. Although the hospitals were clean and there was ample equipment, inspectors found incident reporting was ‘inconsistent’ while staffing in certain departments was ‘unacceptably low’.
“A number of services provided by the trust require improvements to consistently secure patient safety and protect them from risks,” said the report.
In particular staffing low on medical wards at RLI and FGH, and in critical care and high dependancy units at FGH.
Are acute services well-led?
INADEQUATE: The trust was criticised for having a higher number of ‘never events’ than similar trusts.
Data released last year by NHS England revealed that between April and September, 2013, a ‘foreign object’ was left inside a patient, a patient had the wrong body part operated on and a patient had a wrong implant or prosthesis.
Inspectors also criticised the trust’s ‘heavy reliance’ on the bay-wide Better Care Together healthcare review and for not having a clear vision for staff to follow.
Management was also slammed by inspectors, who said the leadership lacks the capacity to manage these challenges.
Are acute services responsive to people’s needs?
REQUIRES IMPROVEMENT: The reports says that the trust was experiencing difficulties in relation to outpatient appointments and the availability of patient records.
But it acknowledged that the trust had work under way to improve this area – and it was also praised for meeting patients’ needs in a ‘timely way’ – staff were aware of their responsibilities in relation to patients unable to make their own decisions and the handling of complaints had ‘significantly improved’.
Are acute services effective?
GOOD: Inspectors praised the care and treatment of patients, which followed national guidelines, and said action plans had been put into place to bring about further improvements.
The theatre team was also praised for ‘cross-bay working’ and a project to monitor theatre use and efficiency was ongoing.
Are acute services caring?
GOOD: Inspectors praised staff for working hard to provide ‘safe and compassionate care’.
“Patients and those close to them were complimentary about the care they received and the way staff responded to them,” said the report.
The report added that staff treated patients with respect and worked hard to promote their dignity and privacy.
Inspectors said they saw ‘many examples’ of staff delivering care in ‘a person-centred and compassionate manner’.
CHANGES ARE ALREADY UNDER WAY
CHANGES have been made at the trust which include more staff being recruited and bosses spending more time on the frontline.
The moves were revealed this week, before the report was leaked, by chief executive Jackie Daniel, who spoke of a ‘challenging year’ which had ‘yielded significant improvements’.
She explained that 130 new nurses had been employed, different working patterns developed for staff and executives were now liaising regularly with frontline staff.
“Our continual improvement will only come from working together as a health economy for the benefit of local communities and not in organisational silos,” she said.
“The trust and its partners have come a long way over the last two years in developing positive and much improved working relationships.
“I look forward to working alongside our partners this year to ensure standards of safety and quality across our hospitals continue to improve for the benefit of patients.”
Ms Daniel explained that recruitment of 130 new nurses had now put the nursing vacancy rate at around four per cent, significantly below the ten per cent national average.
The trust also planned to ‘over-recruit’ in cohorts so that it would have enough permanent staff to make up the deficit left behind when staff retired or moved away.
In addition, there had been moves towards seven-day working with on-site physician cover increased at the weekends.
There were similar plans in the pipeline for acute medicine at the hospitals in Barrow and Lancaster.
“A move towards 24/7 hospital services is vitally important in our modern, round-the-clock world,” she continued.
She also said the trust’s executive team had begun making regular ward visits to talk to patients, staff and volunteers, to ensure a ‘strong knowledge of the working environment’.
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