Leighton Hospital

Updated 22 April 2024

Pages 1 to 2 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at Leighton Hospital.

We inspected the maternity service at Leighton Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

The Leighton Hospital provides maternity services to the population of Crewe and Mid Cheshire.

Maternity services include a triage, labour ward, midwifery led unit, obstetric theatres, a mixed antenatal/postnatal ward, and transitional care. Between April 2021 and March 2022, there were 3,080 babies were born at Leighton Hospital.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well- led key questions.

Our rating of this hospital went down. We rated it as Requires Improvement because:

• Our rating of Requires Improvement for maternity services changed the ratings for the hospital overall. We rated both safe and well-led as Requires Improvement.

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.We visited maternity assessment (Triage), Labour ward / Delivery Suite, the mixed antenatal and postnatal ward, the midwifery led unit and obstetric theatres.

We spoke with approximately 12 midwives, 2 support workers, and 5 doctors. We reviewed 3 medicines records during the inspection.

We received 81 responses to our give feedback on care posters which were in place during the inspection.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what- we-do/how-we-do-our-job/what-we-do-inspection.

Updated 14 April 2020

Our rating of this service improved. We rated it as good because:

• The service controlled infection risk well. Staff assessed risks to patients, acted on them. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
• Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However;

• Whilst the service provided mandatory training in key skills, the number of staff who completed it did not always meet trust targets.
• Whilst staff understood how to protect patients from abuse, the number of staff who completed safeguarding training did not always meet trust targets.
• Whilst there had been improvements in nurse staffing levels, some medical wards did not always have enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• The service used systems and processes to safely prescribe, administer, record and store medicines. However, antimicrobial medicine reviews were not always completed in line with trust policies. Medicines security audit findings showed medicines were not always securely stored.
• Records were not always securely stored across the majority of medical wards. Whilst most records were clear, up-to-date and easily available to staff, we found poor compliance in areas such as completion of follow up assessments for venous thromboembolism (blood clots).
• Key services were not always available seven days a week to support timely patient care.
• Fluid balance charts were not always completed accurately.
• Whilst staff assessed and monitored the majority of patients regularly to see if they were in pain and gave pain relief in a timely way, there was poor compliance against the hospital’s pain relief standards on two medical wards, indicating patients on these wards did not always receive appropriate pain relief.
• Whilst the service treated concerns and complaints seriously and investigated them, complaint responses were not always within trust targets.

Updated 15 January 2015

Care provided by services for children and young people was supportive to children, young people and their families. People told us that the staff were “lovely” and “very kind”. There were processes in place for safeguarding and such concerns were identified and referred to the relevant authorities. There were robust arrangements in place to report and monitor incidents and near misses. Staff were clear about their responsibilities in this regard. However the process for reporting safeguarding concerns via the incident reporting system was not as robust. This meant that incident reporting systems may not accurately reflect the safeguarding concerns identified.

There were clear governance arrangements in place that monitored the outcome of audits, complaints, incidents and lessons learned throughout the service. Staff were positive about the culture in children’s and young people’s services and felt supported by their senior managers. Staff were able to be innovative and introduce new practices to improve the quality of the service provided.

Children’s and young people’s services were forward thinking in how services could to be adapted to provide flexibility and sustainability in the future. There was a strong commitment to developing relationships across health networks.

Updated 15 January 2015

The trust was providing a good critical care service overall. However, to maintain safe care, some improvements were required relating to medical and nursing staff numbers.

There was evidence of strong medical and nursing leadership in the critical care unit that led to positive outcomes for patients. The service submitted regular Intensive Care National Audit and Research (ICNARC) data so was able to benchmark its performance and effectiveness alongside other units nationally.

There was a clear understanding of incident reporting and an embedded culture of audit, learning and development. However, the unit’s risk register contained risks had been there for a number of years and it was not clear whether these had been reviewed as planned or what the actions were.

The unit employed two nurses specifically in practice educator roles, which enabled them to support both new staff and those requiring additional support or performance management. Based in critical care, there was also a well-developed outreach service staffed on a daily basis by experienced band 7 nurses from the critical care unit. On the days of our inspection the unit had five to six empty beds at the start of the morning shift. It was safely staffed with the appropriate number of trained nurses per patient plus a senior co-ordinating nurse, clinical services manager and both junior and consultant medical staff.

Updated 15 January 2015

Patients received a good standard of end of life care that involved relatives and carers. Care was provided by supportive and compassionate staff who respected patients’ need for privacy and dignity. Nursing and care staff were appropriately trained and they were encouraged to learn from incidents. Relatives of patients, nurses and doctors spoke positively about the service provided from the Specialist Palliative Care Team (SPCT). End of life care services worked collaboratively with both primary and tertiary care services to best meet patients’ individual needs.

Patients and those close to them spoke positively about the rapid discharge pathway that enabled patients to be discharged from hospital to home in the last hours/days of their lives. Staff gave examples of how this policy worked in practice and where this had happened for patients. There were also several examples of how the service met the spiritual, religious, psychological and social needs of patients. Future plans for the service included the introduction of the AMBER care bundle, a system that would provide a systematic approach to manage the care of hospital patients facing an uncertain recovery and who are were at risk of dying in the next one to two months.

The trust had policies and a number of monitoring systems in place to ensure that it delivered good end of life care. However there was limited medical input to the SPCT. General medical cover was provided on the wards for patients with end of life care needs. There was only one part-time consultant (two sessions per week) in palliative medicine.

Updated 22 April 2024

Updated 15 January 2015

Patients attending the outpatient and diagnostic imaging departments were treated in a dignified and respectful way by caring and committed staff. Staffing numbers and skills mix met the needs of the patients in the department. However, consultants were sometimes called away to deal with emergency situations in other parts of the hospital or clinic’s over ran the times allocated. This meant that, at times, patients waited a long time to see their doctor.

There was a clear process for reporting and investigating incidents. Learning from incidents was shared and there were examples of changes in practice in response to incidents. Staff received training in safeguarding adults and children, the mental capacity act, health and safety, patient confidentiality and infection control.

The outpatient and diagnostic imaging departments were clean and well-maintained although the outpatient departments were sometimes quite cramped in terms of space and seating arrangements. Patient records generally were available for clinics and were secured and stored securely. There were occasions in the dermatology clinics at Leighton Hospital when patient records were not available for an appointment. In such cases staff prepared a temporary file for patients that included the most recent diagnostic and test results coupled with essential patient information so that the patient’s appointment could go ahead. Staff acknowledged that this was not ideal; however it meant the patient did not have to reschedule their appointment.

There was good local leadership and a positive culture within the service. Staff worked well as a team and supported each other.

Updated 15 January 2015

Surgical services provided good care and treatment for patients. Patient safety was monitored and incidents were investigated to assist learning and improve care. Patients received care in clean, hygienic and suitably maintained premises. The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks appropriately

Surgical services provided effective care and treatment based on evidence-based national clinical guidelines and staff used care pathways appropriately. The services participated in national and local clinical audits to benchmark and improve care and treatment for patients. Surgical outcomes were, in the main, positive. However, the number of patients that had elective surgery and were readmitted to hospital following discharge was worse than the England average. There were plans in place to improve areas where national clinical and performance standards had not been achieved, such as compliance with the national hip fracture audit.

Patients received care and treatment by trained, competent staff that worked well as part of a multidisciplinary team. Patients spoke positively about their care and treatment. Patients were treated with dignity and received their care in a compassionate way. Surgical services were planned and delivered to meet the needs of local people. There was sufficient capacity to ensure patients admitted to the surgical services could be seen promptly and receive the right level of care. There was effective teamwork and clearly visible leadership within the surgical services. There was a positive culture within the service that was focused on patient safety and learning. There was routine public and staff engagement and actions were taken to improve the services in response to patient feedback. The management team understood the key risks and challenges to the service and how to resolve them.

Updated 14 April 2020

Our rating of this service went down. We rated it as requires improvement because:

• There were not always enough staff with the right qualifications, skills, training and experience to provide care and treatment to children and staffing of children’s nurses was not in line with national guidance.
• The service did not ensure that nurses could legally administer specified medicines at all times by ensuring that new patient group directions were authorised and signed by staff immediately upon expiry of existing ones.
• The service did not ensure that the security of documents such as prescription pads were maintained at all times.
• The service did not ensure that all staff were up to date with their mandatory training.
• Some patient pathways and policy documents had not been reviewed at the scheduled time.
• Although people could access the service when they needed it waiting times for treatment were not within national targets and showed a declining picture.

However:

• The service had enough staff to care for adult patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.