Updated 22 November 2023
We visited University Hospital Aintree as part of our unannounced inspection from 29 June to 1 July 2021. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.
Emergency department
We rated this service as inadequate because:
- The service did not make sure all staff completed mandatory training in key skills. The design, maintenance, use of facilities, premises and equipment did not always keep people safe. Patients did not always receive appropriate care and treatment in a timely way, exposing them to the risk of harm. Nursing and medical staff did not have the required levels of training to keep patients safe from avoidable harm and to provide the right care and treatment. The service did not always have enough medical staff. Staff did not always keep detailed records of patients’ care and treatment. The information needed to plan and deliver effective care, treatment and support was not always available at the right time. The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
- Staff did not always provide care and treatment based on trust policies. Fluid documentation was not always accurate and complete. Staff could not demonstrate that they monitored the effectiveness of care and treatment. There were gaps in management and support arrangements for staff, such as appraisal and supervision.
- The service did not always plan and provide care and treatment in a timely way that met the needs of local people and the communities served. The service did not always work with others in the wider system and local organisations to plan care. Ineffective access and flow processes were creating and contributing to significant delays in admissions to the wards. Waiting times were not in line with national standards.
- Senior leaders did not always have a clear understanding of the risks, issues and challenges in the service. We were not assured local leaders and staff understood the vision and knew how to apply and monitor its progress. Staff did not always feel respected, supported and valued by the wider hospital and senior managers. The service did not always have an open culture where patients, their families and staff could raise concerns without fear. Leaders did not always operate effective governance processes, throughout the service, across both sites and with partner organisations. Leaders did not always use systems to manage performance effectively. The service used multiple clinical systems which were impacting on patient safety and effective care. The information systems were not integrated. Leaders and staff did not always actively and openly engage with patients, staff, equality groups, the public and local organisations to plan and manage services. They did not always collaborate with partner organisations to help improve services for patients.
However:
- The service controlled infection risk well and kept equipment and the premises visibly clean. The service managed patient safety incidents well. Staff recognised and reported incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
- Staff protected the rights of patients subject to the Mental Health Act 1983. Staff gave patients enough food and drink to meet their needs and improve their health. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
- The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
- Frontline nursing and medical leaders were visible and approachable within the service. Staff were focused on the needs of patients receiving care. There were plans to cope with major incidents.
Medical care
We rated this service as requires improvement because:
- The service did not have enough staff to care for patients and keep them safe. Staff did not always have training in key skills or manage safety well. The service did not control infection risk well. Staff did not always assess risks to patients, act on them or keep good care records. They did not always manage medicines well. The service did not always learn lessons from safety incidents.
- Staff did not always give pain relief when people needed it. Managers did not always monitor the effectiveness of the service or make sure staff were competent. Staff did not always have access to good information. Key services were not always available seven days a week.
- The service did not consistently plan care to meet the needs of local people, take account of patients’ individual needs or make it easy for people to give feedback. People could not always access the service when they needed it.
- Leaders did not always run services well using reliable information systems and did not consistently support staff to develop their skills. Staff did not understand the service’s vision and values. Staff did not always feel respected, supported and valued. The service did not engage with the community to plan and manage services.
However:
- Staff understood how to protect patients from abuse.
- Staff collected some safety information and used it to improve the service. They gave patients enough to eat and drink.
- Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and supported them to make decisions about their care.
- 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.
- Staff were clear about their roles and accountabilities. They were focused on the needs of patients receiving care.
Surgery services
We rated it as requires improvement because:
- The service did not always manage patient safety incidents well. Whilst managers investigated never events, lessons learned were not always shared with the whole team and remedial actions taken did not minimise the risk of reoccurrence. We were not assured that the service had effective systems in place for identifying and reporting never events.
- Not all patients could access the service when they needed it and receive the right care promptly. The services performed worse than the national average for the percentage of cancer patients treated within 62 days. The average length of patient stay was worse than the national average. The total number of patients on the waiting list continued to increase since January 2021. Whilst the service did not achieve national standards for waiting times from referral to treatment; they performed better than the average when compared with other trusts in the region.
- Mandatory training compliance was below trust targets for a number of training modules, such as paediatric life support and higher level resuscitation training.
- The number of staff that had completed the higher level of adult and children’s safeguarding training did not meet trust targets.
- Complaints were not always responded to within the timescales specified in the trust complaints policy.
- Not all patients could access the service when they needed it and receive the right care promptly. The services performed worse than the national average for the percentage of cancer patients treated within 62 days. The average length of patient stay was worse than the national average. Whilst the service did not achieve national standards for waiting times from referral to treatment; they performed better than the average when compared with other trusts in the region.
- An effective work culture focused on patient safety had not been fully embedded across the surgical teams in theatres.
However:
- The service had enough staff to care for 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.
- 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.
- Local leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued by their line managers. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.