Lincoln County Hospital

Updated 3 August 2023

Lincoln County Hospital serves the city of Lincoln and the North Lincolnshire area. It provides all major specialties and a 24-hour major accident and emergency service.

Between 5 and 8 October 2021, we inspected four core services provided by the trust at this location. We carried out an unannounced inspection of urgent and emergency care, Services for children and young people, Medical care (including older people's care) and a focused unannounced inspection of Maternity.

Focused inspections can result in an updated rating for any key questions that are inspected if we have inspected the key question in full across the service and/or we have identified a breach of regulation and issued a requirement notice, or taken action under our enforcement powers. In these cases, the ratings will be limited to requires improvement or inadequate. We have therefore rated the key question of safe in Maternity services as requires improvement. All other ratings in Maternity services remain unchanged.

Updated 8 February 2022

Updated 8 February 2022

Updated 17 October 2019

Our rating of this service stayed the same. We rated it it as good because:

• 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. 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. 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.

Updated 27 March 2015

The specialist palliative care team provided positive information and advice to general ward staff on the care of the dying patient. However in 2014, the service was not well developed, and there was a disconnect between what managers wanted to happen and what some of the palliative care team were undertaking. Patients using the service had only praise for the staff and felt involved in their care. At our inspection in 2015, we found that this disconnect was no longer apparent, as staff within the specialist palliative care team now felt well supported by the trust. The team had begun to use patient demographics to drive service delivery and training, and implementation of palliative care link nurses was well underway.

In 2014 we stated that improvements to the service, in terms of ensuring that the overarching strategy was accomplished, addressing challenges within the completion of the 'do not attempt cardio-pulmonary resuscitation' (DNA CPR) form, and the training of nursing staff on general wards, were required to ensure a safe, effective and responsive service. However, at our inspection in 2015 we found that significant improvements to training and overarching strategy had been implemented. The completion of DNA CPR forms still requires further improvement to ensure that patients who may lack capacity are protected when these decisions are made about their care.

Updated 8 February 2022

Updated 3 July 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated it as requires improvement because:

• Mandatory training figures for five out of 11 eligible training modules was not met by nursing staff, including basic life support and basic infection prevention and control.
• Safeguarding level three training targets were not met by eligible medical staff.
• There was a system in place to record patient outcomes after each clinic appointment. Managers audited patient outcome results to identify whether some patients did or did not have recorded outcomes. However, we saw there were significant numbers of patients without recorded outcomes, the oldest missing outcome was from March 2017.
• Whilst we found some improvement in the availability and storage of medical records, most staff, particularly within health records and medical secretaries, did not feel the quality of records had improved. Staff told us a large quantity of records were very large or badly filed.
• The trust had instigated a harm review process to assess the harm that may have been caused to some patients as a result of longer waiting times. However, this was a retrospective process and might not prevent harm whilst patients were currently waiting for appointments. The trust did, however, attempt to mitigate this risk by writing to patients who were waiting over certain timeframes.
• Some services were delivered in older buildings which meant parts of the environment presented challenges for staff in delivering services. Some of the waiting areas were small and became overcrowded at times of peak activity.
• From November 2016 to September 2017 the trust’s referral to treatment time (RTT) for non-admitted pathways was worse than the England overall performance.
• The trust was performing worse than the 93% operational standard for people being seen within two weeks of an urgent GP referral. The trust performed significantly worse than the national average for the percentage of people seen by a specialist within two weeks of an urgent GP referral (all cancers). The trust consistently failed to meet the operational standard set at 85% for the percentage of people waiting less than 62 days from urgent referral to first definitive treatment. The trust is performing below the 85% operational standard for patients receiving their first treatment within 62 days of an urgent GP referral.
• People could not always access the service when they needed it. Data from the trust as of 3rd April 2018, there were 2276 patients on the open referrals waiting list over 12 weeks awaiting their first appointment. This was a slight improvement from our previous inspection. Thirteen patients had been waiting on the incomplete pathway for over 52 weeks.
• The rapid deterioration of the waiting times in February 2018, highlighted that changes although reactive were not embedded and demonstrating a prolonged improvement.
• The general manager did not have sufficient capacity or administrative support to manage the trust wide workload for outpatient services.
• We saw improvements in the governance arrangements although there was a degree of inconsistency in the ratings within the risk register.

However:

• Staff understood their roles and responsibilities regarding safeguarding vulnerable adults and children. Qualified nursing staff had received appropriate levels of safeguarding training and could tell us about examples where they had identified and raised concerns.
• There was a system in place to review the harm that may have been caused to patients on the long waiting lists. Patients waiting over 12 weeks and over 24 weeks were sent letters to apologise for the delay.
• We saw nursing and non-nursing staffing levels were appropriate. There were no national guidelines for the staffing of outpatient clinics but senior nurses were undertaking a staffing review to ensure safe and appropriate staffing levels.
• There were reliable systems in place to prevent and protect people from a healthcare-associated infection. We saw staff adhere to policies in relation to hand hygiene and infection control.
• A daily huddle, or ‘time to talk’ had improved staff awareness of current issues on a day by day basis.
• We saw good examples of multi-disciplinary working and involvement of other agencies and support services.
• Staff had the appropriate skills and experience for their roles. Clinical nurse specialists had undertaken additional training and competencies. All staff we spoke with confirmed they had received an appraisal, although the department had not achieved the trust target for appraisals.
• Staff spoke with patients with respect whilst seeking consent, taking observations and delivering care.
• Most patients we spoke with were complimentary about the service and described staff as ‘brilliant’ ‘helpful’ and ‘approachable.
• Patients felt fully informed around the appointment that day, but some patients told us there was a lack of future planning and were not always aware of what to expect.
• The trust planned and provided services in a way that met the needs of local people.
• The ‘did not attend’ (DNA) rate for outpatient services in Lincoln was better than the England average. Staff had procedures in the event of patients not turning up for appointments. Services had started to use a text reminder service to help improve performance. The trust was performing similarly to the 96% operational standard for patients waiting less than 31 days before receiving their first treatment following a diagnosis (decision to treat).
• Staff said and we saw managers shared learning from complaints and concerns through briefings and team meetings. Senior staff were able to give examples of learning from complaints. The trust sought out patient feedback and used it to make improvements to the patient experience.

Updated 3 July 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff understood their responsibilities to raise concerns and report incidents and near misses.
• Lessons were learned and communicated widely to support improvement. For example, changing equipment /products to ensure patient safety.
• Risks to patients were assessed, monitored and managed on a day-to-day basis. These included signs of deteriorating health and medical emergencies.
• Monitoring and audit of safety systems was robust. There was an effective audit for the World Health Organisation (WHO) five steps to safer surgery checklists.
• There were systems, processes and standard operating procedures in infection prevention control, records, and maintenance of equipment, which were mostly reliable and appropriate to keep patients safe.
• Patients were protected from abuse; staff had an understanding of how to protect patients from abuse.
• Care and treatment was planned and delivered in line with current evidence based guidance, standards, best practice and legislation and patients received effective care and treatment.
• We saw where patients symptoms of pain were mostly managed in both ward and department areas with good comfort outcomes. We observed staff positively interacting with patient and patients were treated with kindness, dignity, respect and compassion while they received care and treatment. Feedback from patients was positive about the care and treatment they had received.
• Surgical care services were responsive to patient’s needs; patients could access services in a way and at a time that suited them and there was a proactive approach to understanding and meeting the needs of individual patients and their families.
• The leadership, governance and culture in surgical care services supported the delivery of high quality person-centred care; governance and risk management arrangements were effective and as such able to protect patients from avoidable harm.

However:

• During the last inspection in October 2016 staffing levels across the service were challenging. This was still evident at this inspection. Leading to regular staff moves to unfamiliar areas.
• Housekeeper staffing numbers were reduced throughout surgical areas. This was highlighted on risk registers as an increased risk of patient harm due to post-operative infection.

Updated 8 February 2022