Leicester Royal Infirmary

Updated 14 June 2024

University Hospitals of Leicester NHS Trust was created in April 2000 with the merger of the Leicester General Hospital, Glenfield Hospital and Leicester Royal Infirmary. University Hospitals of Leicester NHS Trust is one of the biggest and busiest NHS trusts in the country, serving the one million residents of Leicester, Leicestershire, and Rutland and increasingly specialist services over a much wider area.

The trust has a Children’s Hospital and one emergency department on its Leicester Royal Infirmary site and 126 inpatient wards across the trust: 1,991 inpatient beds, including 200 day-case beds and 179 children’s beds. Each week the trust runs 1,224 outpatient clinics. The trust’s nationally and internationally-renowned specialist treatment and services in cardio-respiratory diseases, Extra Corporeal Membrane Oxygenation (ECMO), cancer and renal disorders reach a further two to three million patients from the rest of the country.

The trust also provides services from 20 other registered locations including St Mary's Birth Centre.

The trust operates acute hospital services from three main hospital sites:

• Leicester Royal Infirmary.

• Leicester General Hospital.

• Glenfield Hospital.

The trust employs around 17,000 staff.

We carried out this short notice announced focused inspection to both the Maternity service and the Urgent and Emergency Care service.

We inspected urgent and emergency care at Leicester Royal Infirmary as part of our focused winter pressures inspection programme and to check improvements had been made since the last inspection in July 2022, after which we issued a warning notice under Section 29A of the Health and Social Care Act 2008. Our rating of the urgent and emergency care service did not change. We rated it as requires improvement although we recognised the trust had made some significant improvements, met the requirements of the warning notice, and improvements were ongoing in challenged times.

We inspected maternity services at Leicester Royal Infirmary and at Leicester General Hospital and gathered evidence for the key questions of safe and well led at both locations. We did not gather evidence for the key questions of effective, caring, or responsive. The focused inspections were carried out to check improvements had been made since our last inspection in March 2023, after which we issued a warning notice under Section 29A of the Health and Social Care Act 2008. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so.

Overall, we rated maternity services as requires improvement for safe and well-led.

How we carried out the inspection

Emergency and urgent care

The inspection was carried out unannounced and took place over 2 days on the 10 and 11 of January 2024.

In our preparation for the inspection, we reviewed information that we held and analysed data from other sources.

We spoke to senior and junior doctors, nurses and healthcare support workers, managers, ambulance crews and members of the professions allied to medicine. We also spoke to patients as well as relatives and carers. We reviewed records and attended meetings and staff handovers.

Following our inspection, we requested, and were provided with additional information.

Maternity

The inspection was carried out unannounced and took place over 2 days on the 10 and 11 of January 2024.

We inspected clinical areas in the service, including the delivery suite, antenatal and postnatal wards, the antenatal clinic, the maternity day assessment unit, community services, and triage. We spoke with 26 staff, including service leads, midwives, community midwives and medical staff.

We reviewed 7 sets of women; birthing persons records and 7 prescription charts and observed staff providing care and treatment to women. We spoke to 4 senior leaders following inspection and received a response to findings from the Chief Executive.

Updated 8 July 2022

Updated 5 February 2020

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

• The service did not have enough nursing staff to care for children and young people and keep them safe. Not all staff had training in key skills. Staff did not always assess risks to children and young people, act on them and keep good care records.
• Managers monitored the effectiveness of the service. However, good outcomes for patients were not consistently achieved.
• Staff did not always feel respected, supported and valued.
• Information systems were not always effective.
• Not all risks we identified were on the risk register.

However:

• Staff understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff 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 children and young people 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 children and young people, advised them and their families 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 children and young people 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 children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s 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 and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

Updated 26 January 2017

We rated critical care services at Leicester Royal Infirmary as good overall.

There were sufficient numbers of suitably qualified staff to care for patients. We found a culture where incident reporting was encouraged and understood by staff.

Patients and their relatives were cared for in a supportive and sympathetic manner and were treated with dignity and respect.

There was strong clinical and managerial leadership at both unit and management group level. The service had a vision and strategy for the future.

There was an effective governance structure in place, which ensured that the risks to the service were known, recorded on the trust risk register and discussed. The framework also enabled the dissemination of shared learning and service improvements.

However, we also found some issues with access and flow. In 2015, 47 patients had their elective surgery cancelled because there was no critical care bed available.

Bed occupancy levels were consistently higher than 90% for 2015 thus making it difficult to respond to individual needs. The trust target was 85%.

There were higher levels of non-clinical transfers when compared with similar units.

Pharmacy provision for the critical care service did not fully meet the D16 service specification, and the trust was not compliant with all aspects of NICE guidance 83 ‘Rehabilitation after Critical Illness’.

Updated 14 March 2018

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

We rated it as requires improvement because:

• Quality assurance and scientific support for staff was not given sufficient priority. Equipment was not consistently checked and there was a lack of dedicated time from the imaging department to ensure the ionising radiation regulations were adhered to.
• The governance processes in relation to policy, guidelines and dosing levels was not robust. Patient doses were not kept ‘as low as reasonably practicable’, as required under the ionising radiation (medical exposures) regulations 2000.
• There was a lack of awareness and understanding of dose levels and staff were not always using exposure charts.
• We found staff were sometime accessing paper files which were not always the most recent documentation, and lacked awareness of how to access information on the most current procedures.
• Staff were not consistently checking resuscitation trolleys as per trust policy across the majority of the imaging departments. We found some trolleys had out of date, missing or inappropriate stock stored in them.
• There were no sufficient mechanisms in place regarding the handover and handback of equipment prior to and following manufacturer visits

However:

• All patients we spoke to spoke positively about the care they had received in the department and told us they had received reassurance and support whilst using the service. Staff showed an encouraging, sensitive and supportive attitude to people who used the services and we saw they responded in a compassionate and appropriate way when people experienced distress.
• The imaging services within the new emergency department were more convenient and were a more positive patient experience.
• Imaging backlogs were being reduced despite significant IT issues.

Updated 5 February 2020

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

• The service had enough staff to care for patients and keep them safe. Staff 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 but did not always keep 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 but did not always support 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.
• 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:

• DNACPR orders were not always clear and up to date.
• Staff were not familiar with the strategy’s aims or how to achieve them.

Updated 14 June 2024

Updated 5 February 2020

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

• 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 most 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. 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 monitored the effectiveness of care and treatment. They used the findings to make improvements. Outcomes for patients were positive and mostly met expectations, such as national standards.
• The service ensured staff were competent for their roles across all areas of the service. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Staff treated patients with compassion and kindness most of the time, 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 took account of patients’ individual needs and made it easy for people to give feedback.
• Leaders used reliable information systems. 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:

• The service did not always have enough nursing staff to care for patients and keep them safe.
• The service planned care but this did not always meet the needs of local people. People could access the service when they needed it urgently but some had to wait too long for treatment.
• Systems to manage current and future performance were not always effective.

Updated 14 June 2024