Blackpool Victoria Hospital

Updated 1 September 2022

Blackpool Teaching Hospitals NHS Foundation trust is situated on the west coast of Lancashire and operates within a regional health economy catchment area that spans Lancashire and South Cumbria and supports a population of 1.6 million. The trust provides a range of acute services to the 330,000 population of the Fylde coast health economy and the estimated 11 million visitors to the seaside town of Blackpool. The maternity unit delivers approximately 3,000 babies every year.

We only inspected maternity services at Blackpool Victoria Hospital and rerated this core service. This was an unannounced comprehensive inspection of Blackpool Victoria Hospital maternity services .

As a result of re-rating this core service, the ratings for the hospital location changed slightly with the safe domain changing from requires improvement to inadequate. The overall rating for the hospital location remained the same.

This inspection was partly undertaken due to the concerns raised over how the service was managing with low staffing to ensure women and babies received safe care and treatment.

The maternity services had been inspected previously; this included a comprehensive inspection carried out in 2019. The maternity services were previously rated as good overall, with all key questions rated as good.

After our inspection we sent the trust a Section 31 Letter of Intent of the Health and Social Care Act 2008. We wrote to the trust describing the serious concerns found during our inspection and requested an action plan of how the service was going to improve maternity care. Our concerns included:

1. There were ineffective processes to manage and mitigate the risks in relation to the lack of enough suitably qualified midwifery staff to care for women. This was creating and contributing to significant risks to women receiving timely and appropriate care and treatment exposing them to the risk of harm.
2. There was a lack of robust systems and processes to safely store medicines within maternity services which could expose women and babies to the risk of harm.
3. There was insufficient process to ensure staff had access to in date and safely checked equipment which exposed women and babies to a potential risk of harm.
4. There were insufficient processes in place to assess the risk of and prevent and control the spread of infections Women and babies were exposed to an increased risk of infection.
5. There was not effective systems and processes to ensure incidents were reported, reviewed, and investigated appropriately to ensure lessons were identified and shared with teams.

Following us formally raising these concerns with the trust they submitted an action plan on 11 July 2022. The trust included actions to enhance the maternity workforce and access for agency midwives. The trust had reviewed the induction of labour policy that defined delays in induction of labour as those waiting more than four hours. The trust had implemented a written risk assessment for patients waiting for induction of labour and delays over four hours must be reported. Delays in induction of labour would be reported to the trusts board as a monthly report. The trust had agreed that medicines in maternity theatres would be secured with keypad locking devices. The trust had checked equipment to ensure they were fit for use and were checked appropriately and the policies available for use in the department were the correct versions. We will monitor compliance of the action plan through ongoing engagement with the trust.

Details for the summary for the maternity core service inspected can be found later within the report.

Updated 22 July 2022

Updated 17 October 2019

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

• Staff understood of how to protect patients from abuse and the service worked well with other agencies to do this is an appropriate way. All areas of the children’s and young people’s services were located in suitable premises and the service-controlled infection risk well. The service prescribed, administered and recorded medicines in line with guidance.
• Risk assessments for each patient were completed by a paediatric nurse and kept in the patient record. Staff kept detailed paper-based records of patients’ care and treatment. However, due to the size of the patient record this made it challenging for staff to retrieve information quickly.
• Nursing and medical staff had the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. However not all staff had completed their mandatory training, compliance rate amongst nursing and medical staff was low in some training.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. The service provided care and treatment based on national guidance and evidence of its effectiveness.
• Children and young people were given a choice of food and drink and pain was managed well. Managers monitored the effectiveness of care and treatment and used the findings to improve them. Local results were undertaken to further improvements.
• Patients and parents were supported by staff who were kind and compassionate. Staff cared for children in a way that met their personal preferences and needs. Staff provided emotional support to patients, families and carers to minimise their distress and encouraged parents to be active partners in the care and treatment they delivered.
• The service was inclusive and took account of children, young people and their family’s individual needs and preferences. Staff made reasonable adjustments to help patients access services. Patients could access the service when they needed it but those needing surgery did not always have their surgery on time.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. The service had a vision for what it wanted to achieve. All staff understood and were invested in the vision and values of the organisation. Staff felt respected, supported and valued. Staff felt there was a no blame culture and a strong team ethos.
• There were effective governance processes in place. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The service and staff were committed to improving services by learning from incidents, promoting training and innovation.

Updated 19 January 2022

Updated 17 October 2019

We rated it as good because:

• We rated safe, effective, caring, responsive and well led as good
• 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. End of life care was not part of the trusts mandatory training for all staff.
• 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. Staff demonstrated care and compassion to patients.
• 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. The service did not monitor, audit and evaluate rapid discharges from hospital led by the specialist palliative care service.
• 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 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. There was a non-executive director at board level for end of life care. Staff told us they did not always feel valued by senior managers.

Updated 1 September 2022

Updated 17 October 2019

We rated it as requires improvement because:

• People struggled to access services when they needed them and receive the right care promptly. Patients were frequently and consistently not able to access services in a timely way for assessment or diagnosis, and experienced unacceptable waits for some treatments.
• Staff collated reliable data and teams used systems to monitor performance. However, leaders lacked the knowledge and capacity to lead the service and effectively drive improvements. The service was failing to manage services to meet key performance measures.
• There were governance processes in place. However, these were not always used to successfully manage risks and improve performance. Leaders didn’t consistently act on risks and identify and implement actions in a timely manner to reduce their impact.
• The service used paper-based patient records, and this presented a risk to the security and loss of patient information. We saw patient records, although complete and stored securely, were not always clear and easily available to all staff providing care.
• The number of cancelled appointments were not always kept to a minimum and had increased over time. The service did not have systems in place to sufficiently manage cancelled appointment rates.

However:

• The service had enough competent staff to keep patients safe from avoidable harm; and different professionals worked together as a team to benefit patients. Staff understood how to protect patients from abuse. Staff identified and quickly acted upon patients at risk of deterioration.
• Staff were focused on the needs of patients receiving 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, families and carers. Staff followed national guidance to gain patients’ consent and supported patients to make informed decisions about their care and treatment.
• The service used systems and processes to safely prescribe, administer, record and store medicines; and staff assessed and monitored patients regularly to see if they were in pain. The design, maintenance and use of facilities, premises and equipment kept people safe; and the service-controlled infection risk well.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action. We saw some evidence that leaders engaged with staff and local and partner organisations to plan and manage services for patients and encouraged innovation and participation in research.

Updated 19 January 2022

Updated 19 January 2022