Royal Blackburn Hospital

Updated 22 July 2022

Our rating of services stayed the same. We rated it them as good because:

Updated 12 February 2019

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

• The service provided mandatory training in key skills to all staff and this was completed and monitored.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service controlled infection risk well by using a nursing assessment and performance framework to monitor and act on infection and hygiene risks to patients.
• The environment and equipment was visibly clean and tidy and processes and procedures were in place for maintenance and repair.
• Staffing was on the divisional risk register and the service had plans to mitigate risks to patient care by using innovative recruitment plans for nursing and medical staff.
• Incidents were reported, investigated and actions for learning identified to make improvements to the service.
• Care and treatment was based on national guidance and evidence based practice using care pathway models for patient care plans.
• The service had a multidisciplinary working approach to patient care providing seven-day working.
• Staff cared for patients with compassion and feedback from patients was positive.
• The service provided care and treatment using national guidelines and best practice according to patient needs including dementia and learning disabilities.
• The service had managers at all levels with the right skills and abilities to run the service and provide high-quality sustainable care.
• The trust’s vision and values were embedded across the service and staff felt supported.

However,

• People could access care and treatment but this was not always in a timely manner as patients waited for beds. There were high numbers of bed moves at night due to discharges that occurred towards the end of the day and ‘bay flips’ to prevent mixed sex breaches. In the time-period reported there were 38,212 in-patient transfers of which 7,158 were at night and this equated to 19% of the total bed moves. This included moves from the acute medical units to the wards.
• While the management of medicines had improved since the last inspection, the systems for monitoring the temperature of medicine fridges was not fully embedded.
• Patient information was not all in the same place and this meant staff had to look in different places to find all the information needed.

Updated 9 July 2014

Children and young people received safe and effective care from appropriately trained and competent staff. A programme of training was in place which staff confirmed prepared them for their roles and responsibilities.

Staff were positive about working in the family care division of the trust and told us they felt supported and valued in their roles. Parents and carers were satisfied with the care and treatment delivered to their children and told us they felt included and involved. Some parents did state they had only received sufficient information when they had questioned the medical staff.

The environment was clean, bright and airy with sufficient equipment required to deliver the necessary treatments. Toys were available throughout the ward and the children’s observation and assessment unit (COAU).

The care and treatment provided to children and young people was based on national guidelines and directives. Policies and procedures were reviewed regularly and updated as necessary. The care and treatment was audited to monitor quality and effectiveness and, as a result, action had been taken to improve the service.

Staff were provided with regular and appropriate training and an annual performance development review. There was no process for staff to receive formal supervision throughout the year but, during our discussions with staff, we were told that managers were approachable and provided support when required.

Services for children and young people were caring. Patients and their families or carers were treated with dignity and respect. Surveys took place to gather feedback from patients and their families/carers. Interpreter services were available, although we found these had not been used for one person who spoke very limited English.

The service for children and young people was well-led. Risks were managed at a local and trust level. Staff were confident in the leadership of the children’s services at Royal Blackburn Hospital.

Updated 9 July 2014

The critical care services provided safe care and treatment for patients. Patient safety was monitored and incidents were investigated to assist learning and improve care. Patients received care in safe, clean and suitably maintained premises. The staffing levels and skills mix was sufficient to meet patients’ needs. Patients were supported with the right equipment. Patient records were completed appropriately.

The critical care services provided effective care and treatment that followed national clinical guidelines and staff used care pathways effectively. The services participated in national and local clinical audits. Patients received care and treatment by multidisciplinary staff who worked well as a team. The critical care services performed in line with similar sized hospitals and performed within the national average for most safety and performance measures.

Patients or their representatives spoke positively about their care and treatment. Staff kept patients or their relatives involved in their care. There was no trust-wide bereavement or counselling lead in place to support patients, relatives or staff. However, the trust was in the process of addressing this.

There was sufficient capacity to ensure patients could be admitted promptly and receive the right level of care. There were systems in place to support vulnerable patients. Complaints about the service were shared with staff to aid learning.

There was effective teamwork and clearly visible leadership within the critical care services. Staff were highly motivated and positive about their work. Innovation and improvement was encouraged

Updated 20 May 2016

The end of life care service was rated good overall.

The clinical leadership in the specialist palliative care team was effective. There was a strategy and a vision for the end of life service and effective reporting mechanisms to the trust board. All directorates were engaged in the delivery of good quality end of life care.

Staff were enthusiastic and caring and enjoyed working for the trust. They said that the last few years had been difficult but the stability of the current board and executive team contributed greatly to the culture of continuous improvement.

Systems were in place to keep people safe and incidents were reported by staff through effective systems. Lessons were learnt and improvements were made. An integrated care plan had been launched which was comprehensive and staff had been trained to use it. The plan identified priorities for patients in the last few days and hours of their lives. Patients and their relatives were involved in the planning of their care.

The service had a well-developed education programme for medical staff, nurses and unqualified staff in EOL care. Staff in the specialist palliative care team and on the wards were committed to providing good compassionate care for patients and their relatives. There were good audit systems in place and the outcomes of these were used to improve the service.

The bereavement service showed care and compassion to those attending the bereavement centre. There were bereavement champions who worked in a range of departments and across directorates to deliver good care after death for patients and their relatives. The chaplaincy was part of the holistic care of the patient and family at the end of life, giving spiritual and religious support to people of all faiths.

Mortuary staff and porters were compassionate and respectful with patients following death and with relatives who were using their services.

However, consultant cover for out of hours and seven day working was not always available. The specialist palliative care telephone advice line for out of hours was answered by a nurse and referred to a doctor if necessary. This doctor was not always a consultant in palliative medicine and could be a GP. This did not fully meet the National Institute for Health and Care excellence (NICE) quality standards for end of life care.

Updated 9 July 2014

Patients were treated with dignity and respect by caring staff. Patients spoke positively about their care and felt they had been involved in decisions about their care. Staffing numbers and skills mix met the needs of the patients. There was a clear process for reporting and investigating incidents. Themes and trends were identiifed and action taken to minimise risks. The outpatients departments we visited were clean and well-maintained.

Patients and staff told us that clinics were sometimes cancelled at short notice and we found that clinics frequently ran late. Patients spoke of the anxiety and incovenience this caused them. Staff were auditing this and considering ways to address it. Changes to the patients’ ambulance transport services had caused confusion for staff, resulting in them not knowing which patients had transport arranged. Patients could wait for long periods for transport if their appointment was late.

Patients told us they found car parking at the hospital difficult, as the demand for spaces was high, and often required a long walk to get to the department. This often made them late for appointments and made them feel anxious.

There was good local leadership and a positive culture within the service. Staff worked well as a team and supported each other. Staff said they had confidence in their managers and all disciplines worked together for the benefit of patients.

Updated 12 February 2019

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

• The service identified, managed and responded to risks well.
• There was a good incident reporting culture and there was evidence of learning when things went wrong.
• The service had sufficient numbers of suitably skilled, experienced and competent staff to help protect patients from avoidable harm.
• The service followed best practice recommendations and guidance. They monitored outcomes to inform areas for improvements.
• Multidisciplinary teams worked well together.
• Staff demonstrated kindness and compassion towards their patients and families, they provided for their emotional needs and involved them in their care and treatment.
• The service was responsive to the individual needs of patients, their needs were considered in care planning and delivery. Reasonable adjustments were made to enable patients to access the service.
• The leadership, governance and culture enabled the promotion of high quality person centred care. Service managers were competent, visible and well respected.
• Staff understood the vision and strategy of the service and were invested into achieving service goals.
• Managers in the service had good systems in place to identify, understand and react to risks to the service.

However,

• The day surgery unit had been used as an escalation area but staff were concerned that it did not have adequate staffing. It was not a suitable environment for patients staying overnight. The surgical triage did not have an appropriate standard operating procedure to triage patients.
• Records were not always legible, signed or stored securely.

Updated 12 February 2019

• We rated the service as requires improvement for safe and responsive domains.
• Though improvements had been made through the introduction of a rapid assessment triage model, the service still performed worse than the England average for the time patients waited from arrival to initial assessment.
• At the time of our inspection patients were cared for on trolleys in the corridor. We were not assured that all staff followed the standard operating policy when caring for those patients. We saw that the dignity and privacy of those patients was not always respected. There was a risk that patients on corridors or in other areas could not alert staff if they became unwell.
• Access and flow remained an ongoing focus for the service and senior managers had acted to address challenges. However, the service did not meet standards for the number of patients waiting for more than one hour for treatment or the percentage of patients admitted, transferred or discharged within four hours.
• During our inspection we saw patients waiting over 12-hours to be admitted to hospital and the service reported 149 patients had waited over 12-hours between August 2017 and July 2018. Most patients waiting over 12-hours (143 out of 149 patients) had been assessed by the local mental trust and were waiting for mental health beds. The service was working collaboratively with the local mental health trust to address the issue.

However,

• There were enough staff with the right qualifications, skills, training and experience to provide the right care and treatment. The service had introduced a new medical rota to address gaps in medical vacancies. Gaps in nursing shifts were filled by agency and bank staff.
• The service had improved the number of staff trained in safeguarding adults since the last inspection.
• The service maintained a culture of reporting and investigating incidents, as found at the last inspection. It shared learning to promote improvements to patient care and treatment.
• There was evidence of adherence to national guidance to provide evidence based care and treatment. The service maintained use of care bundles to support staff to deliver care in line with best practice.
• Staff received mandatory and additional training and support to ensure they were competent for their roles. They felt supported to develop areas of interest and key competencies.
• We saw effective multidisciplinary team working between staff of different grades, disciplines and specialities.
• Staff were caring and compassionate. We observed positive interactions and effective communication between staff and patients.
• The service identified patients with additional and complex needs to enable staff to provide appropriate care and treatment. Support was available from specialist nurses in learning disabilities, dementia, organ donation and end of life care.
• Senior managers worked collaboratively with local partners to reduce the length of stay in the emergency department for patients needing mental health care.
• Senior managers worked with external agencies and partners to develop plans and strategies for the development of the service. They had a clear vision of what they wanted to achieve and workable plans. The service was opening a new ambulatory and emergency care unit at the end of September 2018 and the final building work was being completed during our inspection.
• Performance, risks, incidents and complaints were monitored and reviewed in monthly governance meetings. The service had a risk register which aligned with concerns raised by staff and managers.