Mersey and West Lancashire Teaching Hospitals NHS Trust

Updated 20 March 2019

Not used

Updated 20 March 2019

Our rating of the trust improved. We rated it as outstanding because:

• We rated safe, effective and responsive as good and caring and well-led as outstanding.
• We rated six of the trust’s eight services as good, one as outstanding across two sites and one as requiring improvement. In rating the trust, we took into account the current ratings of the five services not inspected this time.
• Whiston Hospital was rated good overall.
• St Helens Hospital was rated outstanding overall.
• Community services were rated as good overall.
• We rated Marshalls Cross Medical Centre as requiring improvement however this service was only acquired by the trust in April 2018 and therefore these ratings are not aggregated in to the overall ratings.
• As the community services had been delivered by the trust for less than two years we have agreed not to aggregate the rating for community into the overall trust rating.
• We have rated well led for the trust as outstanding. There had been significant progress within the maternity services and some upward movement within the ratings although there has been some deterioration in one rating in urgent and emergency care.
• The Trust retained the outstanding ratings for the Whiston and St Helens Hospital outpatient services, which were rated in 2015.
• The trust was rated good for Use of Resources.
• This gives a combined rating of outstanding.

Updated 20 March 2019

Updated 20 March 2019

Updated 20 March 2019

We did not previously rate this service. We rated it as good because:

• The trust took responsibility for delivering the services provided by the Healthy Hearts team, chronic obstructive pulmonary disease team and tissue viability nursing in April 2018. We were impressed by how quickly these services had integrated into the trust. They were performing well and staff told us they felt valued by the trust.
• We saw community based services worked closely with inpatient services to provide integrated pathways for patients and coordinated care and treatment for patients moving out of hospital and into community services.
• Overall, staff told us they felt positive about their work and we saw they worked in cohesive teams that delivered person-centred care and treatment.
• We saw strong local leadership of community teams at line management and senior management level.
• We saw several examples of outstanding practice and excellent examples of services working with the public and local agencies in innovative ways that supported the care and treatment of vulnerable patients.
• The service had some characteristics that, when teams are embedded into the trust, could be defined as outstanding.

However,

• Each team or service worked as part of the division it aligned to professionally such as surgery or care of older persons. There was no identity, vision or strategy for community services as a whole.
• We saw that policies and guidelines for staff working alone in the community and secure storage of patient records were not applied consistently across all the teams within community services for adults.

Updated 20 March 2019

We did not previously rate this service. We rated it as good because:

• The service controlled infection risk well. The areas we visited were exceptionally clean and tidy.
• All relevant staff, teams and services were involved in the assessing, planning and delivering of patients’ care and treatment and there was excellent multi-disciplinary working to ensure holistic and effective patient care and evidence of close partnership working with community services and other outside areas.
• Accurate and up-to-date information about the effectiveness of care and treatment was shared internally and externally. Positive changes had been implemented based on findings from previous Intermediate Care Audits, to improve patient outcomes and patients had access to seven-day therapy services.
• Staff responded compassionately when patients or their relatives needed help. Support was always given by caring staff, in order to meet the needs of the patients and their families.
• Staff ensured that patients and those close to them were partners in decisions about their care and treatment, including decision making processes.
• We saw examples of outstanding care and staff going to great lengths to ensure the needs of the patients were met.
• The service planned and provided services in a way that met the needs of local people, often admitting patients on the same day when they were able. The service provided a 24-hour service for intermediate care delivered to the local population.

However:

• There were no robust records of cleaning schedules being completed.
• There were some gaps in effective documentation, as we saw evidence of signatures that were missed in three out of the 13 records we examined.
• There were 46 medication errors in the last 12 months, which included issues with the doses of medication given.