Archived: Southport and Ormskirk Hospital NHS Trust

Updated 29 November 2019

Southport and Ormskirk NHS Trust provides inpatient healthcare to approximately 224,402 people across Southport, Formby and West Lancashire. Acute inpatient care is provided at Southport and Formby District General Hospital and Ormskirk and District Hospital. The trust also provides sexual health services for the metropolitan borough of Sefton. The North West Regional Spinal Injuries Centre is at Southport hospital and provides specialist care for spinal patients across the North West and the Isle of Man. Services at the trust are commissioned by West Lancashire and Southport & Formby Clinical Commissioning Groups.

We last inspected the trust in 2017.

Updated 29 November 2019

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

• We rated safe, effective, responsive and well-led as requires improvement, and caring as good. At this inspection we inspected eight core services. We rated five of the trust’s services as good and three as requires improvement. In rating the trust, we took into account the current ratings of the four services not inspected this time. This means overall there are six services rated as requires improvement and six services with overall ratings of good.
• We rated well-led for the trust overall as requires improvement.
• We were concerned that issues raised at our previous inspection in relation to medical wards had not been effectively addressed and mitigated in a timely manner. Our concerns meant the rating for the well-led domain for medicine remained inadequate.
• Across the trust we were concerned regarding the completion levels of mandatory training for resuscitation (61%).
• At our last inspection we had concerns relating to the storage of hazardous materials. At this inspection we remained concerned.
• We identified concerns during our last inspection as we found the use of bed rails was not consistent with the trust’s policy. Patients’ needs were not always assessed, which represented a patient safety risk. We found similar concerns at this inspection.
• We were concerned regarding medicines, including medicines that were passed their expiry date and in relation to the way that controlled drugs were managed. We escalated this to the trust at the time of our inspection.
• At our last inspection during our reviews of records we identified that staff had not completed documentation for Mental Capacity Act, Deprivation of Liberty safeguards and do not attempt cardiopulmonary resuscitation plans appropriately. This represented a patient safety risk. We had similar concerns at this inspection.
• We were concerned regarding staff competencies including how they were evidenced. In relation to equipment, we were not assured that the trust had oversight as to whether staff were competent. We found gaps in records relating to competencies. Staff were also unclear regarding their roles and responsibilities in relation to capacity assessments.

However:

• During this inspection we improved the overall rating of children and young people’s services and the rating for effective in end of life care to good. We improved the safe domain rating for urgent and emergency services to requires improvement. Our overall hospital rating for the well-led domain was improved to requires improvement.
• Since our last inspection the trust had developed a strategy and a vision, which most staff were aware of.
• Our full inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – https://www.cqc.org.uk/provider/RVY/reports

Updated 29 November 2019

Updated 29 November 2019

Updated 15 November 2016

Community health services for adults in Southport & Ormskirk were last inspected in November 2015. The service received an overall rating of Requires Improvement although the caring domain was rated as Good. We found staffing numbers to be low and inadequate, particularly in district nursing services. It was felt there was a lack of senior management attention. An action plan was introduced to remedy the situation which we have monitored.

It should be noted that;

• At the time of our inspection in April 2016, the service was going through a procurement process in both its commissioned areas of activity.

• The trust were not successful in the tender process for the community adult services in West Lancashire and its current adult services would be transferred to a new provider shortly.

• The remaining services in Sefton were in the process of being tendered at the time of inspection and the Trust was hopeful of retaining the services commissioned in that area.

• It was recognised that the procurement process had an effect on the services ability to proactively develop the shape of its services and may have caused some issues around the recruitment and retention of staff in the period between our inspections.

• Whilst we found a certain level of anxiety in the staff group and its managers because of the procurement process, we also found them to be resilient and motivated. The staff had put enormous effort into stabilising the service and were on an upward trajectory to making the service good, despite a number of setbacks.

At this inspection we rated the service as Requiring Improvement because:

• Although we saw significant improvement from our last inspection it was from a low base. The service had improved its rating in two areas in both the Responsiveness and the Well Led domains. The Caring domain continued to be good. Safety and Effectiveness were still seen as requiring improvement although improvement had been seen.

• Some of the areas of concern which we found in this inspection had been highlighted in our last visit in 2015.

• The service had an over reliance on agency staff to cover vacancies. At times agency staffing reached 50% of the workforce, especially in some district nursing teams. The service itself had recognised that this over reliance on agency staff was a risk. Time and energy was targeted towards filling in gaps through the use of agency staffing on a weekly basis. The reliance on agency staffing led to teams having limited time to reflect on future planning of care and reviewing the effectiveness of what they did.

• The community health services for adults were unable to show us how they shaped service delivery. The managers in community health services for adults noted that information systems were slow and hard to make sense of both in interview and on the local management log. We felt the service needed to improve at showing how they made patients’ lives better and healthier with hard evidence.

• Despite improvements in staffing numbers a legacy still existed of some teams having not undertaken staff meetings or supervision.

• Mandatory training rates and personal development plans (PDPs) were below what was expected by the Trusts own standards in a number of community teams.A direct correlation existed between high use of agency staffing and the lack of personal development plans and mandatory training. The numbers of staff in community health services who had been appraised were below the numbers expected in the trusts own performance targets. In some district nursing teams the lack of appraisal was concerning.

However ;

• The services staffing numbers were on an upward trend but still required improvement and this had an impact on how well it performed in the area of safety. In February 2015 the teams collectively had 53% of the staff they required to deliver its services. As of January 2016, this figure had risen to over 86% of required staff.

• Considerable improvement had been made in leadership. The staff told us that they were listened to by managers and in most cases found that change had occurred after our last inspection.

• The responsiveness of staff to patient need was seen as good with appropriate facilities, delivering planned care, in a way that suited individual’s needs.

• Whilst teams focused on patient care, staff also told us they were unsure about where they would be employed in the future. Planning for changes in services was on hold until the completion of the final tender bid.

• Community health services for adults had developed a reporting tool, which gave senior managers real time updates on staff numbers and enabled them to make high level decisions about filling staff vacancies quickly.

• The service had made a concerted effort to fill its vacant staffing positions but this was, mainly by the use of employing agency staff in its teams.

• Managers advertised posts based on established staffing levels and used agency to achieve safe levels  of care.   t all levels managed risk positively and responsively and reacted when needed. Senior managers showed flexibility and pragmatism in allowing the use of agency staff or allowing advertisement of posts due to service need.

• We found that the majority of staff were happy about the progress made by the service in terms of staffing and they were appreciative of being listened to and had noticed positive change.

• Good processes were in place to reduce the risk of abuse and avoidable harm to patients. Training was on offer so that teams could identify concerns regarding Adult abuse or Child abuse. Systems were in place to report and record concerns about patients who were in the services care.

• The data we gathered provided us with evidence that incidents of harm to patients was relatively low when compared to the rest of the Trust.

• We were told by staff that teams had an open culture, where they felt free to disclose concerns and report issues as they occurred. The managers showed us that they took those concerns on board by making changes when staff voiced an issue about potential patient safety.

• Patients told us they felt safe and “in good hands”, whilst in the care of the community health services for adults.

• The service and its teams were seen as providing good care and were person centred and committed. The staff showed empathy and concern for people they treated. We observed staff giving good care to patients in their homes and in clinic treatment rooms.

• We found that staff were responsive to patient need and were good and competent at their job. The teams provided care to patients in different ways depending on circumstance.

• The patients we talked to valued what the staff did for them and felt Involved in their treatment. The staff talked to them and their families about treatment and placed patients and carers at ease.

• We saw a workforce who obviously supported each other and who were resilient and vocal about health care.

• We found examples of good leadership across the individual services. The recruitment of some new staff has enabled managers to start to have some space to think about leading rather than covering gaps in their own services because of lack of staff.

• We found on the whole that managers were visible in services. The staff noted how managers up to district level were available and supportive, often coming to services to see how staff were coping. Staff members talked of managers helping out at the shop floor when needed and they clearly had a fondness and respect for them.

• Despite uncertainty in their future employment staff were positive about their role and told us they concentrated on patient care first before anything else.

Updated 15 November 2016

Overall rating for this core service Requires Improvement

We found the overall rating for this service as requires improvement because:

• The computer system did not consistently flag up patients with safeguarding concerns. Systems in place to address this were not robust across the service’s different clinics.

• The number of staff that were up to date with their statutory and mandatory training were below the trust’s target.

• The lack of an electronic patient record presented risk of patients attending multiple clinics unknown to staff.

• Patients were turned away from clinics which could not meet the demand and 168 clinics were cancelled in the 12 months to January 2016.

• The management team did not document, monitor or manage the numbers of patients turned away from clinics or the cancellation of clinics when the service was not always meeting the demand for the service. However they told us that they were in consultation with the commissioners regarding the increased demand.

However,

• There was a good incident reporting culture. Feedback was provided and staff met regularly to address how services could be improved.

• The service followed British Association for Sexual Health and HIV (BASHH) Guidance and service audits demonstrated compliance with BASHH guidelines.

• The Faculty of Sexual and Reproductive Health CEU clinical guidelines are accredited by NICE and the service was compliant with these guidelines.

• Staff demonstrated a good understanding of people’s needs, ensured they maintained privacy and dignity and took extra time to support people.

• The service worked closely with commissioners to ensure they were targeting local service users; needs.

• The service regularly reviewed the provision it made with other stakeholders to ensure the needs of the community were addressed.

• The service had created multi-agency relationships which ensured service leaders and those within the team were aware of current health economy factors.

Updated 29 November 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 made sure everyone completed it. The mandatory training was comprehensive and met the needs of patients and staff.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The service provided care and treatment based on national guidance and evidence-based practice which was specific to sexual health and contraception services. Managers checked to make sure staff followed guidance. Staff had links with community mental health services so that adults and children could get their mental health needs addressed when and if issues arose.
• Staff gave patients practical support and advice to lead healthier lives. We found the community outreach team to be responsive and creative in its practice with young people and vulnerable communities.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. The service provided bespoke training to parents to enhance family conversations about sexual health
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• Patients had a wide range of access points into the service when they needed care and treatment. However, the service sometimes had long waiting times of up to two hours at specific times during some of its walk-in clinics.
• Leaders had the integrity, skills and abilities to run the service and this was being done whilst teams and the whole service were going through transitional changes, including job roles. They understood and managed the priorities and issues the service faced and sought support to enhance leadership by gaining additional support due to structural change.
• The service had an evolving vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
• The vast majority of staff felt respected, supported and valued, however the service was going through structural change which impacted on some staff members. Despite these changes staff were focused on the needs of patients receiving care.
• The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

• We found the majority of staff were competent for their roles and were supplied nationally accredited enhanced training. However, supervision rates and appraisal rates needed to improve in some staffing groups.