Updated 25 November 2022
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; 1991 inpatient beds, including 200 day-case beds and 179 children’s beds. Each week the trust runs 1224 outpatient clinics.
The trust’s nationally and internationally - renowned specialist treatment and services in cardio-respiratory diseases, 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 and has an income of £1.3bn for the current financial year 2022/23.
The trust had set a financial plan to break even in 2022-23. The achievement of this plan was recognised as being a challenge and risks had been identified with system partners committed to develop a collaborative approach to managing any financial risk that emerges throughout the 2022/23 year. There was also a system approach to managing the urgent care pathway.
In April 2022, we conducted an unannounced inspection of urgent emergency care and medical care core services at Leicester Royal Infirmary using our focused methodology as we had concerns about the quality of services in these core services. Following the inspection we served a warning notice to the trust requiring them to make improvements to their urgent and emergency care services, to address safety concerns in respect of staff deployment, flow in, through and out of the emergency department, timely and consistent medical in reach processes, privacy and dignity, clarity in respect of clinical responsibility when patients were referred to speciality services and triage processes.
As part of that inspection, we had an additional focus on the urgent and emergency pathway across Leicester, Leicestershire and Rutland. This was to assess how patients’ risks were being managed across health and social care services during increased and extreme capacity pressures.
Between June and September 2022, we conducted a comprehensive inspection of surgery at Glenfield Hospital (28 and 29 June 2022) because we had concerns about the quality of the service provided. These included the number of patients awaiting elective surgery which were breaching 104 weeks. Cancer performance was also a challenge with 31 and 62 day waits continuing on a downward trend, which provided special cause for concern. We also inspected the well-led key question for the trust overall.
We did not inspect any other services at the trust because our monitoring process had not highlighted any concerns. We will re-inspect these services as appropriate.
NHS England System Oversight Framework (SOF) provides the framework for overseeing systems including providers and identifying potential support needs. The framework looks at five national themes: quality of care, access and outcomes, preventing ill health and reducing inequalities, finance and use of resources, people and leadership and capability.
Based on information from these themes, providers are segmented from 1 to 4, where 4 reflects providers receiving the most support, and 1 reflects providers requiring the least support. As of April 2022, the trust’s SOF score was 4.
Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level within the trust. Our findings are in the section headed ‘is this organisation well-led’. We inspected the well-led key question on 1 and 2 September 2022. NHS England also conducted a financial governance review at the same time as the well-led inspection. A separate ‘Use of Resources’ assessment was not conducted for this inspection.
Our rating of well-led went down. We rated them as requires improvement because:
- The trust had not always taken effective action to mitigate some risks to patients which were within their ability to improve, with the impact on patient care not yet fully realised in response.
- The trust’s vision and strategy did not accurately reflect current priorities.
- Although action was being taken to improve the culture in the trust not all cultural issues had yet been fully addressed.
- Not all staff, including those with protected characteristics under the Equality Act, felt they were treated equitably.
- The trust’s current governance arrangements resulted in duplication which meant there was duplication in the flow of information through to the executive boards and board committees.
- The audit committee was focused mainly on statutory financial issues with more limited oversight of the other responsibilities.
- The process to identify, escalate and mitigate all current trust risks was not always robust. There were significant delays from referral to treatment for patients waiting for elective care and treatment.
However:
- Leaders had the skills and abilities to run the trust with relevant experience and capability to deliver sustainable care.
- There were the same number of board members from an ethnically diverse background as at the last inspection. There were more women on the board and the senior management team was more diverse.
- The emphasis on the safety and wellbeing of staff within the trust was improving.
- The trust was improving governance structures, processes and systems of accountability to support the delivery of the strategy and good quality, sustainable services.
- The trust now had clear plans and timeframes to implement the new strategy.
- All staff were committed to continually learning and improving services.
- Leaders encouraged innovation and participation in research.