East Lancashire Hospitals NHS Trust

Updated 12 February 2019

East Lancashire Hospitals NHS Trust was established in 2003 and is a large integrated trust providing acute and community healthcare to the people of East Lancashire and Blackburn with Darwen, in Lancashire, and specialist services for the people of Lancashire and South Cumbria. It serves a population of approximately 550,000. There are two acute hospital sites: Royal Blackburn Hospital and Burnley General Hospital as well as three community hospital sites: Accrington Victoria Hospital; Clitheroe Community Hospital and Pendle Community Hospital. The trust also provides services from community sites across East Lancashire.

The Trust employs 8,000 staff and treats over 700,000 patients a year from the most serious of emergencies to planned operations and procedures. The trust has 1079 beds across 48 wards on five hospital sites.

The trust provides a full range of acute hospital and community services and is a regional specialist centre for hepatobiliary, head and neck and urological cancer services. The trust also provides specialist cardiology services and level three neonatal intensive care.

In April and May 2014, we carried out a comprehensive inspection of the two acute hospital sites. We followed this up with an inspection in October 2015 of the four core services which we had previously rated as requires improvement. In September 2016 we carried out a review of how well led the trust was.

Updated 12 February 2019

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

• We rated safe, effective, caring and well-led as good. We rated responsive as requires improvement. Of the ten services we inspected we rated seven as good, two as outstanding and one as requires improvement. In rating the trust, we took into account the current ratings of the services not inspected this time.
• We rated well-led for the trust overall as good.
• Our ratings for Royal Blackburn Hospital and Burnley General Hospital were both good which was the same as the last inspection
• Our ratings for surgery, at both hospitals, were good, which was the same as the last inspection. Our rating for urgent and emergency care at Royal Blackburn Hospital was requires improvement, which was a deterioration from the last inspection, when we rated it as good. Our rating for urgent and emergency care at Burnley General Hospital was good, which was the same as the last inspection. Our rating for medical care at Royal Blackburn Hospital was good which was the same as the last inspection. Our rating for medical care at Burnley General Hospital was also good which was an improvement since the last inspection.
• Our rating for community end of life was outstanding. Our ratings for community adults and community inpatients were good. This was the first time we have inspected these services.
• Our ratings for specialist community mental health services for children and young people was outstanding. This was the first we have inspected this service.

Updated 12 February 2019

Updated 12 February 2019

Updated 12 February 2019

This is the first time we have rated this service and we have rated it as good. We rated it as good because:

• The service ensured that there were enough staff in the right areas to keep people safe. Staff had received mandatory training, knew what to do to protect patients from abuse and how to report an incident if things went wrong.
• The environment and equipment was clean and in general well maintained.
• Patients were risk assessed and prioritised to ensure they received safe treatment. The service was managing medicines well and made good records of patient care.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. They monitored the effectiveness of care and treatment and findings to improve them.
• The service assessed and monitored patients’ nutritional and pain needs effectively.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff of different kinds worked together as a team to benefit patients. Staff encouraged patients to make healthy lifestyle changes and promoted ways for patients to manage their own health.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress. They involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs. We saw good examples of personalised care.
• People could access the service when they needed it, referrals were triaged to prioritise those with the most urgent needs.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. There was a vision for what it wanted to achieve and workable plans to turn it into action.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However

• While there were systems for assessing risk, systems did not flag high risk patients.
• The service had not developed a process to audit electronic records to monitor quality. The service used primarily electronic records on a computerised system which had been newly introduced in April 2018.
• We were not assured that there was an adequate process in place for the maintenance of equipment in community locations
• whilst we saw that most areas were visibly clean and tidy we found mobile workstations which were not visibly clean in the podiatry clinic rooms at Bacup Health Centre.
• Across the service we were told that did not attend rates were high, the service was working towards introducing a text reminder system for appointments.
• The service had not developed a system for extracting data to audit the quality of information which had been inputted into the system.
• The service did not have a consistent approach to lone worker safety and the use of the policy.

Updated 12 February 2019

We rated it as good because:

• The trust provided mandatory training in key skills and made sure all staff were included. Staff understood how to safeguard patients from harm and abuse, they could identify different forms of abuse and knew how to make a safeguarding referral.
• The service completed risk assessments for patients and had processes for managing deteriorating patients. The service was following best practice when prescribing, giving, recording medicines. Staff kept appropriate records of patients’ care and treatment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. All hospitals collated information about the effectiveness of care and treatment and this was shared internally and externally.
• Patients received food and drink to meet their needs.
• The service made sure staff were competent for their roles and staff worked well with each other as a team.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff were caring and compassionate to patients and understood the impact that a person’s care could have on them. We saw staff ensured patients and their families understood the decisions about their care.
• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs and circumstances. People could access the service when they needed it.
• The service had managers at all levels which were visible, knowledgeable and had the right skills to manage the service. There were plans for the service which were aligned to the trust’s vision and strategy.
• Staff were positive about their roles and the team working around them.
• There were governance structures in place and processes to monitor and act on risks. The service used management information and engaged with staff and patients to improve services.

However,

• The service was not storing drugs appropriately and in line with best practice. Fluid and food thickening powder were not always safely secured and fridges used to store medicines at one of the hospitals was not properly monitored.
• The service did not always ensure that records were stored securely. We found records trolleys were not all locked and nursing records for patients in individual rooms were kept on bumper bars outside of the rooms.
• The service did not always have the numbers or mix of nursing staff to meet the planned staffing allocation, although they did have processes to mitigate the risk.
• Staff did not observe hand hygiene best practice.
• The service did not always assess and monitor patients regularly to see if they were in pain. Patients did not always have timely pain relief, reassessment of pain or access to sufficient pain relief.

Updated 12 February 2019

We rated it as outstanding because:

• The approach to end of life care was truly multi-disciplinary with all partners working together to support patients at the end of their lives. Care was evidence based and we saw that guidance was updated as necessary. Patients symptoms were addressed in a timely manner.
• There was a culture of learning and continuous improvement in the service with targeted education for all staff involved in the care of end of life patients. Training was available to a range of staff in different settings and staff were supported by medical colleagues. There were audit systems in place to support and improve the service.
• There was 24 hour cover for end of life services and support for staff out of hours and patients were triaged according to need. There was learning and improvement from complaints. There were processes in place to support more vulnerable patients.
• Patients and relatives were supported and care was holistic, feedback from patients and their relatives described exemplary treatment and care. Staff were compassionate and there was training for staff to support their communication skills in dealing with patients at the end of their lives.
• Services were safe and well managed. Patient records were electronic and staff could access records in patient’s homes through electronic devices. 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. We saw how the mental capacity act had been applied and robust documentation of patient decisions.
• There was a vision and strategy for the service that had been developed with a range of stakeholders and that service development and improvement was ongoing. There were governance processes in place and risk was managed appropriately.

Updated 12 February 2019

We had not inspected this service previously. We rated it as outstanding because:

• The service had a well-established team with low levels of staff vacancies. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Staff shortages were responded to quickly and adequately.
• There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse.
• There was a proactive approach to managing risks. Staff continually monitored patients risk and updated risk assessments regularly.
• Patients had access to a wide range of therapies to meet their individual needs including support groups. New evidence-based techniques were used to support the delivery of high quality care. Care records were holistic, person centred and recovery orientated.
• The service had received accreditation by the quality network for community child and adolescent mental health services. They were one of only seven services within the country to be accredited with this.
• The service had a highly skilled multidisciplinary workforce to effectively meet the needs of the patients using the service which was consultant led. Patients had access to a wide range of evidenced based psychological, educational and therapeutic social activities to support their recovery.
• Staff compliance with supervision, mandatory training and appraisals was 100%, 99% and 94% respectively. This evidenced the whole team’s commitment to development and reflective practice. Managers actively supported staff to access specialist training. Staff morale was very high and the team felt valued.
• All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review, accreditation and research were proactively pursued. New evidence-based techniques were used to support the delivery of high quality care.
• Patients and carers were actively encouraged and supported to drive service improvement initiatives with staff.
• People we spoke to were highly complementary about the service and felt staff went the extra mile for them. They felt involved as partners in their care.
• There was a strong, visible person-centred culture and staff were highly motivated and inspired to offer care that was kind and promoted patient’s dignity.
• Staff were highly motivated and committed to recognising and responding to the totality of patient’s needs. They took peoples personal, cultural, social and religious needs into account and tailored services to meet these. Tackling health inequalities was a priority for the service.
• The service had outstanding response rates to assessment and treatment of patients from referral into the service. Transition between services and discharges were planned thoughtfully with patients, carers and stakeholders to promote a smooth transition.
• Same day access to a psychiatrist and a senior clinician was available due to the on-call system in place.
• The involvement of other organisations and the local community was integral to how services were planned and ensured that services met the patient’s needs.
• The leadership drove continuous improvement and staff innovation was celebrated within the service and continuously encouraged. Staff had implemented a range of innovative practices and embedded these in practice with the involvement of stakeholders to improve patient outcomes.
• The visions and values of the trust were embedded in the service delivery model.
• There were consistently high levels of constructive engagement with staff, people who used the services and stakeholders.