North Lincolnshire and Goole NHS Foundation Trust has been told it must continue to make improvements following its latest inspection by the Care Quality Commission.
Overall, the trust has again been rated as “requires improvement” after being inspected between 13-16 October 2015, and again on 6 November 2015 and the 5 January 2016.
“I am particularly concerned by the backlog of patients waiting for outpatient follow up”
The trust’s Scunthorpe General Hospital was rated “inadequate” overall, while Diana Princess of Wales Hospital, Grimsby, was rated “requires improvement” and Goole Hospital as “good”. It addition, community services were rated as “requires improvement”.
Inspection teams had particular concerns with outpatients’ services at Scunthorpe General Hospital and Diana Princess of Wales hospital.
There was evidence of patients coming to harm within the outpatient services because of poor management of the follow up appointment system, said the CQC in its report.
CQC chief inspector of hospitals Professor Sir Mike Richards highlighted that 18 months ago the regulator recommended that the trust should come out of special measures.
Sir Mike Richards
“My inspectors have found a positive change in some services,” he said. “However we found that the services in A&E at Scunthorpe, outpatients and surgical services had either not improved or had deteriorated since our last inspection.
“I am particularly concerned by the backlog of patients waiting for outpatient follow up and the high levels of clinic cancellations, leaving some patients being cancelled time after time, without the involvement of doctors or nurses in reviewing their needs,” he said.
Inspectors could see that the trust was actively recruiting nurses, yet there remained a high number of nursing posts vacant on a number of wards and other services, added the CQC.
Meanwhile, in Scunthorpe A&E a registered children’s nurse was not on duty on every nursing shift, as recommended by national guidance.
The inspectors highlighted areas for improvement including that the trust must ensure the outpatient backlog was promptly “addressed and prioritised” and that all risks to patients with a mental health condition were removed in Scunthorpe emergency department.
The trust must also ensure the safe storage and administration of medicines, including the storage of oxygen cylinders on the intensive care unit at Diana Prince of Wales hospital, and ensure it continues to improve on the number of fractured neck of femur patients who receive surgery within 48 hours.
In contrast, inspectors saw several areas of outstanding practice including a “highly motivated and compassionate” matron who had the lead for dementia and also learning disabilities.
North Lincs trust told to improve further by CQC
Trust chief executive Karen Jackson said she was pleased the CQC had recognised many examples of excellent work at all three of its hospitals and community services.
But she said she was “extremely disappointed in the overall rating for Scunthorpe hospital”, which she claimed was not a reflection of the overall quality of care at the hospital.
She argued that the rating was “is in the main attributable to two issues” – namely a backlog of outpatient follow-up appointments that developed during 2015, and a delay in making some physical changes to the emergency centre facilities that the CQC had previously recommended.
“As our patients and staff would expect, the trust has already taken significant steps to address the issues identified at the inspections, some of which took place as long ago as October 2015,” she said.
“In addition, we were already aware of the outpatients issue and were in the process of rectifying it before the CQC’s visit, and the actions we had agreed to take by the end of December 2015 were completed,” she said.
“Vacancies for doctors and nurses are a major issue for most hospitals”
Trust medical director Lawrence Roberts noted the issue of staffing levels raised in the reports, acknowledging that it was “necessarily” to use agency, bank and locum staff to fill gaps in rotas.
“Vacancies for doctors and nurses are a major issue for most hospitals, with recruitment remaining a challenge across the country,” he said. “We have recruited 236 doctors and 107 nursing staff during 2015, and will continue to focus on recruiting more both within the UK and overseas.”
He added: “Of course we want to reduce our reliance on agency staff and we are making progress. For example, we are introducing a number of retention schemes to keep the staff we already have and to encourage more nurses to join our ‘bank’ or work additional shifts as a bank nurse.”