Northern Lincolnshire and Goole NHS Foundation Trust has been put back into “special measures” after inspectors raised serious concerns about quality, safety and ongoing staffing issues.
The move by NHS Improvement follows an inspection by fellow regulator the Care Quality Commission, which covered the trust’s Scunthorpe General Hospital, Diana Princess of Wales Hospital and community services.
“There had been an overall deterioration in quality and patient safety”
Inspectors, who rated the trust “inadequate” overall, identified significant issues in outpatients, maternity and in urgent and emergency care.
These included the fact that care and treatment of patients in both hospitals’ accident and emergency departments “did not always meet their basic care needs”, with questions about nursing input.
The trust was one of 11 originally placed into special measures by Sir Bruce Keogh in July 2013, as part of his review of hospitals with high mortality rates.
It left the support regime in April 2014, after making improvements. But the latest inspection – carried out in October and December last year – found quality and patient safety had deteriorated.
“Having seen improvements to patient care previously, we are disappointed that our latest inspection found these improvements had not been sustained and there had been an overall deterioration in quality and patient safety,” said Ellen Armistead, deputy chief inspector of hospitals at the CQC.
“For this reason, we have recommended that the trust should re-enter special measures so it can receive the necessary leadership support it needs to deliver a robust improvement plan,” she said.
“The focus of the improvement plan will be to ensure that patients receive safe, high quality and compassionate care at all times,” she added.
“We are disappointed, but fully accept, the shortfalls the CQC has identified”
The trust has also been placed into financial special measures by NHS Improvement.
Among safety and quality concerns, inspectors said they could not be sure patients in emergency care were being properly monitored or getting “appropriate nursing care”, such as assessment of pressure ulcers.
They reviewed 56 sets of patients’ records across the two sites and found the completion of key documentation was “variable and at times inadequate to ensure delivery of safe care”.
“We could not tell if nursing care was actually given, because nursing care was not documented as being given in any of the 56 records,” said the CQC’s latest report on the trust.
“This included no record of pressure ulcer assessment or pressure care given and no documentation if the patient had been offered or given food or drinks whilst in ED. Four patients had a falls assessment completed,” it stated.
When they returned for an unannounced visit, the inspectors found some recording of basic checks in eight out of the 17 records they reviewed, but “completion of the record remained inconsistent”.
While there had been some improvements in staffing, inspectors found there were still nursing and medical vacancies throughout the trust.
“The trust had systems in place to manage staffing shortfall as well as escalation processes to maintain safe patient care,” said the CQC report.
“However, a number of registered nurse shifts remained unfilled, despite these escalation processes, and we saw examples of wards not meeting planned staffing levels and high patient acuity not identified appropriately,” it added.
Nevertheless, inspectors noted that some questionable practice around staffing rotas identified in a previous inspection had now ceased.
“At the 2015 inspection, nurses who were awaiting their registration number had been rostered to cover qualified nursing shifts,” said the report.
“At this inspection we saw that the practice had stopped and the trust confirmed that the band 4 nurses awaiting registration were designated in healthcare assistant shifts until their registration number had been assigned,” it said.
The trust was told it must ensure safe and appropriate staffing levels, especially in surgery, medicine and maternity, and make sure that the right staff were available to meet the needs of children and young people on both paediatric wards and in emergency care.
Other concerns raised by inspectors included poor infection control practices at Scunthorpe General Hospital, delays in outpatients appointments and poor leadership and oversight in a number of services.
However, they rated the trust “good” overall for being caring and found some improvements across community services at Scunthorpe and in critical care and end of life services at both hospitals.
Examples of positive practice highlighted in their report included a Skype service run by the infant feeding co-ordinator to support mothers to breastfeed at home.
Trust re-enters ‘special measures’ after nurse failings
Trust interim chief executive Richard Sunley said the organisation accepted the CQC’s conclusions.
“We are disappointed, but fully accept, the shortfalls the CQC has identified,” he said. “We are sorry we have let down our patients, their families and carers but not meeting the quality standards they rightly expect.
“We are determined to move forward and make changes with pace and focus, so we can consistently deliver high quality standards for patients across all of our services,” he said.
The trust highlighted improvements already made in some of the areas identified by the CQC, including recruiting 10 additional midwives and four extra nurses in the A&E at Scunthorpe.
It had also “strengthened the way we care for people in A&E, particularly those who are at risk of deteriorating; identifying and responding to them more quickly and ensuring the basic needs of all patients are met”, said the trust.
Lyn Simpson, executive regional managing director for NHS Improvement North said: “Following the CQC’s report and recommendation, we have agreed to place the trust into special measures, and put immediate actions in place to help tackle the challenges raised.”