University Hospitals of Morecambe Bay NHS Foundation Trust has reached another milestone on its improvement journey, having been rated “good” in what is described as a “remarkable turnaround”.
The Care Quality Commission found further significant improvements had been made at the trust, which was previously rated “requires improvement” and was taken out of special measures in December 2015.
“This is a truly remarkable turnaround for a trust that faced very significant difficulties”
The trust was rated “outstanding” for being caring, following its latest inspection in October. It was rated “good” for whether services were effective, responsive and well-led, but improvements were still needed on some aspects of safety, including staffing in some departments, said the regulator in its new report.
CQC chief inspector of hospitals Professor Sir Mike Richards said improvements were particularly evident in end of life services, gynaecology and maternity – where the trust had implemented the recommendations from Dr Bill Kirkup’s high profile inquiry into care failings at the trust.
The regulator praised the way patients, wider public and staff had been involved in the design of a new maternity unit. Service users had also been involved in recruiting and interviewing new staff, including midwives and matrons, as well as developing guidelines and strategies.
In addition, inspectors flagged up efforts to improve communication in maternity care, after the trust was awarded funding for a pilot scheme that involves using patient feedback to shape services and develop staff training.
“It also means we are among the top rated NHS hospitals in the country”
In end of life care, as an example of outstanding practice, inspectors identified the development of innovative “death cafés” to encourage people to talk more openly about death and dying.
The chaplaincy, specialist palliative care team and bereavement team, which includes bereavement nurses, worked together on the initiative for the public as part of Dying Matters week and use them to support staff to talk about death and promote better communication with patients and relatives at the end of life.
Innovative work by nurses was praised, including in the field of stroke care. At the Royal Lancaster Infirmary, nurse specialists had provided training to accident and emergency staff to improve early identification of stroke patients. Meanwhile, the role of advanced nurse practitioner had been extended to include signing off CT scan requests, which made the process more efficient.
“Overall the University Hospitals of Morecambe Bay NHS Foundation Trust has made real progress,” said Sir Mike. “This is a truly remarkable turnaround for a trust that faced very significant difficulties. Senior management and staff deserve huge credit for this.”
Sir Mike Richards
Inspectors found the trust had made big improvements when it came to nurse staffing levels, although there were still issues in some areas.
“Nursing and medical staffing had improved since the last inspection. However, there were still a number of nursing and medical staffing vacancies throughout the hospital, especially in medical care services and the emergency department,” said the inspection report.
“Staffing levels and skill mix in emergency, medical and surgical care was below the actual planned levels at times, despite the use of bank, agency and locums,” it added.
Nurse staffing concerns were also identified in the neonatal unit at Royal Lancaster Infirmary. The trust was told it must ensure there were enough nursing staff at the hospital to comply with official guidance on care for children and young people.
Record keeping was variable in some services when it came to nursing documentation and risk assessments, said the report, and care pathways were not always reviewed in the emergency departments.
Jackie Daniel chief executive of University Hospitals of Morecambe Bay Foundation Trust
The trust was told it must monitor performance in urgent and emergency care, and ensure patients were assessed and treated “in a timely manner”.
Trust chief executive Jackie Daniel described the trust’s new rating as “terrific news” for staff, partners and patients.
“This means we have continuously improved over three successive hospital inspections over the last three years moving from ‘inadequate’ and in special measures to today’s rating of ‘good’ and ‘outstanding’ for caring,” she said.
“It also means we are among the top rated NHS hospitals in the country. We are extremely proud of what our staff have achieved,” said Ms Daniel.
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“Every single day, they have worked with energy, commitment and determination to improve, and it is because of them and the involvement of our partners and the local communities, that we have achieved such a fantastic improved rating,” she said.
Ms Daniel said the past three years had seen a “tremendous turnaround”, but acknowledged “we aren’t there yet”. “We are committed to do all we can to continue to improve,” she said.