A Lincolnshire trust has been recommended to return to “special measures”, after the Care Quality Commission found a number of services had deteriorated in the year and a half since it last carried out an inspection.
United Lincolnshire Hospitals NHS Trust said one of its “biggest challenges” was around shortages of permanent staff, with reliance on temporary workers sometimes affecting the quality of care that it provided. The recruitment and retention of staff have been long-term problems for the organisation.
“Having seen improvements to patient care previously, we are disappointed that our latest inspection found these had not been sustained”
The trust was first placed in the system for struggling NHS organisations in 2013, following a major review of trusts with high mortality rates by NHS England medical director Sir Bruce Keogh.
It was moved out of special measures and rated as “requires improvement” when inspectors visited in February 2015 and saw changes had been made.
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However, during the latest visits to the trust, in October and December 2016, the CQC found the improvements “had not been sustained” and there had been an “overall deterioration in quality and patient safety”.
As a result, the trust, which runs Lincoln County Hospital, Pilgrim Hospital, and Grantham Hospital, is now rated “inadequate” and has been put back in special measures by NHS Improvement.
It is the second trust in the region to be put back in the support scheme for struggling trusts, and also the second of the original 11 Keogh trusts to be so.
Last week Northern Lincolnshire and Goole NHS Foundation Trust shared the same fate after serious concerns were raised by inspectors about quality, safety and ongoing staffing issues.
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Problems uncovered at United Lincolnshire included a “significant number” of occasions where medicine doses had been missed – particularly for critical drugs – that accounted for around a third of safety incidents reported at one point in the year.
In addition, patients were not always being treated for sepsis quickly enough, despite having met the criteria.
On average, 50% of patients diagnosed with sepsis were receiving antibiotics within one hour – despite all patients being recommended treatment within this timeframe – according to data for the 12 months leading up to September 2016.
“The trust were recruiting nurses from overseas, although there had been some difficulties with this”
Treatment times were worse at different points in the year, with October 2015 seeing only 15% of patients given antibiotics within one hour.
In its report on the trust, published today, the CCQ noted improvements had been put in place, including the introduction of a patient group direction for intravenous meropenem – used to treat a wide variety of infections – and the recruitment of two full-time sepsis nurses.
Meanwhile, staff were working under high levels of stress and work overload, and some said they did not feel respected, according to the CQC’s report.
Inspectors noted the organisation had identified staffing problems as a strategic risk and was working to ensure it reduced its reliance on agency nurses, filled nursing shifts with the appropriate level of staff, and brought down its vacancy rates.
“The trust were recruiting nurses from overseas, although there had been some difficulties with this. The trust also faced challenges retaining overseas nurses. This was particularly problematic at Pilgrim Hospital, which is in a much more rural area near the east coast,” said the report.
During 2016 the trust also failed to meet the majority of the national standards for cancer referral targets.
From April to August, the organisation was under the target of 93% people with suspected cancer being seen within 14 days. For breast cancer, at one point in the year – in August – only 31% of patients referred were seen within two weeks, when it should have been 93%
“Our biggest challenges are around our shortages of permanent staff and we struggle to meet some national quality standards”
However, the organisation took immediate action to address the delays and by September it was able to see 91% of patients within the required timeframe.
Delays in follow-up outpatient appointments across several specialities were also noted by inspectors, who found more than 3,000 appointments that were overdue by more than six weeks.
Significant concerns in medical care and outpatients services at Pilgrim Hospital were highlighted in particular.
The CCQ did note that staff were caring for the most part, and assessed the organisation as being “good” in this area of its inspection.
Some areas of outstanding practice were also highlighted, including a new coloured sticker system for elderly patients which indicated how much assistance they required, and the use of a new tool in the emergency department to assess every hour how much pressure it was under.
“Having seen improvements to patient care previously, we are disappointed that our latest inspection of United Lincolnshire Hospitals NHS Trust found these improvements had not been sustained and there had been an overall deterioration in quality and patient safety,” said CQC chief inspector of hospitals Professor Sir Mike Richards.
“For this reason, we have recommended that the trust should re-enter special measures so that it can receive support at the highest level to deliver all the necessary improvements,” he said.
“ULHT has a five year plan in place to improve long-term quality and safety of our services”
“We raised a number of issues with the trust that needed urgent attention at the time of the inspection. We were impressed with the response by the chief nurse who sought opportunities to learn from other trusts to improve patient care,” he added.
The trust’s board said it was disappointed with but accepted the findings of the CQC report and with the decision to place the organisation into special measures.
Trust chief executive Jan Sobieraj said: “The safety and quality of patient care is our number one priority. We’re disappointed with some of the findings in the report but we are taking them very seriously. We are sorry to our patients as we know this isn’t good enough.”
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He said he was pleased that the CQC had rated just over half of the organisation’s services as being “good”, but that the organisation recognised it had more work to do.
“Our biggest challenges are around our shortages of permanent staff and we struggle to meet some national quality standards,” he said.
“We’re working hard to recruit staff locally, nationally and internationally but the reality is we rely on locum and agency staff, and this sometimes affects the quality of our services,” he said.
”ULHT has a five year plan in place to improve long-term quality and safety of our services – our share of Lincolnshire’s sustainability and transformation plan (STP) – and we’re working hard to quicken the pace of these changes,” he added.