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Lancashire trust rated 'good' by CQC but told to continue to increase staffing

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An NHS trust in Lancashire that was previously in special measures has now been rated as “good” overall by the Care Quality Commission, following a recent inspection.

East Lancashire Hospitals NHS Trust has been making progress in recent years, suggest a series of ongoing reports from regulators.

“Staffing throughout the medical and surgical services… had been identified as an issue for the trust”

CQC report

It was rated “requires improvement” and moved out of special measures in May 2014, and in May 2016 the CQC published a report looking at the trust’s two main sites, Royal Blackburn and Burnley General hospitals, which it assessed as being “good”.

Now, following a “trust-level” review in September that included an assessment of its governance and risk management processes, the CQC has concluded the organisation as a whole should be rated as “good”.

The trust was praised across a number of areas including its incident reporting rates – which were higher than the average for all acute trusts – its good use of multi-disciplinary working, for staff being described as helpful, caring and kind by patients, and for its proactive approach to addressing whistleblowing concerns.

The CQC again welcomed the trust’s introduction of quality initiatives in its urgent and emergency services, such as a mental health triage tool and observation policy, rapid assessment review, introduction of a sepsis nurse lead – which it also noted in its last report on the Royal Blackburn hospital.

“The trust does still face some challenges and the managers are well aware that there are still areas for improvement”

CQC report 

Nurse staffing had improved in accident and emergency, medical and surgical departments and, although there was still a reliance on agency staff, the trust had recruited more nurses who were waiting to start in post, said the CQC in its latest report on the organisation.

But it said “a number” of wards still fell below the 80% fill rate for registered nurses in the day, though they were sufficiently staffed at night.

“Staffing throughout the medical and surgical services, together with the neonatal intensive care unit services, had been identified as an issue for the trust and actions had been implemented to manage the risk,” said the report, published today.

Meanwhile, the CQC noted that the emergency department continued to find it “challenging” to meet the waiting target of 95% of patients being seen and treated within four hours.

Sir Mike Richards

Sir Mike Richards

Sir Mike Richards

The trust’s risk management strategy, last approved in August 2016, was also highlighted as needing improvements, partly due to its failure to clearly articulate its goals.

In addition, the descriptions of risks did not include the cause and consequences for all of them, said the inspectors.

They noted nursing and medical shortages were only linked to financial consequences, and did not refer to patient safety and experience. However, inspectors said this was “not reflective of interviews with the executive team”, who clearly articulated potential risks to patients.

In its recommendations for the trust to build on its improvements so far, the CQC said it should ensure nurse staffing levels did not fall below recommended levels, and that it must review its risk management approach.

The trust should also reduce the time taken to investigate and close complaints, include more detailed conclusions in root cause analysis reviews, and ensure patients were notified within 10 days of a patient safety incident in order to meet duty of candour regulations.

“[The CQC rating] is a reflection of the hard work that our committed and dedicated staff have been carrying out”

Kevin McGee

CQC chief inspector of hospitals, Professor Sir Mike Richards, said the latest report represented further progress at East Lancashire Hospitals NHS Trust, which had shown “steady and sustained improvement”.

“The trust has a clear vision to be widely recognised as a provider of safe, personal and effective care – and we saw this in practice during our inspection,” he said.

“I note that the number of staff who would recommend the trust as a place to work has improved further. All the staff we met were dedicated to achieving the best care for patients,” he added.

“The trust does still face some challenges and the managers are well aware that there are still areas for improvement…We shall continue to monitor the work being done to address these issues and return in due course,” said Professor Richards.

Kevin McGee

Kevin McGee

Kevin McGee

East Lancashire Hospitals NHS Trust chief executive Kevin McGee said: “I am delighted that the CQC have rated our trust as good – this is a reflection of the hard work that our committed and dedicated staff have been carrying out ever since the trust was put into special measures in 2013.”

“Our next goal is to improve even further, ensuring those areas still requiring improvement are tackled, and work towards receiving an outstanding rating in the future,” he said.

”Thank you to all our staff, patients and stakeholders for working with us on this journey and ensuring we have a clear vision, direction and stability which contributes to our continual improvement,” he added.

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