Morecambe Urgent Treatment Centre

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Morecambe Urgent Treatment Centre on 25 April 2022. This was the first inspection of this urgent treatment centre under this registered provider. Overall, the service is rated good.

A summary of CQC findings on urgent and emergency care services in Lancashire and South Cumbria.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Lancashire and South Cumbria below:

Lancashire and South Cumbria.

Provision of urgent and emergency care in Lancashire and South Cumbria was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, integrated urgent care, acute, mental health, ambulance services and adult social care. Staff felt tired and continued to work under sustained pressure across health and social care.

We found demand on urgent care services had increased. Whilst feedback on these services was mostly positive, we found patients were accessing these services instead of seeing their GP. Local stakeholders were aware that people were opting to attend urgent care services and were engaging with local communities to explore the reasons for this.

The NHS 111 service which covered the all of the North West area, including Lancashire and South Cumbria, were experiencing significant staffing challenges across the whole area. During the COVID-19 pandemic, the service had recruited people from the travel industry. As these staff members returned to their previous roles, turnover was high and recruitment was particularly challenging. Service leaders worked well with system partners to ensure the local Directory of Services was up to date and working effectively to signpost people to appropriate services. However, due to a combination of high demand and staffing issues people experienced significant delays in accessing the 111 service. Following initial assessment, and if further information or clinical advice was required, people would receive a call back by a clinician at the NHS 111 service or from the clinical assessment service, delivered by out-of-hours providers. The NHS 111 service would benefit from a wide range of clinicians to be available such as dental, GP and pharmacists to negate the need for onward referral to other service providers.

People who called 999 for an ambulance experienced significant delays. Ambulance crews also experienced long handover delays at most Emergency Departments. Crews also found it challenging managing different handover arrangements. Some emergency departments in Lancashire and South Cumbria struggled to manage ambulance handover delays effectively which significantly impacted on the ambulance service’s ability to manage the risk in the community. The ambulance service proactively managed escalation processes which focused on a system wide response when services were under additional pressure.

We saw significant delays for people accessing care and treatment in emergency departments. Delays in triage and initial treatment put people at risk of harm. We visited mental health services delivered from the Emergency Department and found these to be well run and meeting people’s needs. However, patients experienced delays in the Emergency Department as accessing mental health inpatient services remained a significant challenge. This often resulted in people being cared for in out of area placements.

We found discharge wasn’t always planned from the point of admission which exacerbated in the poor patient flow seen across services. Discharge was also impacted on by capacity in social care services and the ability to meet people’s needs in the community. We also found some patients were admitted from the Emergency Department because they couldn’t get discharged back into their own home at night.

Increased communication is needed between leaders in both health and social care, particularly during times of escalation when Local Authorities were not always engaged in action plans.

At this inspection of Morecambe Urgent Treatment Centre we found:

• There was an established leadership team who prioritised a safe and effective service that supported the local emergency department and other primary care services.

• The provider ensured staff were supported by accessible leadership and good communication networks, training and development. A staff “Wellbeing” agenda was in place. Team members spoken with demonstrated a commitment to deliver a quality service.

• There were clearly defined and embedded systems to minimise risks to patient safety. Incidents, complaints and patient feedback were viewed as opportunities to learn and to improve processes. A learning log was in place which offered an overview of improvements implemented in response to issues and this log also included compliments received which were also shared.

• A comprehensive cycle of continuous quality improvement with supporting business plans was underpinned by the service strategy and this reflected the provider’s vision and values.

• The culture of the service was to work in partnership with local community health and social care services to deliver a person-centred responsive approach to people living in the local area.

• Staff involved and treated people with compassion, kindness, dignity and respect.

• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

We saw an area of outstanding practice:

• Collaborative working relationships with the local GP practices were established. The UTC monitored their appointment capacity and if able offered the local GPs additional appointments to meet unexpected patient demand.

The area where the provider should make improvements are:

• Adapt the patient survey report to provide a service specific feedback report for each of the Urgent and Emergency Care services that patients are commenting on.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated