Liverpool Heart and Chest Hospital

Updated 3 July 2019

Liverpool Heart and Chest Hospital is situated in the Broadgreen area of Liverpool. The hospital provides specialist heart and chest services for the North West of England, including North Wales and the Isle of Man. The hospital has 183 inpatient beds split across nine inpatient wards. In addition to this, they run 266 outpatient’s clinics per week including 115 physical healthcare clinics. From June 2017 to May 2018 the hospital had 10,470 inpatient admissions, 75,107 outpatient attendances (20% increase) and 204 patient deaths (20% increase). The hospital has 1,457 staff which includes 146 medical staff and 496 nursing staff.

At the time of our inspection the hospital provided:

• Medical care;
• Surgery;
• Critical Care;
• Children and Young People service;
• End of life care;
• Community services; and
• Outpatients

Services are provided 24 hours a day seven days a week. During the inspection we:

• spoke with 12 patients, four carers and 24 staff.
• visited surgical wards and the theatre suite.
• had 26 meetings with staff and reviewed 15 care records and 10 prescription charts.

Updated 3 July 2019

Our rating of services improved. We rated it as outstanding because:

Updated 16 September 2016

We rated critical care services at Liverpool Heart and Chest Hospital as ‘Good’ because :

Care was provided in line with NICE CG50. Patient’s risks were assessed to determine their fitness for surgery. The service had protocols and guidelines in place to assess and monitor patient risk in real time.

Consent processes were robust and documentation associated with these processes was adapted to the individual patient’s needs and understanding.

Patients received evidenced based care, treatment and patient outcomes had improved.

The ‘Patient-Led Assessments of the Care Environment’ assessment in 2015 rated the trust higher than the national average on privacy, dignity & wellbeing, the dementia friendly environment, facilities and food.

Service planning and delivery considered patients’ needs, which resulted in changes to the service and how it was delivered, which benefited the patient.

Support was in place for those patients and their families who had either learning disabilities or dementia type conditions. The trust had identified a lead nurse for dementia who was also a ‘Dementia Friends Champion.’

The ‘Home for Lunch’ initiative was implemented trust wide to improve the timeliness of in-patient discharge from hospital by ensuring everything was in place for a safe and timely return to their place of discharge by 12 mid-day. Patients who met its criteria used the discharge lounge which opened in November 2015.

Clinical equipment was serviced. Daily monitoring of resuscitation equipment had taken place. We observed that flooring in the theatre corridors was damaged and had been taped. Staff said that the entire theatre flooring was due for replacement under the planned maintenance programme during 2016. 

Updated 16 September 2016

We rated End of Life Care at Liverpool Heart and Chest Hospital as ‘Good’ because :

The specialist palliative care team [SPCT] were competent, knowledgeable and responded to patients and their loved ones needs.

The team had completed mandatory training and had received annual appraisals.

They knew how to report incidents and raise concerns although not all incidents relating to end of life that were reported across the wards were escalated to the team which meant they didn’t have an overview of the service or improvements required.

There was an end of life strategy in place that had been shared across services at the hospital however not all staff on the wards were aware of the vision for end of life services.

There were processes in place to monitor quality of the service and complaints were responded to appropriately.

Palliative and End of Life care was provided on all wards at Liverpool Heart and Chest hospital and all staff were caring and committed to meeting patients’ needs. In the previous twelve months, 174 patients had died in the hospital. During this time there were 255 in patient referrals made to the specialist palliative care team although there were occasions were referrals to the team were late due to the sudden deterioration of patients.

DNA CPR and ceilings of care, which involved the cessation of all invasive treatments and non-essential medication, were clearly documented and visible for staff to see.

Patients were included in decisions about their care and treatment and we saw evidence of discussion with patients where relevant and families regarding decisions made and reasons why.

The SPCT worked effectively within their team but also with as part of multi-disciplinary teams, to deliver effective and timely care to patients.

There was a multidisciplinary approach from chaplaincy services, patient services, and the SPCT and ward staff in supporting both patients and their loved ones. All staff we spoke to felt it was an important part of their role to care for patients and families and we save evidence of staff going above and beyond to ensure patient’s needs were met.

The trusts bereavement team consist of the End of Life Lead and two named bereavement staff. Families we spoke with said they felt supported. 

Updated 16 September 2016

We rated medical services at Liverpool Heart and Chest Hospital as outstanding in the caring, responsive and well -led domain. We rated the safe and effective domains as good. This was because :

Services provided by the trust reflected people’s individual needs and preferences and continuity of care for patients was central for staff. There was a proactive approach to understanding the needs of different groups of people including vulnerable patients and reasonable adjustments were made.

Facilities and premises were appropriate for the services delivered and were well resourced, especially on the holly unit and cherry ward. When there were delayed discharges staff worked with partner organisations to ensure these were kept to a minimum and the majority of the time under 24 hours.

Staffing levels on all the wards were good. Staff vacancies were noted on the risk register and actions had been identified to mitigate this risk. There was a reliance on temporary staffing on some of the wards but there was a buddy system in place to make sure they were well supported.

Care was provided in line with national best practice guidelines and medical services participated in the majority of clinical audits where they were eligible to take part. For example the heart failure audit.

Pain was managed effectively and pain scores were being completed. Staff had access to information they needed to support patients.

Local policies and procedures were followed in relation to the care of patients. The service actively engaged with research networks and recruited well to national research studies. For example the assessment of tapping techniques in cystic fibrosis patients. These techniques are used to clear the airways in patients.

Patients told us staff were caring, kind and respected their wishes. We saw staff interactions with people were person-centred, and people we spoke with during the inspection were complimentary about the staff who cared for them.

Patients and their relatives were supported with their emotional needs and there were services in place to provide support for patients and relatives. Patients could be referred to external counselling services if they required ongoing support. The friends and family test was positive for the medical wards.

Patients received compassionate care and their dignity and respect were maintained. Staff were highly motivated to offer support to patients which was kind and caring and they were willing to go the extra mile.

The facilities and premises were appropriate for the services that were planned and delivered. There were excellent facilities in bedrooms, the majority of which had en-suite facilities. In areas where facilities were below the trust’s high standards, such as birch ward and maple ward, medical services had plans in place to improve these.

There was a specialist nurse who was the clinical lead for dementia. The nurse provided support for staff and a central point for queries. The trust also had access to psychiatric services that saw and assessed patients with a cognitive impairment, if required.

Each ward had an activity box and reminiscence files to provide stimulation and assist to orientate patients who had a cognitive impairment to time and place.

Updated 16 September 2016

We rated outpatients and diagnostic imaging services at Liverpool Heart and Chest Hospital as good because :

Policies and procedures were in place for the prevention and control of infection and to keep people safe.

Care provided was evidence based and followed national guidance.

Staff worked together in a multi-disciplinary environment to meet patients’ needs and a range of specialist nurses were available.

Staff responded and managed deteriorating patients appropriately and records and observations were updated regularly. There was an outreach team that followed up patients after being discharged.

Services were delivered by caring, committed and compassionate staff and care was planned that took account of patients’ wishes.

The trust met national referral to treatment standards for incomplete pathways between June 2015 and February 2016 with the exception of December 2015.

The trust consistently met the targets for cancer patients to be seen by a specialist within two weeks of urgent GP referral and to receive first definitive treatment within 31 days of diagnosis.

Quality and performance were monitored and there was evidence of continuous improvement and innovation

Updated 3 July 2019

Our rating of this service improved. We rated it as outstanding because:

• Patients were protected by a strong comprehensive safety system that all staff were aware of and worked to achieve. All staff worked well together to maintain patient safety and meet individual needs.
• Staffing levels and skill mix across all disciplines were planned, implemented and monitored to meet patients’ needs.
• Patients records were detailed, person centred and accurately reflected the care planned and delivered. Patients cultural, personal preferences and individual needs were reflected in the care delivered.
• Patients care was monitored and appropriate action taken in order that effective outcomes were achieved.
• The service actively engaged with local networks and other trusts to increase learning and best practice.
• There was a holistic approach to assessing, planning and delivering care and treatment to patients. This included supporting patients to live heathier lives.
• Patient and carers were treated with dignity and respect with the importance of their emotional needs recognised.
• There was an emphasis on recognising the service areas for improvement. All staff were committed to ensuring that improvements could be recognised and addressed.
• There was a strong culture of staff working in partnership with patients and their carers.
• Technology was used in a variety of ways to make sure that the latest developments could be implemented safely.
• Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver sustainable care.

However,

• Some areas of mandatory safety training were not meeting the trusts own targets.