Furness General Hospital

Updated 23 August 2023

Furness General Hospital (FGH) is one of three hospital sites of University Hospitals of Morecambe Bay Foundation Trust’s and is one of the two main hospital sites. It serves the population of Furness and the surrounding areas in South Cumbria with consultant led maternity services.

At Furness General Hospital the maternity department consisted of one ward of 14 en-suite rooms where obstetricians and midwives provided antenatal, intrapartum, and postnatal care. Two maternity theatres adjoined this area and a specialist bereavement suite, a separate antenatal clinic and day assessment area. There was also a triage area on the birthing ward with trained rotational midwives providing cover.

Around 2,800 babies are delivered within Morecambe Bay Maternity services per year.

We carried out this unannounced comprehensive maternity inspection because at our last inspection we rated the service overall as inadequate. The trust was receiving mandated support as it was placed in SOF4 by NHSE. It was also in receipt of mandated maternity support.

Details of our last inspection on 20 April 2021 and the actions taken were published on 20 August 2021 and can be accessed on our website.

Our rating of this location improved. We rated it as requires improvement because:

• The service had enough staff to care for women and keep them safe. Most staff had training in key skills and understood how to protect women from abuse. Staff managed safety well. Staff assessed risks to women, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Key services were available seven days a week.
• Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
• The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders had improved information systems and supported staff to develop their skills. Staff were focused on the needs of women receiving care and were clear about their roles and accountabilities. The service was improving engagement with women and the community to plan and manage services. All staff were committed to improving it.
• Leaders had identified and acted on cultural issues where not all staff felt respected or valued.
• The service used systems and processes to administer and document medicines safely.

However:

• Women receiving maternity care, who were assessed as at risk of sepsis, did not always follow the required care and treatment pathway in line with national guidance and antimicrobial medicines were not always prescribed appropriately.
• The was no documented prioritisation of women requiring an induction of labour and there were delays in accessing fetal anomaly referrals. Staff did not always follow best practice guidance when monitoring the fetal heart rate and followed out of date emergency protocols.
• Medical staff mandatory training including safeguarding compliance had not improved since our last inspection and staff did not know or understood the service’s vision and values, or how to apply them in their work.
• The service did not always control environmental infection risk well or remove equipment when out of service. There was not always enough blood pressure monitoring equipment.

Updated 22 July 2022

Updated 19 March 2020

Children and young people’s services were a small proportion of hospital activity.

We previously rated this service as good in 2017. However, this inspection was a focused inspection and no new rating could be made.

Updated 9 February 2017

Following our last inspection, in July 2015, we found that overall the critical care service provided at the Furness General Hospital required improvement.

During this inspection we rated this service as good overall, with good ratings in safe, effective, caring, responsive and well-led because:

• During our inspection we found that nurse staffing levels were good, with sufficient staffing levels for provision of critical care. Recruitment was underway to provide a supernumerary coordinator and practice educator in line with Guidelines for the Provision of Intensive Care Services (GPICS) (2015). Supernumerary induction for new nursing staff was good with an organised approach to nurse appraisal and nursing achievement of competence in critical care skills. This was an improvement upon findings in 2015 when we found that, although nurse staffing levels had improved from the 2014 inspection findings, there were no supernumerary coordinator or funded practice educators in post.
• Medical staff we spoke with discussed the historic shortfalls in anaesthetic staffing levels for out of hours cover. We had noted in 2015 that intensive care services, obstetrics, anaesthetics and emergency surgical services across the trust did not have enough anaesthetic staff to meet the required national recommendations and standards. However, this was well understood by the executive team and clinical staff. An additional five consultants at RLI and three consultants at FGH ha been funded to ensure safe staffing levels and mitigate risks. A recruitment strategy was in place.
• We observed good medical handover and staff we spoke with told us that the system in place for responding to acutely unwell patients outside of ITU was good.
• We had reported in 2015 that medicines were not stored securely in the unit, however, this had improved at the 2016 inspection and we did not observe any breaches in pharmacy storage standards or any poor compliance with regular safe storage of medicines audits. Similarly, improvement in general storage in the unit was observed with well-organised, locked access, storage rooms available on the entrance corridor to the secure main unit. The main unit was tidy and stores were well organised.
• The emergency resuscitation equipment and patient transfer bags were checked daily with a good system in place as per trust policy. There was good provision of equipment in critical care with robust systems for medical device training. The risks associated with loss of service, should equipment be broken and require replacement, were on the risk register.
• The unit was visibly clean and appeared light and spacious for the four patients in the main bay. Sstaff we spoke with told us that there had been capacity to flexibly increase to five bed spaces in the main area, but recently agreement had been made to close that area to create more floor space. The strategy included future planning for a larger combined critical care unit.
• Standards of infection prevention and control were in line with trust policy. Staff we spoke with told us that isolation of patients was risk assessed and documented. Liaison with the infection control team supported the assurance that patients with infections received best practice care and, should patients need specialist ventilated isolation facilities they would be transferred. This would apply to only a small proportion of patients. Patients with infections were isolated as per the trust's policy, however, the two isolation rooms were not designed in line with Health Building Note (HBN 04-02) and did not have en suite shower rooms or ventilated lobby areas.
• There was ongoing progress towards a harm-free culture. Incident reporting was good with low incidence of harm and infection. There was a proactive approach to the assessment and management of patient-centred risks, and staff took responsibility for driving improvement to reduce risk of patient harm or acute deterioration. The programme for care of patients with tracheostomy across wards was comprehensive. There was further work ongoing to identify specific admission wards at FGH, in line with work at the RLI site.
• In 2015 we reported that there was no Critical Care Outreach Team (CCOR) across either critical care unit at UHMB. The trust did not have a dedicated CCOR team and this continued to be noted on the risk register. However during our 2016 inspection we noted good provision of principles in line with GPICS (2015), NICE CG50 and against the seven core elements of Comprehensive Critical Care Outreach(C3O 2011). Staff we spoke with told us that there was an ‘educational model’ of outreach embedded across the trust. We observed one occasion of a rapid response to an acute emergency by the team during the inspection.
• Patients were at the centre of decisions about care and treatment. The weight of positive comments gave evidence of a caring and compassionate team. Staff were positive and motivated and without exception delivered care that was kind and promoted dignity, and focused on the individual needs of people.
• The team in critical care services was well-led. A genuine culture of listening, learning and improvement was evident amongst all staff we spoke with. Staff across the team were passionate about their roles and proud of the trust. The investment in leadership programme was good and it was clear that learning from it was shared, staff had a shared purpose and they made an impact in practice. Governance arrangements were embedded in the directorate.
• We found that ICNARC data showed that patient outcomes were comparable to or better than expected when compared with other units nationally; this included unit mortality.
• In line with recommendations by NICE CG83 and GPICS (2015), follow-up clinics were in place H for critical care patients who had experienced a stay in critical care of longer than four days. Emotional support was given as part of the follow-up appointment, and post critical care admission and additional psychological support were assessed on an individual basis. The use of patient diaries had been embedded in practice since our last inspection.
• Patients received timely access to critical care treatment and consultant-led care was delivered 24/7. A low number of critical care elective admissions were cancelled and there was a low number of readmissions to the unit. Patients were not transferred out of the unit for non-clinical reasons. Staff worked hard to avoid discharging patients to wards during the night, and there was a low number of out of hours discharges, comparable with other similar units.
• Less than half of all discharges to ward areas were delayed beyond four hours due to pressures on hospital beds, with 25% - 40% reported in ICNARC in 2015/16. This did not prevent patients from receiving the care and treatment they needed, and staff paid attention to patient dignity when Department of Health (DoH) single sex accommodation breaches occurred. ICNARC data did indicate that the unit position was comparable nationally with other units against the eight hour reported target in the CMP.
• Staff we spoke with in critical care and theatres did not express concern about the patients when ‘outlier’ admissions took place and staff had not reported any incidents of harm as a consequence. The FGH unit had reported an increase in annual admissions of around 40 in 2015/16. Staff we spoke with attributed the outliers to bed pressures across the trust. Critical care training had been increased for staff in theatres as part of an LiA project. Nurse skill mix in the critical care unit was not compromised to cover the theatre recovery activity, as had been previously reported, and all admissions were short stay and rarely level 3.

However:

• There was no provision for dedicated critical care pharmacy cover at the FGH site, despite recommendation of such by GPICS (2015).
• Patients discharged from critical care should receive a ward follow up visit by critical care nurses within 36 hours of discharge, it was reported that this could not be provided consistently by staff in the unit and was affected by activity and staffing resources. Staff we spoke with were planning improvement as part of the appointment of a supernumerary coordinator.
• We observed that physiotherapy cover in the unit did not provide enough opportunity to be involved in unit activity, nor did it deliver care that was in line with GPICS (2015) in the cases of six patients, and there was reduced opportunity to develop standards of patient rehabilitation in critical care.

Updated 9 February 2017

In the last inspection of Furness General Hospital, in July 2015, we rated end of life care services as 'good'. During this inspection we rated the end of life care service as 'outstanding' because:

• The trust had clear leadership for end of life care services, that was supported at a senior level within the organisation. There was active involvement strategically from the deputy chief nurse and executive leadership at board level.
• End of life care services were very well-led. There was a clear vision and strategy that focused on all people being treated with dignity, respect and compassion at the end of their lives.
• We saw evidence of proactive executive involvement in terms of the development of the end of life care strategy.
• There was very good public and staff engagement.
• There was a commitment by the trust, underpinned by staff, that patients would be cared for in a dignified, timely and appropriate manner.
• There were examples of innovation across the service. During 'dying matters week' the trust had introduced death cafés, aiming to raise the profile end of life care. This also included the development of the bereavement service.
• Patients were cared for holistically and there was strong evidence of spiritual and emotional support being recognised for its importance within the trust. This was apparent through the development of ‘death cafés’, where issues relating to death and dying were talked about openly.
• The staff throughout the hospital knew how to make referrals and people were appropriately referred to and assessed by the specialist palliative care team in a timely manner, therefore ensuring that individual needs were met.
• Staff had access to specialist advice and support 24 hours a day from a consultant on-call team for end of life care.
• The Chaplaincy and bereavement service supported families’ emotional needs when people were at the end of life, and continued to provide support afterwards.
• The mortuary was clean and well maintained, infection control risks were managed and clear reporting procedures were in place.
• The bereavement service had been nominated for a compassionate care award in 2015.
• The survey of bereaved relatives results were positive in relation to dignity and respect afforded to patients.
• The trust had recently introduced a 'Hospital Home Care Team' service where patients could be transferred to their own homes and supported by trust staff, in cases in which care packages were difficult to access in the community.
• An ‘ease of access to hospital’ group had been developed by the trust which included representation from the bereavement and Chaplaincy service, and initiatives were in place to improve access to the mortuary.
• DNACPR (do not attempt cardio-pulmonary resuscitation) records were generally completed well and the trust was making use of audits and was learning from incidents in order to drive improvements.
• Mandatory training was in place and attendance at this by the specialist palliative care nurses exceeded the trust target.
• The care of the dying patient (CDP) document was in use throughout the trust.
• The trust had introduced EPaCCS (electronic palliative care co-ordination system). This enabled recording and sharing of patients' care preferences and details about their care at the end of life

Updated 23 August 2023

Updated 9 February 2017

We rated outpatients and diagnostic imaging services as 'good' because:

• During our previous inspection we had identified concerns about the timely availability of case notes and test results in the outpatients department. At this inspection staff and managers confirmed that the trust had reduced the use of paper records and implemented an electronic records system for most outpatient areas. This was still being rolled out across all departments, but we found that there had been significant improvements in the availability of case notes. Staff were positive about the improvements in efficiency and effectiveness for outpatient services, such as the availability of test results and timely access to information.
• We found that, since the 2015 inspection, there had been some improvements in diagnostic imaging staffing numbers. When we inspected this time the department continued to work with vacancies but a new rota system enabled the department to make improvements.
• During our last inspection we had noted that there was no information available in the departments for patients who had a learning disability, nor any written information in formats suitable for patients who had a visual impairment. We saw this time that there was a range of information available in different formats and staff had involved the public and groups including vulnerable people in producing information for use by patients.
• Outpatient and diagnostic services were delivered by caring, committed and compassionate staff.
• Patients were overwhelmingly positive about the way staff looked after them. Care was planned and delivered in a way that took account of patients’ needs and wishes. Patients attending the outpatient and diagnostic imaging departments received effective care and treatment. Care and treatment was evidence-based and followed national guidance.
• Staff were competent and supported to provide a good quality service to patients. Competency assessments were in place for staff working in the radiology department along with preceptorship for all new staff to the department.
• We found that access to new appointments throughout the departments had improved.
• Overall, staff felt engaged with the trust and felt that there had been some improvements in service delivery since our last inspection. There were systems to report and manage risks. Staff were encouraged to participate in changes within the department, and there was departmental monitoring at management and board level in relation to patient safety. The service held monthly core clinical governance and assurance meetings with standard agenda items such as incident reporting, complaints, training, and lessons learned.

However:

• There remained a shortage of some staff groups including occupational therapists, radiographers, and radiologists. Some staff raised concerns about the sustainability of the team under prolonged staffing pressures.
• Some referral to treatment targets were missed, and follow-up appointments continued to suffer backlogs and delays.

Updated 20 August 2021

Updated 20 August 2021