Westmorland General Hospital

Updated 20 August 2021

Westmorland General Hospital is a part of the University Hospitals of Morecambe Bay NHS Foundation Trust. It has an urgent treatment centre and a midwifery-led maternity unit and provides elective surgery and out -patient services.

We visited Westmorland General Hospital as part of our unannounced inspection from 20 to 22 April 2021.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

We visited urgent and emergency care and maternity core services as part of the inspection.

The Urgent Treatment Centre (UTC is staffed by GPs, doctors, emergency nurse practitioners and nurses.

The UTC became part of University Hospitals of Morecambe Bay Foundation Trust in April 2018. Prior to this is it was managed by a different foundation trust. The UTC was initially a Primary Care Assessment Service. It was then reclassified to an UTC in line with national guidance.

The UTC is designed to treat patients with minor illnesses and injuries. Patients with more serious conditions such as chest pains, strokes, serious illness or serious injuries attend the nearest Accident and Emergency department in Lancaster. If a patient attends with these more serious conditions, then the trust arranges for transfer to the nearest emergency department whilst maintaining the patients care and safety within the unit capabilities.

The UTC operates between 0800 and 2200 seven days a week.

Helme Chase is a midwife-led unit, based at the Westmorland General Hospital. A midwife-led unit means there are no doctors present. Women can give birth at Helme Chase 24 hours a day, seven days a week, supported by a midwife.

Women who have been identified with an uncomplicated pregnancy, i.e. they are unlikely to develop any complications during pregnancy, whilst giving birth, or after their baby is born, can choose to give birth at Helme Chase.

Community midwifery services provide antenatal, intrapartum and postnatal care including birth at home.

Between April 2020 and March 2021 there have been 15 babies born at Helme Chase. The birth rate prior to the COVID-19 pandemic was reported as 10 to 12 births per month including home births.

We were not able to observe care and treatment as no one was using the service during our site visit.

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

• Across both services, staff did not always feel supported by the executive leadership team and reported they were not visible.

Maternity care

• There was not always enough staff to care for women and keep them safe. Concerns were identified in relation to cleaning the birthing pool. The design, maintenance and use of facilities, premises and equipment in maternity services were not managed well to keep people safe. Maternity staff did not always complete and update some risk assessments for each woman nor take action to remove or minimise risks. Staff did not always identify and quickly act upon women at risk of deterioration. The maternity service did not always have enough staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. The maternity service did not always manage safety incidents well.
• The service did not always provide care and treatment based on national guidance and evidence-based practice. Managers did not check to make sure staff followed guidance. There was a lack of clear information to evidence how the service monitored the effectiveness of care and treatment. The service could not demonstrate how they used findings to make improvements and achieve good outcomes for patients. The service did not always make sure staff were competent for their roles.
• The service did not plan and provide care in a way that met the needs of local people and the communities served. Women could not always access the service when they needed it nor receive the right care promptly.
• The service did not run services well using reliable information systems or always support staff to develop their skills. Leaders did not operate an effective governance process and not all relevant risks and issues were identified and escalated with actions identified to reduce their impact. It was unclear what the vision was for the service.

However:

• Across both services, staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff kept good care records and managed medicines well.
• Staff treated patients 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 patients, families and carers.

Urgent and emergency care

• The service had enough staff to care for patients and keep them safe. The service controlled infection risk well. Staff assessed risks to patients, acted on them and safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients. Patients were advised on how to lead healthier lives and supported them to make decisions about their care. Key services were available seven days a week.
• Urgent and emergency services had improved and planned towards care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. We saw information about how patients could give feedback throughout the centre. People could access the service when they needed it and did not have to wait too long for treatment.
• Local leaders ran the urgent treatment centre well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service had improved since the last inspection and engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Maternity care

• Patients and women were given enough to eat and drink, and pain relief when they needed it.

Updated 16 May 2019

Our rating of this service was good. We rated it as good because:

• There was a holistic approach to planning and delivering care and treatment. Innovative approaches were being used to maximise resources and deliver up to date evidence-based techniques. Care was of a good quality.
• Staff were well supported to improve quality and continuously develop. Staff were encouraged to contribute and work collaboratively to provide innovative ways to deliver more joined up care.
• Consent practices were strong, and patient focussed including the accommodation of individual needs. People who use services were involved in the development of tools and support to aid informed consent.
• Staff morale was high. Teams supported each other well and we saw examples of good teamwork. We saw staff from different professions working well together and staff told us they were proud of their work.
• Feedback for the service was good and there were very few complaints. The culture was very person-centred and promoted kindness and dignity. People’s needs, and preferences were respected. The emotional needs of patients were in the forefront of the minds of staff and they worked with patients to develop better ways to encompass these.
• There were good mechanisms in place to report, feedback and learn from incidents and staff were aware of the importance of doing so.
• Infection control measures were effective. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• Patient records across the trust were of a good standard, up to date, legible and accessible.
• The service participated in local and national audit. Results were good, and the service set high standards to improve still further.
• Staff demonstrated good knowledge and understanding of their responsibilities under the Mental Capacity Act 2005. Staff were 100% complaint with the relevant training.
• The service was responsive to individual patients’ needs. Learning disability and mental health nurses worked on wards to provide bespoke care and wider ad-hoc learning opportunities for other ward staff. People with a learning disability or dementia had their preferences recorded and respected.
• The care group leadership team had good oversight and knowledge of their strengths and weaknesses and leaders at ward level were visible and approachable. Managers had the right skills and abilities to run their service.
• Provision of IT and other equipment was good in the care group, and staff told us they had the right tools to do their jobs.

Updated 20 August 2021

Updated 9 February 2017

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

• During our last 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 there had been some improvements in diagnostic imaging staffing numbers since the previous inspection. When we inspected this time the department continued to work with vacancies, but a new rota system enabled it to make improvements.
• During our last inspection we had noted that there was no information available in the department for patients who had a learning disability, nor any written information in formats suitable for patients who had a visual impairment. At this inspection we saw hat 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.
• We noted that space was still limited in some areas and the service provision was physically constrained by the existing environment. However, the overall environment had improved, with changes in flooring materials. We found that overall access to appointments had improved, but performance was variable.
• 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 preceptorships for all new staff to the department.
• We found that access to new appointments throughout the department had improved.
• Overall, staff felt engaged with the trust and felt that there had been some improvements in service delivery since our previous inspection. There were systems in place for reporting and managing 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 16 May 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Nurse staffing was managed using daily monitoring, acuity tools and professional judgement. The service provided mandatory training in key skills to all staff and monitored compliance.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• There were escalation policies, guidance and care pathways for deteriorating patients. Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff involved patients and those close to them in decisions about their care and treatment. Patients confirmed that staff treated them well and with kindness, providing emotional support to minimise their distress.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Staff used the World Health Organisation (WHO) surgical safety checklist, ‘Five Steps to Safer Surgery’. National and local safety standards for invasive procedures incorporated the contents of the WHO surgical safety checklist.
• Managers checked to make sure staff followed guidance, monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. They planned and provided services in a way that met the needs of local people, taking account of patients’ individual needs. The service had been reconfigured to increase availability of surgical beds and access to rehabilitation.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

However:

• Not all staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Not all staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They did not always follow trust policy and procedures when a patient could not give consent.
• Staff training compliance for Safeguarding Adults and Children, levels 1, 2 and 3, which included Mental Capacity Act and Deprivation of Liberty Safeguards training, failed to meet the trust target.
• The number of staff within surgery who had received an appraisal was below trust compliance targets.
• All specialties except ear, nose and throat (ENT) were below the England average for referral to treatment times (RTTs) within 18 weeks for admitted pathways.

Updated 20 August 2021