Updated 24 November 2023
Lancashire Teaching Hospitals NHS Foundation Trust is an acute trust providing services to the Preston and Chorley areas and a range of specialist services to people in Lancashire and South Cumbria. The trust delivers services from three core sites, Royal Preston Hospital, Chorley & South Ribble Hospital and the Specialist Mobility and Rehabilitation Centre. It is also a major trauma centre. The trust serves a population of 395,000 people and provides regional specialist care to 1.8 million people.
The trust is situated in an area where 20% of the population are 10% most deprived nationally, up to 25% of children and 20% of over 65s are living in poverty. There are high levels of long-term conditions including mental health, cardiovascular disease, asthma, and dementia. By 2035 the over 75s will double. 17% of people in Pennine Lancashire are from a black minority ethnic background.
The trust employs over 8,800 staff and has 900 beds across 2 sites. It has an income of 738 million.
We carried out this unannounced inspection as part of our continual checks on the safety and quality of healthcare services at the trust. We inspected urgent and emergency care at Royal Preston Hospital and Chorley and South Ribble Hospital, and medicine, and surgery at Royal Preston Hospital.
A focussed inspection of maternity services was also undertaken as part of the CQC national maternity inspection programme which looked at the safe and well led questions.
We also inspected the well-led key question for the trust overall.
Where we did not inspect services, using our rating principles the ratings for these services have been aggregated from the inspection in 2019.
No Use of Resources review was undertaken as part of the 2023 inspection.
Our rating of services stayed the same. We rated them as requires improvement because:
- We rated safe, effective, responsive and well led as requires improvement and caring as good.
- We rated surgery at Preston and urgent and emergency care and maternity at Chorley as good. We rated urgent and emergency care, medicine and maternity at Preston as requires improvement. In rating the trust, we took into account the current ratings of the 9 services not inspected this time.
Leaders showed adequate experience, knowledge, and skills to run the service. They mostly understood and managed the priorities and issues the service faced, however during some, interviews leaders could not clearly or consistently articulate certain business details.
Some staff felt leaders were less visible in services where there were greater pressures.
Leaders and teams used systems to manage performance. There was progress with performance but there was still much to do to address elective recovery and delivery of the financial plan.
The trust had processes to escalate relevant risks and identified actions to reduce their impact. However, during our inspection of urgent and emergency care we issued a letter of concern about the management of mental health patients. The trust responded quickly to the concerns raised and monitoring is continuing to ensure there is continued sustainability in mitigation of ongoing risks. Performance since the inspection has been submitted to the CQC fortnightly and shows assurance about the actions that were taken to address these issues.
Also, following our inspection of maternity and a review of trust data, we issued a letter of intent under section 31 of the Health and Social care Act 2008 to the trust who provided the required assurances. No regulatory action was required as a result.
The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
Most staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The trust supported staff to develop their skills and take on more senior roles. Mandatory training for medical staff needed improvement.
Leaders operated effective governance processes, throughout the service and with partner organisations. Staff were clear about their roles and accountabilities. External assurance continued to develop governance processes throughout the trust and with partner organisations.
Urgent and Emergency Care
This emergency department was classed as a type 1 service.
The department had 16 individual bed areas to care for patients. These were a combination of cubicles with doors and spaces with privacy curtains. These were designated as majors and included a resuscitation area. The service was co-located with an urgent care centre where services were delivered by an independent healthcare provider for adults and children 24 hours a day, seven days a week.
At the time of the last inspection, the emergency department treated both adults and children. However, the service is now available for patients over the age of 18 years between 8am and 8pm daily. This included minor injuries. Patients needed to attend the trusts emergency department in Preston when the Chorley department was closed. All children, requiring emergency care and treatment both for illnesses or accidents needed to attend the emergency department at Preston or other hospital that had an emergency department that accepted paediatrics.
We visited the service as part of our unannounced inspection on 26 June 2023. We inspected the urgent and emergency care services at the hospital as part of a trust inspection. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.
The inspection was carried out by two CQC hospital inspectors, a medicines inspector, and a specialist advisor. We observed care, spoke with eight patients and their relatives, reviewed care records for four patients. We spoke with 18 members of staff of different grades including nurses, doctors, allied health professionals, support staff and senior managers.
Our rating of this service stayed the same. We rated it as good because:
- The service had enough staff to care for patients and keep them safe. Most staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
- Staff provided good care and treatment, offered patients food and drink, and gave them pain relief in a timely manner. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week between 8am and 8pm.
- Staff treated patients with compassion and kindness, did not always respect 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.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it, between 8am and 8pm, and did not have to wait too long for treatment.
- Leaders ran services 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. Staff generally felt respected, supported, and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
However:
- We found that not all staff, particularly medical staff had completed all mandatory training requirements.
- We found that there were consumables, in the resuscitation area that were passed their expiry dates and the airway drawer in the emergency trollies were overcrowded. The transfer bag, for emergencies, was not included in daily checklists.
- We observed consultations with patients and their families that were overheard by other patients. Noticeboards, that were visible to public visitors included patient identifiable information.
- The cubicle identified as the room to support patients with a mental health concern included equipment that could be used to cause self-harm.
Maternity
We inspected the maternity service at Chorley Birth Centre, at Chorley and South Ribble District General Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.
Chorley and South Ribble District General Hospital is 1 of 2 sites for maternity services for the trust. Chorley Birth Centre is a stand-alone midwifery led unit adjacent to the hospital in Chorley, Lancashire. The birth centre has 3 ensuite birthing rooms with birthing pools and 2 clinic rooms. It is staffed by the continuity of carer team who provide a continuity of carer service to women and birthing people across Lancashire, as well as staffing the birth centre. Between June 2022 and May 2023 there were 186 births at Chorley Birth Centre, which is 4.5% of all births at the trust.
We will publish a report of our overall findings when we have completed the national inspection programme.
We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.
Following our inspection and a review of trust data, we issued a letter of intent under section 31 of the Health and Social care Act 2008 to the trust. The letter of intent requested further information around delays within reporting incidents and the grading of incidents. The trust responded quickly to the concerns raised and provided the required assurances.
We also inspected 1 other maternity service run by Lancashire Teaching Hospitals NHS Foundation Trust. Our report is here:
Royal Preston Hospital – https://www.cqc.org.uk/location/RXN02
Our rating of this service stayed the same. We rated it as good because:
- Staff received training in key skills, such as responding to obstetric emergencies.
- Staff understood how to protect women and birthing people from abuse and worked well together for the benefit of women and birthing people.
- The service controlled infection risk well.
- Staff assessed risks to women and birthing people, acted on them and managed safety well. They kept good care records. They managed medicines well.
- The service had enough suitable skilled, trained and competent midwifery staff to keep women, birthing people and babies safe from avoidable harm.
- Leaders ran services 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.
- Managers monitored the effectiveness of the service and made sure staff were competent. Staff felt respected, supported and valued. They were focused on the needs of women and birthing people receiving care. Staff were clear about their roles and accountabilities.
- The service engaged well with women and birthing people and the community to plan and manage services People could access the service when they needed it and did not have to wait too long for treatment. All staff were committed to improving services continually.
However:
- Not all staff had training in life support, compliance with life support training was below trust targets.
- Staff did not always ensure all equipment was available, in date and safe for use.
- The service did not consistently report incidents to the National Learning and Reporting System (NRLS) in a timely manner.