6 to 8 June 2023 and 11 to 13 July 2023
During a routine inspection
We plan our next inspections based on everything we know about services, including whether they appear to be getting better or worse.
This report describes our judgement of the quality of care provided by this trust. We base it on a combination of what we found when we inspected and other information available to us. It includes information given to us from staff at the trust, people who use the service, the public and other organisations.
We rated well-led (leadership) from our inspection of trust management, taking into account what we found about leadership in individual services. We rated other key questions by combining the service ratings and using our professional judgement.
Overall summary
North Cumbria Integrated Care NHS Foundation Trust (NCIC) was created in October 2019 following an acquisition of North Cumbria University Hospitals NHS Trust (NCUH) by Cumbria Partnership Foundation Trust (CPFT). During the acquisition the mental health and learning disability services were transferred out to another NHS trust.
When a trust acquires another trust in order to improve the quality and safety of care, we do not aggregate ratings from the previously separate trust at trust level for up to two years.
Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, our usual inspection work has been curtailed by the COVID-19 pandemic and since that time we have maintained a risk based approach.
In our ratings tables we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect at this time. The ratings shown are an aggregation of ratings from the original trust and those acquired by the trust which have been inspected since the acquisition as well as new ratings from this inspection.
The trust provides a range of acute hospital services based at the Cumberland Infirmary in Carlisle (CIC) and the West Cumberland Hospital (WCH) in Whitehaven. It also provides a midwifery-led maternity service at Penrith Community Hospital and community services covering the Cumbria region (adult and children's community services in north Cumbria and some which are whole county based). The trust has 536 inpatient beds across the acute hospital sites and 133 beds across six community hospitals. The trust employs over 5,400 members of staff.
The trust serves a population of approximately 320,000 in the west, north and east of Cumbria, in the districts of Allerdale, Carlisle, Copeland, Eden Valley and South lakes and Furness for some community services. It also provides services to parts of Northumberland and Dumfries & Galloway. The community is spread over a large geographical area, with 51% of residents living in rural settings. Over 65s make up a larger proportion of the population than the national average. Deprivation is similar to the England average and about 11,700 children (14.5%) live in poverty.
We carried out this unannounced inspection of North Cumbria Integrated Care NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services.
We inspected Emergency and Urgent Care and Medical care. We also inspected the well-led key question for the trust overall. We did not inspect maternity services, surgery, critical care, services for young people and children, end of life care, out-patients, or diagnostics at this inspection.
At our last inspection in 2020 we rated the trust overall as requires improvement. At that inspection we issued the trust with a section 29A warning notice in regard to the standards of care provided. At this inspection the trust rating has stayed the same. We did see improvements made as a result of our warning notice.
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 4 of the trust’s 17 services as requires improvement. In rating the trust, we took into account the current ratings of the 13 services not inspected this time
- The service did not always have enough staff to care for patients and keep them safe. Not all staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service did not always control infection risk well. Staff did not always assess risks to patients, act on them and keep good care records. Pain relief was not always given timely when they needed it
- The service did not always manage the safe storage of medicines and hazardous cleaning materials
- The service did not always manage safety incidents well and although there was evidence of learning following safety incidents, there was further work required to manage environmental hazards and associated risks
- Leaders did not always run services using reliable information systems. The trust’s vision and values were developed but did not have clear underpinning strategies
However:
- 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
- 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
How we carried out the inspection
The team that carried out the inspection included two inspection managers, 10 inspectors, 5 specialist advisors, one assistant inspector and an inspection planner. In addition, there was an executive reviewer plus three specialist advisors experienced in executive leadership of NHS trusts. The inspection team was overseen by Sarah Dronsfield, Deputy Director of Operations.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.