Archived: Royal Liverpool and Broadgreen University Hospitals NHS Trust

Updated 17 July 2019

The Royal Liverpool and Broadgreen University Hospital is a large teaching hospital based in Liverpool and has two hospital sites. It is based close to the city centre, providing care and treatment to patients from across the North West of England, North Wales and the Isle of Man.

The trust, which was established in 1995, and provides services to the adult population with a busy emergency department. They also provide care for patients with more routine illnesses and injuries. They provide a comprehensive range of specialist services to 750,000 people each year within a total catchment population of more than two million people in Merseyside, Cheshire, North Wales, the Isle of Man and beyond.

The trust is a major centre for the diagnosis, treatment, care and research of cancer. They are a regional cancer centre for pancreatic, urological, ocular, testicular, anal, and oesophago-gastric cancers, specialist palliative care, specialist radiology and specialist pathology and chemotherapy cancer treatment services. They are also a national centre for ocular oncology (eye cancer).

As one of the largest employers in the city. They employ around 7,600 people and provide services through outsourcing arrangements.

Updated 17 July 2019

Our rating of the trust went down. We rated it as requires improvement because:

We rated the trust as requires improvement for responsive and well led. We rated caring as outstanding and safe and effective as good. We rated five of the trust’s services at this inspection. In rating the trust, we took into account the current ratings of the services not inspected this time.

We rated well-led at the trust level as requires improvement.

We rated community services as good for safe, effective, responsive and well led. We rated caring as outstanding.

Our decisions on overall ratings take into account, for example, the relative size of services and

we use our professional judgement to reach a fair and balanced rating.

• Services had not always completed and updated risk assessments for patients. We found that risk assessments such as those for falls or pressure ulcers had not always been completed where required.
• The trust had not ensured that there had been sufficient numbers of suitably qualified staff available in endoscopy to recover patients. Nursing staffing numbers were not always sufficient for the number of patients being cared for in urgent and emergency services.
• The service had suitable premises and equipment but had not always looked after them well. This was because we found substances that were hazardous to health that had sometimes been left in unlocked areas, meaning that patients or members of the public could access them. In addition, oxygen cylinders had not always been stored safely, in line with best practice guidance and trust policy.
• The trust had not always collected, analysed, managed and used information well to support all its activities. This was because information that was provided to CQC before, during and after the inspection had not always been accurate.
• Staff did not always understand how and when to formally assess and record whether a patient had capacity to decide about their care. We found that capacity had not always been documented when it should have been.
• The waiting list for the dental paediatric department was excessive. The referral to treatment (percentage within 18 weeks) compliance for October 2018 was 41.9%. This had worsened since October 2017 when the compliance was 54.7%.
• Medication and controlled drugs were not always securely stored or prepared in line with trust policy, national guidance and legislation. Antibiotic medication were not always reviewed in line with trust policy and best practice guidelines.
• Waiting times in the emergency department had all risen and were greater (longer or more) than the national average. Patients waited for extended periods of time on the corridor to be seen, in some cases more than ten hours. Although complaints had been managed appropriately and with compassion, response times needed improving
• There was evidence that incidents were not always being reported and investigated in a timely way in line with trust policy and national guidance.

However:

• The trust managed infection prevention and control well, the results of infection prevention and control audits were scrutinised and improvements to practice actively sought.
• The service had effective arrangements in place to recognise and respond appropriately to patients
• Staff understood how to protect patients from abuse and the service worked with other agencies to do so. Staff received training in safeguarding.
• Managers across services promoted a positive culture that and valued staff, creating a sense of common purpose based on shared values.
• Staff cared for patients with compassion and patient’s dignity was maintained on all occasions that we observed care being delivered.
• There was consistent and effective multidisciplinary working across the service. Staff worked alongside; medical staff, external partner agencies, mental health professionals, commissioners and social workers to plan care for patients and provide a joint approach to patient care.
• The trust had developed appropriate strategies which directly linked to the vision and values of the trust.

Our full Inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website –

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Updated 17 July 2019

Updated 17 July 2019

Updated 17 July 2019

This service had not previously been inspected. We rated it as good because:

• There were appropriate systems in place to keep people safe. Relevant risk assessments were completed for each patient who accessed community services. Thorough records were kept detailing the care and treatment provided to each patient and these records were accessible when needed.

• Staff took a holistic approach to planning patient care. Where appropriate, staff took the opportunity to promote positive lifestyle changes such as to improve diet and exercise. As well as this, staff considered the emotional needs of patients and those close to them.

• We observed staff treating patients and their relatives with respect and compassion. Feedback from patients was consistently positive and those we spoke to told us of how accessing the services had directly improved their quality of life.

• Staff across the service had worked to build and maintain close links with local charities, support groups and patient groups so that they could provide more holistic care to patients and their relatives.

• There was consistent and effective multidisciplinary working across the service. Staff worked alongside; medical staff, external partner agencies, mental health professionals, commissioners and social workers to plan care for patients and provide a joint approach to patient care.

• There was effective leadership across the service. Senior leaders acted as a driver for continuous learning and improvement.

• Staff working within the service worked alongside external stakeholders such as charities and patient groups to deliver services which met the needs of patients.

  However;

• Staff working remotely told us that they were unable to access the same information within the electronic records system used by acute services within the Trust and external providers. When we raised this with senior managers they informed us that staff did have access to these systems.

• Service leads were working to improve data collection so that they could better evidence the effectiveness of the service in terms of patient outcomes.