The Care Quality Commission (CQC) has rated Liverpool University Hospitals NHS Foundation Trust as requires improvement overall following an inspection at Aintree University Hospital and Royal Liverpool University Hospital in June and July.
CQC carried out an unannounced inspection of the trust’s urgent and emergency care, surgery and medical care services due to continuing concerns about the quality and safety of some services. Inspectors also looked at how well-led the trust was.
Following this inspection, the overall rating for the trust is requires improvement. It is also rated requires improvement for being safe, effective and responsive, inadequate for how well-led it is, and good for being caring.
The trust was created on 1 October 2019 following a process of acquisition, in which Aintree University Hospital NHS Foundation Trust acquired Royal Liverpool and Broadgreen University Hospitals NHS Trust. When this happens, in order to improve the quality and safety of care, ratings at trust level are not combined for up to two years. Therefore, the overall ratings following this inspection are based only on the ratings for Aintree University Hospital and how well-led the trust is overall. Previous ratings for other services cannot be directly compared with those now in place.
Due to the significant concerns identified during this inspection, CQC wrote to the trust to impose conditions on their registration under Section 31 of the Health and Social Care Act 2008. These conditions require the trust to take urgent action to ensure people are not exposed to further risk of harm. Full details of the conditions imposed can be found in the report.
Ted Baker, chief inspector of hospitals, said, “When we inspected services at Liverpool University Hospitals NHS Foundation Trust, we were concerned that the trust’s leadership team had a lack of oversight of what was happening on the frontline.
“There were significant issues with patient access and flow through the emergency department and this was affecting the ability for staff to deliver safe care and treatment. We observed lengthy delays and poor monitoring putting patients at serious risk of harm. We were particularly concerned about how long people were waiting to be admitted onto medical wards and by the absence of effective processes to prioritise patients for treatment based on their conditions.
“There weren’t always the right number of staff with the right skills and training, to treat people effectively or keep them safe in the trust’s emergency departments and on medical wards.
“Staff on the frontline were working hard to provide services in the face of significant pressure. We saw that staff treated patients with compassion and kindness and took into consideration their individual needs, helping them understand their conditions and providing emotional support to families and carers. Additionally, although we saw some collaborative teamworking, there was variation in positive culture and staff experience, at all levels of the organisation with a lack of cultural integration between the two hospital sites.
“Since the inspection, the trust has responded proactively. Changes have been made within the trust’s senior leadership team and we have seen evidence of improvement with plans in place for further action. Going forward the trust must assure us they have robust oversight and effective processes in place to support staff to deliver the consistently high-quality care they want to give and mitigate any risks to keep people safe.
“We will continue to monitor the trust closely and will return to check on their progress.”
CQC inspectors found:
- Patients in emergency departments did not always receive appropriate care and treatment in a timely way, exposing them to the risk of harm
- Staff did not always assess and monitor patients regularly to see if they were in pain or give pain relief in a timely way
- The trust did not always manage the access and flow of patients in the urgent and emergency departments and in medical care services, with patients spending long periods waiting for an in-patient bed
- There was a lack of robust systems in place to manage and mitigate risks in relation to infection prevention and control measures within the emergency department at the Royal Liverpool University Hospital
- Surgical services performed worse than the national average for the percentage of cancer patients treated within 62 days. The average length of patient stay was worse than the national average
- Wards were not always designed to meet the needs of patients living with dementia
- Staff were supported by local leadership, but some did not always feel respected, supported and valued. Senior managers were not always visible in services
- Trust governance processes were not robust or always effective. Risks were not always identified correctly with appropriate mitigations put in place
- Staff did not always recognise and report incidents and near misses in some services. Also, staff did not always share lessons learnt from these, to help prevent any future incidents from happening.
- In surgery there was enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them and kept good care records
- 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
- The trust planned care to meet the needs of local people and made it easy for people to give feedback.