Blackpool Victoria Hospital on verge of being rated good - but series of failings are seen in A&E

Fourteen out of 16 services provided by Blackpool Teaching Hospitals NHS Foundation Trust are now rated as ‘good’, as well as three of five core areas looked at by Care Quality Commission (CQC) inspectors, while one service – adult community health – was ‘outstanding’.


It means that, if the outpatient and diagnostic imaging service, found lacking in 2014, is found to have improved when inspected separately next year, the trust is likely to see its overall rating bumped up from ‘requires improvement’ to ‘good’.


But bosses have been told they must take urgent action after a number of failings were identified in the emergency department, which earlier this year was named the worst in the country for hitting its four-hour waiting time target and fell below standards.


Patients were consistently left waiting too long to be seen, often in corridors, with not enough suitably trained medics to keep them safe and treat them properly, the health watchdog said.


Equipment wasn’t being looked after or stored properly, medication wasn’t checked properly, and there was no suitable place for seriously ill mental health patients because the department was being overhauled at the time of the inspectors’ visit.


Some of the staff working there didn’t have the right training, with just 56 per cent compliant in advanced life support training after many of their year-long qualifications lapsed, while outcomes for patients ‘continued to be poor’ and ‘worse than the national average in most areas’.


Earlier this year, The Gazette reported how the Vic managed to see just 40.1 per cent of patients turning up at A&E within four hours in December, compared to the national average of 77.3 per cent.


No other trust was below 57 per cent.


More than one in seven of all patients forced to wait more than 12 hours in A&E across England last month were in Blackpool, with only Bristol leaving more people waiting for half a day than the resort’s 75.


Speaking ahead of the report being published today, chief executive Wendy Swift (above) said: “We are really pleased that 15 out of 16 of our core services have got good or outstanding.


“We are delighted for the outstanding result, and the fact all our services got good for [the inspected category of] caring.


“That’s really good and a real tribute to every single member of our staff.


“We’re disappointed that has translated into a ‘requires improvement’ for the trust, but we are on a journey and we will address that and make a difference to that.”


But she continued: “The areas where we do have to improve, which we are aware of, are urgent and emergency care.


“That is a real demand issue. We have got some very poorly people and we have had more people come through our A&E department than we have ever known.


“We have a department that can cope with 50 to 55 people and most of the time we have 90, 100 people in there, so the demand is excessive and that has reflected in the results.


“We have got staff shortages but we are under-staffed for the numbers we have got coming through. When you have 90 or 100 people waiting to be triaged and you don’t have the capacity, you have to have the extra staff to look after those people, which is what we’ve done.”Blackpool Teaching Hospitals NHS Foundation Trust, which also runs Clifton Hospital in St Annes and Fleetwood Hospital, now has ‘good’ ratings in the key areas of effectiveness and leadership after improving over the past four years, while the area of care was again judged to be good.


The trust still needs to improve in the areas of safety and responsiveness, and has now been given a checklist of things to remedy, including four legal breaches relating to staffing levels and safeguarding training.


Director of nursing and quality, Marie Thompson, said: “As we would expect, the CQC identified areas for improvement and we are determined to do all we can to make the necessary improvements to develop and further improve the quality of care we give to our patients.


“We recognise the main focus for improvement is the … urgent and emergency services. These services, nationally and locally, have been under great pressure and we have just faced the most challenging winter period ever seen on the Fylde coast.


“Through all this, our staff have again been working incredibly hard to deliver effective, caring services in the best way possible.


“We are reviewing our processes to help them and to further improve services inside and outside the hospital setting.”


Medical director, Prof Mark O’Donnell, said he believed the trust has ‘massive strengths’ which have led to ‘real progress’ since 2014, when the CQC also rated it ‘requires improvement’.


“But we are committed to making further improvements and addressing the issues identified by the CQC report to further enhance our patient care,” he added.


See Friday's Gazette for a full in-depth interview with Wendy Swift, Marie Thompson, and Prof Mark O’Donnell, as well as reaction from several health commentators.

The Inspection

Nicholas Smith, the CQC’s head of hospital inspection, led a team of one inspection manager, 12 inspectors, 19 specialist advisers, and an industry expert.


They looked at all areas of the trust from November 15 to December 14 last year, with their report published today.


That asked five key questions: Are services safe, effective, caring, responsive, and well-led?


“Our decisions on overall ratings taking into account factors including the relative size of services, and we use our professional


judgment to reach a fair and balanced rating,” the CQC’s report said.


It brought attention to challenges with patient flow, emergency department performance, safeguarding training, staffing levels, and mortality figures, which remained higher than expected that inspectors saw ‘evidence that the strategy to reduce the mortality rates was having a positive effect.’


The CQC said the trust was in breach of four legal requirements, relating to ‘safe care and treatment’, ‘safeguarding’, ‘good governance’, and ‘staffing’, and told bosses to take action to resolve them.

The Departments

URGENT AND EMERGENCY SERVICES


Overall, it ‘requires improvement’, the same as it did four years ago.


But it saw its rating for the key area of ‘safe’ fall from ‘good’ to the worst possible score - ‘inadequate’.


The department had ‘consistently failed’ to meet a triage target of 15 minutes, during which time patients are given an initial assessment, the report said, while patients were seen in ‘inappropriate’ areas like the corridor on a ‘number of occasions’.


The department was understaffed, and staff did not always have the right training, skills, or experience.


Equipment wasn’t well looked after or stored properly, and medicines were not always well managed.


However, infection risk was controlled well, and appropriate records were kept.


Managers had worked to reduce the risk to patients during busy periods, and patients were given enough food and water.


Patient outcomes were ‘poor’, but they were treated with ‘compassion by staff’, involved in decisions about their care, and given emotional support. Their ‘privacy and dignity’ was not always maintained, however.


“People could not always access the service when they needed it,” the report said. “The department had consistently failed to meet the four-hour standard for admission, transfer, or discharge.


“The service had a vision for what it wanted to achieve but did not always have workable plans to turn it into action.”

MEDICAL & OLDER PEOPLE


Overall, it’s now ‘good’, up from ‘requires improvement’ in 2014. It was good for effective, caring, responsive, and well-led, and ‘requires improvement’ for safe.


Staff were found to be competent, controlling infection risk well and keeping good records of patients’ care and treatment.


Incidents were recognised and reported appropriately, and patients were given enough food and drink to meet their needs and improve their health.


Medics worked together as a team to benefit patients, and staff cared for patients with compassion.


Outcomes for patients were ‘variable’ and privacy and dignity was not always maintained.

SURGERY


Overall, it’s ‘good’, up from ‘requires improvement’, and was rated good in all five key areas.


Timely and appropriate pre-op assessments were carried out by a specialist, staffing was sufficient, and records and notes completed appropriately.


Patients had their dignity and privacy needs met, and measures were in place to improve care, safety, and outcomes.


Managers were well respected and supportive of their staff, who were ‘on the whole positive and proud of their work and happy in their roles’.


However, performance in some areas were below the national average, and ‘the number of cancelled operations continued to be a concern’.

COMMUNITY DENTAL


Overall, it’s good’. It had not been inspected before. It was good in all areas except safe, which was ‘requires improvement’.


Premises and equipment was clean and well looked after, and the service was well staffed by people with the right skills, qualifications, training, and experience.

COMMUNITY HEALTH SERVICES FOR CHILDREN AND YOUNG PEOPLE


‘Good’ overall, having never been inspected before. It was good in all five areas.


Staff knew how to protect patients from abuse, and worked together to benefit them.


There were ‘effective systems in place’ to support the transition from children’s to adult services, with patients treated with compassion.


COMMUNITY HEALTH SERVICES FOR ADULTS


Rated ‘outstanding’, the best possible score. It had not been inspected before.


It was ‘good’ for safe, effective, and well-led, and outstanding for caring, and responsive.


Inspectors saw ‘outstanding’ practice across 162 community sites, with the service treating people across Blackpool, Fylde, Wyre, and Morecambe Bay.

SEXUAL HEALTH SERVICES


‘Good’ overall and in all five areas, and had not been inspected before.


The service’s mandatory training target had not been met, though there were ‘strong levels of compliance’.

SPECIALIST COMMUNITY MENTAL HEALTH SERVICES FOR CHILDREN AND YOUNG PEOPLE


Rated as ‘good’ overall and in all areas except one, safe, which was ‘requires improvement’.


Patients were seen in a safe environment with well-maintained buildings and meeting rooms.


Staff understood the safeguarding arrangements, had manageable case loads, and kept their training up-to-date.

WHAT ARE PEOPLE SAYING?

Paul Maynard, Conservative MP for Blackpool North and Cleveleys:


“I am pleased to hear the CQC has seen improvements across the trust, but like many I am not surprised and disappointed that those improvements have yet to include Urgent Care and A&E.


“Despite the best efforts of dedicated staff, there are urgent questions I believe the NHS trust leadership need to answer.


“Much excellent work has gone into reducing demand for A&E compared to previous years, so I am keen to understand why waiting times have worsened.


“I wrote to the chief executive Wendy Swift in mid-January and have been surprised and disappointed not to receive a reply yet.


“I hope in the light of the CQC report that such a reply will be forthcoming.”


Gordon Marsden, Labour MP for Blackpool South:


“We all know that multiple factors have caused such stress at the trust over the winter period, and they are related significantly to funding problems in social care and other factors that make Blackpool particularly vulnerable, in terms of transients and other long-term conditions.


“The report recognises the excellent work that is being done by rank and file NHS people day after day, who are working very hard under these constraints.”