Staff at Southport & Ormskirk NHS Hospital Trust have been praised for “treating patients with compassion and kindness” after an unannounced visit by the Care Quality Commission (CQC).
CQC Inspectors carried out this unannounced focused inspection following information of concern received from the public.
They noticed “improvements across all assessed domains” in care provided at the Trust since their last inspection, in August 2019, when medical care was rated as Requires Improvement.
They also noted that: “Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.”
The snap inspection was made following concerns from members of the public.
They said: “We received information about patients absconding from wards and that patients and their families had not always been involved in decision making regarding the application of Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR).”
They inspected safety processes in the trust’s medical care services and also looked at the wider oversight and management of risk, governance and safety of patients across the service.
Responding to the Care Quality Commission’s report today, Trish Armstrong-Child, Chief Executive of Southport and Ormskirk Hospital NHS Trust, said: “I am really pleased inspectors found significant improvement since their last inspection across all the areas they reviewed.
“They also noted staff spoke positively about the culture in the hospital and the support and visibility of the leadership teams on the medical wards.
“These improvements are the result of hard work, compassion and commitment from our dedicated nurses, doctors, all other health professionals, and our non-clinical support teams.
“We are committed to providing the best care possible to all our patients and will continue to build on these improvements to make sure we consistently deliver safe, high quality care for local people.”
Inspectors said: “We previously inspected medicine at Southport and Ormskirk NHS Trust in August 2019 as part of our comprehensive methodology where we rated the medical care (including older people’s care) service as Requires Improvement in safe, effective, caring and responsive and inadequate in well led.
“During this inspection on the wards visited there was an improvement across all assessed domains. All the staff we spoke with were friendly and helpful.
“They spoke positively about the culture and the support and visibility of leadership on the medical wards.
“Following the inspection, we requested and reviewed information relating to the concerns raised and the evidence we had gathered following the observations we had made.
“The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
“Managers regularly reviewed and adjusted staffing levels and skill mix and gave bank and agency staff a full induction. This was an improvement against the requirement notice from the last inspection.
“Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. This was an improvement from the last inspection. • “Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
“The leadership of the clinical business unit had been reviewed and expanded. Although the leadership team were relatively new to their posts, they demonstrated clearly defined and visible leadership roles and lines of accountability. This was significantly better than at the last inspection.
“The service managed patient safety incidents well. Managers investigated incidents, shared lessons learned with the whole team and the wider service and ensured that actions were implemented and monitored.
“There were some incidents relating to poor discharges which the trust was taking action to improve.
“Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
“The service had an open culture where staff could raise concerns without fear.
“Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
“Whilst we did not inspect infection prevention and control processes as part of this inspection, we did not identify any concerns in relation to the environment and we saw that staff were following appropriate guidance in relation to social distancing and the use of personal protective equipment on the wards we visited.”
There were some areas where Inspectors wanted to see improvements made.
They said: “Staff supported and mostly involved patients, families and carers to understand their condition and make decisions about their care and treatment. However, there were a small number of instances where the family had not been involved in meaningful conversation around the making of important decisions about resuscitation. However, a recent audit demonstrated improvement in this area.
“Staff completed but did not always update risk assessments for each patient. However, falls risk assessments had improved since the last inspection and staff identified and acted upon patients at risk of deterioration.
“The service did not always have enough substantive medical staff. Although, managers regularly reviewed and adjusted staffing levels utilising locum and bank staff and new roles had been introduced to help keep patients safe.
“At the previous inspection we found consultants did not lead daily ward rounds on all wards and consultants were not available on wards at weekends. At this inspection we found that this had improved.
“Consultant ward rounds varied, being held two or three times a week. In addition, multi disciplinary board rounds were held daily on weekdays. This included medical, nursing, allied health professionals, social workers and a discharge coordinator daily on weekdays.
“Over the weekends there was a discharge ward round on the ward carried out by a consultant and a junior doctor. We were told there was access to additional consultant reviews as required. “Consultants were now present on site at weekends, with on-call consultants available during out of hours periods.”
West Lancashire MP Rosie Cooper is pleased to see that improvements have been made, but wants to see more done quicker.
She said: “I am pleased that the Care Quality Commission (CQC) and Southport and Ormskirk Hospitals NHS Trust (S&O) believe there have been improvements to the Trust’s services, but I am far from convinced. The unannounced inspection took place after I contacted the CQC to draw their attention to an incredibly serious incident that I had been made aware of by a whistleblower.
“This incident involved an elderly man being discharged from the Hospital by North West Ambulance Service (NWAS) with only a blanket wrapped around his bottom half. This incident occurred because both S&O and NWAS failed to follow their own processes. They should be deeply ashamed of this, and I had hoped that the CQC would bring this to light and properly hold them accountable.
”Instead, both CQC and S&O seem to be brushing it under the carpet, burying this incident with only the slightest of references to it in the report. How can the Trust be held accountable if the regulator won’t even acknowledge serious failings like this!?
“I am also far from assured that Do Not Resuscitate orders are properly consulted on with patients and families not just placed on a patient record without following the proper process. Family members have told me they knew nothing about the DNR that was placed on their loved ones’ record. Across the NHS as a whole, I believe the Police should be involved where the strict guidelines are breached. The public needs confidence in the medical staff treating them.
“Southport & Ormskirk may be improving but it needs to improve more quickly than it is.”
Southport and Ormskirk NHS Trust provides healthcare to approximately 224,402 people across Southport, Formby and West Lancashire.
Acute inpatient care is provided at Southport and Formby District General Hospital and Ormskirk District General Hospital.
The medical care service at Southport and Formby District General Hospital has 209 inpatient beds. The urgent care clinical business unit manages medical care services.
The medical care service operates from nine wards at Southport and Formby District General Hospital. This consists of a cardiology ward (7a), a short stay unit (9a), a respiratory ward (14b), a stroke ward (15b with two hyper acute stroke beds), an emergency assessment unit (10a) and three care of older people wards (9b, 15a and 7b).
The trust had 18,293 medical admissions from November 2019 to October 2020.
Emergency admissions accounted for 10,037 (54.9%), 168 (0.9%) were elective, and the remaining 8,088 (44.2%) were day cases