Medical care at Royal Lancaster Infirmary rated inadequate by health watchdog

The Care Quality Commission (CQC) said the unannounced inspection in August was prompted by concerns over risks to patients.

The service is also rated as 'inadequate' for being responsive to people’s needs and for how well-led the service is.

It is rated as 'requires improvement' for being safe, effective and caring. At the previous inspection in December 2018, the service was rated as 'good'.

As part of the latest inspection, CQC inspectors visited the medical care services, speaking with 10 patients. They observed care and treatment and looked at 19 care records and 15 prescription drug charts.

They also spoke with staff members across the department including staff nurses, senior nurses, a pharmacy technician, junior doctors, consultants, care support workers, matrons, clinical service managers and the associate director of nursing, the associate director of operations, and the clinical director.

Following this inspection, the CQC sent the trust a letter of intent in respect to the regulated activity, treatment of disease, disorder and injury and diagnostic screen procedures.

They said: "We took this action as we believed a person would or may be exposed to the risk of harm if we had not done so. The trust provided actions at the time of inspection that assured us people were kept safe."

Karen Knapton, CQC’s head of hospital inspections, said in the report published on Wednesday: “When we looked at medical care services at the Royal Lancaster Infirmary, we saw poor leadership that was impacting on patient care and the experience of staff working there.

“We found there wasn’t always enough nursing and medical staff to keep people safe.

“We saw that staff didn’t always treat patients with compassion or respect their privacy and dignity. We observed varying quality of interactions with patients. In some areas, patients were not always supported to maintain their independence with aspects of daily living, such as getting dressed.

“There was a poor culture on some wards. Staff told us that although ward managers and matrons were visible and supportive, senior managers weren’t. Staff didn’t feel the managers were always approachable, or that enough actions were being taken to mitigate risks to patients.

“During this inspection, inspectors saw an environment that wasn’t suitable for people’s needs. There was damaged flooring, crumbling walls and broken furnishings. There was a lack of dedicated facilities to support older people’s recovery and rehabilitation from illness or injury.

“Since our inspection, action has been taken to move patients into more suitable environments, with plans in place for further service improvements. We were also pleased to see that progress was being made in improving stroke services following our previous inspection.

“We have told the trust leadership team it must have improved and more robust oversight to keep people safe. We will continue to monitor the trust closely and return to check on their progress.”

The inspection does not change the overall rating for the RLI, nor the trust rating, which both remain as requiring improvement.

In August, we reported how University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) was placed into special measures after CQC officers visited the hospital and found a “significant downturn in the quality of services” at the trust and patients were not getting the care they deserved.

Jackie Bird, interim executive chief nurse at UHMBT, said: "We were aware of the issues within the wards inspected and had shared the improvements we were implementing and working on with the CQC during their inspection.

"We are grateful they have recognised the work being done and which has been undertaken since they inspected and have been continuing our work with the improvement team at NHS England/ Improvement to improve the wards.

"We have already taken a number of actions, including moving one of the wards to new purpose-built facilities, enhancing the level of care offered to the patients. We are also pleased that the levels of care in those areas have already improved.

"There has been some really great work to improve the safety of patients, the care offered and the culture within the wards the CQC visited.

"We also want to pay tribute to our colleagues working in the areas inspected who have worked tirelessly throughout the pandemic and now are continuing to improve the care offered."

Improvement work undertaken so far includes:

* Additional building work on the existing wards in Medical Unit 2 is taking place to enhance the accommodation.

* Improving the care offered to patients by employing two new doctors, two new physiotherapists and a new advanced nurse practitioner

* Continuing to ensure every patient is reviewed three times per day with a view to discharging patients quickly

* Escalating patients ready to leave our care with senior teams to ensure their care is transferred as quickly as possible.