Blackpool Teaching Hospitals NHS Foundation Trust

Updated 19 January 2022

Blackpool Teaching Hospitals NHS Foundation Trust is situated on the west coast of Lancashire and operates within a regional health economy catchment area that spans Lancashire and South Cumbria and supports a population of 1.6 million. The trust provides a range of acute services to the 330,000 population of the Fylde coast health economy and the estimated 11 million visitors to the seaside town of Blackpool. Since April 2012, the trust also provides a wide range of community health services to the 445,000 residents of Blackpool, Fylde, Wyre and North Lancashire. The Trust also hosts the National artificial eye service, which provides services across England.

The trust provides a full range of hospital services and community health services. These include adult and children’s services such as health visiting, community nursing, sexual health services and family planning and palliative care. The trust provides tertiary cardiac, haematology and adult cystic fibrosis services to 1.5 million population catchment area covering Lancashire and South Cumbria.

At our last inspection in October 2019, we rated safe, effective and responsive as requires improvement, caring as good and well-led for the trust overall as inadequate.

The trust had experienced significant challenges over the past 18 months due to the COVID-19 pandemic. There was significant redeployment of staff at the trust during that period to support staff in critical areas.

We carried out this unannounced inspection, from the 14 September to the 20 October 2021, of Blackpool Teaching Hospitals NHS Trust. We inspected core services at the Blackpool Victoria Hospital including urgent and emergency care, medical care, critical care and surgical care services because of continuing concerns about the quality and safety of these services. We also inspected the well-led key question for the trust overall. We rated urgent and emergency services as inadequate and surgery, medical care and critical care as requires improvement. We rated well-led for the trust overall as requires improvement.

Following this inspection, due to the concerns we had identified at Blackpool Victoria Hospital, we wrote to the trust asking for urgent action to be taken to ensure safe care and treatment.

Details for the summary for each core service inspected can be found later within the report, a summary of the trust wide well led is below.

We rated well led as requires improvement at Blackpool Victoria Hospital because:

• There were several new appointments to the board but the plans they had developed had not yet had time to evidence their impact or sustainability. Not all leaders had the capacity to lead effectively. Not all senior leaders were visible or approachable in the organisation. Leaders were not always fully sighted with what was happening on the front line. They did not always identify their priorities and did not always develop plans to manage these in an effective and timely way.
• The trust did not have a clear vision. Although the trust had not developed a new five year vision and strategy because of COVID-19, they had taken a pragmatic approach by putting the one-year overarching strategy in place within the organisation and had started to develop a five year one; however, there were several strategies that were out of date.
• Not all staff felt supported, respected and valued by their local leaders. There was a lack of supportive inclusion for staff with protected characteristics. The trust was working towards an open culture where patients, their families and staff could raise concerns without fear. However, not all staff felt secure to raise concerns. The trust had work to do in relation to promoting equality, diversity and inclusion in daily work.
• The arrangements for governance were not clear and did not always operate effectively. Not all staff in leadership roles were clear about their roles and accountabilities. Processes were not always effective and completed in a timely manner.
• Risks, issues and poor performance were not always dealt with appropriately or quickly enough. There were systems to manage performance; however, these were not used efficiently. The risk management approach was applied inconsistently and was not linked effectively into planning processes. Significant risks were not always identified or escalated appropriately and there were insufficient processes to identify actions to reduce their impact.
• The information that was used to monitor performance or to make decisions was inaccurate, and unreliable or not relevant. There was inadequate access to and challenge of performance by leaders and staff. The trust was delayed in implementing its digital strategy and had no implementation date at the time of our inspection.
• There was minimal engagement with people who used services, staff, and the public. There was a limited approach to sharing and obtaining the views of staff. There was insufficient attention to appropriately engage with people, including those with protected equality characteristics. Feedback was not always reported or acted upon in a timely way.

However:

• Senior leaders demonstrated the necessary knowledge, capability and integrity. They worked well as an executive team and with leadership teams across the trust.
• The trust did have three key ambitions for what it wanted to achieve within a one-year strategy. The strategy was focused on sustainability of services and aligned to local plans within the wider health economy.
• All staff we met were focused on the needs of patients receiving high quality and compassionate care.
• The trust had sourced an external organisation to review and report on governance processes throughout the trust.
• The trust was beginning to invest in continuous learning and improvement within the organisation, however there was still work to be done through the appropriate use of external accreditation and participation in research. There was knowledge of improvement methods and the skills to implement improvement was beginning to be shared among the organisation.

We rated one of the trust’s 14 services as inadequate overall and three as requires improvement. In rating the trust, we took into account the current ratings of the 10 services not inspected this time.

How we carried out the inspection

During our inspection we spoke with a variety of staff including consultants, doctors, therapists, nurses, healthcare support workers, pharmacists, patient experience, domestic staff and administrators and the trust’s board. During the inspection we also spoke with patients and relatives. We visited numerous clinical areas across the hospital site. We reviewed patient records, national data and other information provided by the trust.

We held several staff focus groups with representatives from all over the trust to enable staff who were not on duty during the inspection to speak to inspectors. The focus groups included junior and senior staff from pharmacy, junior and senior nursing staff, junior doctors and consultants, allied health professionals, staff representing equality diversity and inclusion, a separate focus group for staff from a black, Asian and minority ethnic backgrounds. We also had focus groups for the non-executive directors and governors.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/ how-we-do-our-job/what-we-do-inspection.

Updated 17 October 2019

Updated 17 October 2019

Updated 17 October 2019

Community adult services was last inspected in November 2017 and was rated overall as outstanding.

Our rating of this service stayed the same. We rated it as outstanding because:

• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan and deliver care in a way to ensure flexibility, choice and continuity of care.
• There were innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs.
• People could access community health services for adults when they needed them, and technology was used innovatively to ensure people have timely access to treatment, support and care.
• People were respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by dedicated staff.
• Staff were motivated and passionate in providing care that is kind and promotes dignity.
• Patients felt cared for and valued their relationship with staff and their personal preferences and needs were always reflected in the care they received.
• Staff found innovative ways to enable people to manage their own health and care when they could and to maintain independence as much as possible.
• Staff of different kinds were committed to work collaboratively within their service but also with external organisations to benefit patients and provide good and effective care.
• Staff consistently supported people to live healthier lives, including identifying those who need extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they used every contact with people to do so.
• The leadership, governance and culture promoted the delivery of high-quality person-centred care.
• Leaders had the skills and abilities to run the service and were visible, approachable and supportive for patients and staff.

However:

• Not all staff had received all relevant training in safeguarding children.
• There were limited opportunities for staff to engage and share good practice or better ways of working across different localities.

Updated 17 October 2019

Our rating of this service stayed the same. We rated it as good because:

• The service provided mandatory training in key skills to all staff and most staff received and kept up to date with their mandatory training.
• Staff understood how to protect children, young people and families from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The design, maintenance and use of facilities, premises and equipment in the service kept people safe. Staff managed clinical waste well. A large number of the directorates services were delivered in modern high specification primary care centres and children’s centres across the localities of the teams services.
• Staff in the service completed and updated risk assessments for each child and young person and acted to remove or minimise risks. Staff identified and quickly acted upon children and young people at risk of deterioration.
• Data provided by the trust showed that the service had less staff than it had planned for. In our interaction with staff we found that the service had enough 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 staff a full induction.
• Staff in the service understood the relevant consent and decision-making requirements of legislation and how this related to young people such as guidance for Mental Capacity Act 2005, Children’s Acts 1989 and 2004, Gillick competence 1985.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. The directorate reported no incidents classified as never events and no serious incidents in the period from May 2018 to June 2019.
• The service provided care and treatment based on national guidance and evidence-based practice.
• Staff teams understood the needs of local people and had introduced systems so that staff deployment met the need of high and low population areas.
• The staff in the service were aware of the diversity of populations and the challenges faced by some of its communities. Staff had access to multi-lingual sources such as translation services to support patient care.
• The directorates leaders had the skills, knowledge and experience to guide and lead staff. management were respected, seen as supportive and effective in their roles.
• Leaders in the trust and in the directorate had a vison for children and families’ services which focused on promoting well-being and nurturing. The service planned to move to a more holistic model of care which was connective with other services to promote well-being

However;

• In a number of teams, patients had long waits to start treatment. Arrangements to admit and treat patients were sometimes not in in line with national standards. Young people and families found it difficult to receiver treatment when they needed it and therefore did not received the right care promptly.
• Whilst the service provided mandatory training in key skills to all staff and most staff received and kept up to date with their mandatory training. We found that the directorate still had some room for improvement to reach the trust completion target in some of its mandatory courses.
• It was clear that supervision process needed to be reviewed and adjusted so that a clear chain of evidence concerning discussions about safeguarding occurred. Serious safeguarding concerns were still escalated and shared with the trusts safeguarding team.
• Whilst records audits showed positive results we found some recording to be patchy in some services with elements of care planning missing.

Updated 17 October 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment in line with nationally recognised guidance. Managers monitored the effectiveness of the service and made sure staff were competent. 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.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Audits of the decontamination process were only carried out annually.
• Medical emergency medicines and equipment were not taken on domiciliary visits. This had not been formally risk assessed.
• Waiting times for a paediatric general anaesthetic in the south region were excessive.

Updated 17 October 2019

We rated it as good because:

• Since our last inspection the service continued to be provided by an integrated partnership between the trust and Trinity Hospice. There were enough staff to care for patients and keep them safe. Staff assessed risk to patients and acted on them. They managed medicines well.
• The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it.
• The service was planned, organised and delivered well. Care was delivered by competent practitioners who considered the needs of all patients and families in their care.
• Since our last inspection the end of life care service’s vision and strategy had been set out for 2017-2020. The service had an action plan to monitor and deliver the vision and strategy working with external partners and the involvement of staff.
• Staff provided a range of treatment and care for patients based on national guidance and best practice.

However:

• Training in end of life care was not mandatory for all staff.
• There was no non-executive director at board level for end of life care.

Updated 17 October 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. 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.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 17 October 2019

Our rating of this service went down. We rated it as requires improvement because:

• Staff did not always develop holistic, recovery-oriented care plans in collaboration with patients, families and carers. Staff did not engage in clinical audit to evaluate the quality of care they provided.
• Children who did not require urgent care waited too long to start treatment. The criteria for referral to the service excluded children and young people who would have benefitted from care.
• Governance systems and processes did not always ensure that the quality and safety of the services provided was accurately assessed, monitored or improved. The service did not provide us with valid data about waiting times. The trust did not accurately identify which staff were eligible for some mandatory training topics, meaning that compliance figures were incorrect. Information on risk was not always easy to find in patients’ care records and staff did not document whether they had offered patients a copy of their care plan.

However:

• The service provided safe care. Clinical premises where patients were seen were safe and clean. Patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff provided a range of treatments that were informed by best-practice guidance. The team included the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was easy to access for children who met the referral criteria.
• The service was well led and the governance processes ensured that most of the procedures relating to the work of the service ran smoothly.