Following its inspection of the University Hospitals of Leicester NHS Trust in November and December 2017 and January 2018, the Care Quality Commission (CQC) has published its findings.

Between the 28 – 30 November and 4 – 7 December 2017, the CQC inspected a total of five core services across four locations.  They inspected urgent and emergency care at the Royal Infirmary, medical care at the Glenfield and Royal Infirmary, diagnostic imaging, maternity and outpatients at the Royal Infirmary and the General Hospital, and maternity services at St Marys Birthing Centre.

Through their inspections, the CQC have found a strong link between the quality of overall management of a Trust and the quality of its services.  For that reason, all Trust inspections now include inspection of the ‘well-led’ key question at the trust level and this was the area that the CQC inspected between 10 and 12 January 2018.

Inspectors have rated the Trust as Requires Improvement overall; rating Good for being effective and caring and Requires Improvement for being safe, responsive and well-led.

Chief Executive John Adler said: “I am really pleased to see that we have improved in a number of areas since our 2016 ratings.  Inspectors have improved our ratings for the ‘effectiveness’ of services overall  and our maternity service, both of which are now rated as good*.  None of our services are now rated as inadequate.  I am particularly pleased to see the very significant improvement in our urgent and emergency services despite continued pressure.”

“I would like to take the opportunity to thank all of our staff for their hard work and commitment to improving our services.”

Karamjit Singh CBE, Chairman at Leicester’s Hospitals said: “I am delighted to see that CQC inspectors found many examples of outstanding practice whilst they were with us.”

“They commended our dedicated sepsis team in our Emergency Department; the first of its kind in the UK.  There was praise for our Red 2 Green process (which reduces wasted time within a patient journey) and our Meaningful Activity Co-ordinators, both of which benefit our older patients.  They mentioned the electronic system used in outpatients that links to GPs to identify the correct pathway for patients or to recommend other care and treatment.”

“They also paid tribute to our maternity services, particularly our new dedicated Home Birth Team, prenatal and antenatal clinics, both locally and across borders, and the TED (Time, Escalation, Decision making) movie created to improve the outcomes for babies.”

“The CQC have highlighted the importance of diversity, something I and the Trust Board are passionate about improving and we know is important to our staff and local people.”

Chief Executive John Adler added: “It is regrettable that following their inspection the CQC served us with a warning notice because the care we give diabetic patients in relation to the management of their insulin requires significant improvement.”

“We recognise this too and since the inspection we have accelerated our programme of work to ensure immediate improvements and safety of our patients. The actions focus on face to face education and training for our doctors and nurses, improved decision tools to aid prompt management and intervention overseen by enhanced support from the diabetic specialist team. We are pleased that the early evidence supports these actions have delivered improvements in knowledge and care of patients with diabetes.”

Chief Nurse Julie Smith added “As with our previous inspection you can read examples throughout the report where inspectors observed good and outstanding practice and compassionate care being carried out by our staff.  They heard feedback from patients that staff treated them with kindness and provided emotional support to minimise their distress.”

“Overall, we think that the CQC’s assessment is accurate, balanced and fair and reflects an improving picture in the services that were reinspected.  We have already started to develop an action plan which maps out the improvements we will continue to make based on their findings.

 

Notes:

* the ‘effectiveness’ of services overall  and maternity services, rated good in 2018,  were both given a ‘requires improvement’ rating in 2016

 

Some examples of outstanding practice highlighted in the CQC report:

Urgent and Emergency Care Leicester Royal Infirmary:

  • The department had established one of the first dedicated Emergency Department Sepsis Team in the UK. The sepsis team were clearly visible throughout our inspection and were available 24-hours per day. Since the launch of this team, the number of patients recognised at possible risk of sepsis had doubled from 50 to 100 per week. Treatment of high risk patients with antibiotics within 1 hour of arrival had significantly improved as had the delivery of all “sepsis six” actions.
  • The purpose built department catered for the holistic need of the whole population. We saw how the department had been designed to take into account those with mental health needs and children. The department had been designed to ensure suitable long term sustainability.

Medical Care (including older persons care) at the Royal Infirmary and Glenfield:

  • Wards had all implemented the initiative ‘Red2Green’. This was an initiative launched by NHS Improvement which aimed to reduce the wasted time within a patient journey where no interventions occurred and they received little benefit from remaining in an acute hospital.
  • Meaningful activities coordinator’s supported multi-disciplinary working across 11 wards at Leicester Royal Infirmary including care of older people, speciality medicine and the Acute Frailty Unit. The team provided support for patients who were living with dementia or were distressed and agitated.
  • The meaningful activities co-ordinators continued to make a difference to patient’s hospital experience. The team provided support for patients who had dementia or were distressed and agitated through their individualised programme of activities. The team were highly regarded by patients and staff members.

Maternity services at the Royal Infirmary, General Hospital ad St Marys Birthing Centre:

  • A dedicated home birth team was created in September 2017, with the aim of increasing the home birth rate across the trust and was able to provide greater continuity of care within the woman’s own home.
  • Detailed records for use in pregnancy and a maternity inpatient risk assessment record was continually improved to ensure it was fit for purpose within maternity.
  • The wide variety of antenatal and prenatal clinics was continually assessed and new services provided for women, both locally and across borders.
  • St Mary’s Birth Centre provided extended postnatal care to all women, regardless of whether their babies had been born there. This was of particular benefit to women with complex needs, for example those with physical disabilities or mental health conditions.
  • Staff promoted the T.E.D movie for time, escalation and decision making to improve outcomes for babies.

Outpatients at the Royal Infirmary and General Hospital:

  • Outpatient services used an external company and an electronic system to develop improved referral pathways. The system linked into an electronic system used by GPs and helped them to identify the correct pathway for the patient or to recommend other care and treatment. The system also enabled patients to access urgent care and treatment quicker. Managers said this was the first system of its kind.
  • The diabetes clinic delivered an outstanding service to patients and the rest of the hospital. Staff wrapped care and multidisciplinary clinics around patients and we observed patients accessing a range of medical and lifestyle advice and support. Staff in the clinic accessed and delivered community based services and supported other areas of the hospital including inpatient wards and training staff. The environment was modern, clean and bright and the service demonstrated positive patient outcomes.

Diagnostic Imaging at the Royal Infirmary and General Hospital

  • The trust had a renowned CT forensic service, which provided virtual autopsies and were leading experts in the development of this service
  • Role extension of non-medical staff was a priority in the imaging department. We saw a number of practitioners with extended roles operating effectively in the departments.

 

 

 


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