Press Release from University Hospitals of Leicester (UHL) – CQC Report into visit in June 2016

Following its inspection of the University Hospitals of Leicester NHS Trust in June 2016, the Care Quality Commission (CQC) has today (Thursday 26 January 2017) published its findings.

John Adler, Leicester’s Hospitals Chief Executive said: “When the CQC arrived in June (20th) to inspect our organisation we told them that our biggest strength was our staff; their strong motivation, commitment and ambition to improve our services for our patients and for each other.” “The CQC saw this for themselves and it was echoed in their feedback. They told us that they found our staff to be “universally welcoming, open and transparent” and they were clearly very impressed by the compassion, professionalism and loyalty of everyone they encountered. This is reflected in the fact that “Caring” has been rated “Good” across all three hospital sites.

“We were also honest with the CQC about the challenges that we face. We told them that we are steadily improving quality whilst dealing with large increases in demand. That we were working better with our partners to tackle longstanding strategic issues such as emergency care, and that along the way we were building a more empowered culture. All these things are reflected in the CQC report.” The report said “Although the overall rating we gave the trust in this inspection was the same as they were awarded in their 2014 inspection, we did find improvements had been made. These were particularly evident in staff engagement and confidence in the leadership team.”

Since our first inspection in 2014, when we were one of the first Trusts to be inspected using this methodology, the bar has been significantly raised with the current inspections taking a more thorough and forensic look at services. The CQC team inspected eight core services across our three hospitals.

The CQC rated the Trust overall, as ‘Requires Improvement’; Rating the Royal Infirmary, the General and the Glenfield Hospitals all individually as ‘Requires Improvement’. Of the 100 ratings in total (for each domain of each main service grouping), 1 is Outstanding (for the effectiveness of our East Midlands Congenital Heart service at Glenfield), 55 are Good, 41 are Requires Improvement and 1 is Inadequate (the Responsive domain of emergency care at the Royal). Two elements were unrated for technical reasons. We were particularly pleased that the CQC judged our East Midlands Congenital Heart Centre (which is under threat of decommissioning by NHS England) to be “Good” overall, with 4 domains “Good” and 1 “Outstanding”. Julie Smith, Chief Nurse at Leicester’s Hospitals said: “Throughout the reports were examples of good practice that the CQC had witnessed during their time with us. We are of course proud of these and for the staff for openly sharing them with the inspectors.” “Of course there are areas where we need to improve, which we will be picking up through our action plan which we need to submit by 16 February 2017.”

Andrew Furlong, Medical Director at Leicester’s Hospitals added: “When the inspectors were with us we already had in place an enforcement action given to us in November 2015 following an unannounced CQC visit to our adult Emergency Department. On 15 November 2016 that enforcement action was lifted after inspectors were assured that we had made improvements to ensure that staff in the department had the appropriate mix of skills to treat the patients arriving, that patients received an appropriate clinical assessment by a qualified member of staff within 15 minutes of arriving, and that patients received the right care and treatment in line with our sepsis clinical pathway.”

Finally, Chief Executive John Adler added: “The reports highlight some areas where we need to improve further. Our Outpatient clinics were highlighted and last summer as part of our Quality Commitment we began a piece of work to improve our processes in outpatients and the experience of patients being seen in those clinics. We still have more to do, but are already seeing improvements.”

“Overall, we think that the CQC’s assessment is accurate, balanced and fair. We are now in the process of developing an action plan which maps out the improvements we’ll continue to make based on the CQC’s findings and we will post information about these on our website over the coming months.” 

Some examples of outstanding practice highlighted in the CQC report:
Staff in the paediatric emergency department told us about the development of ‘greatix’, this was to enable staff to celebrate good things in the department.Staff likened it to ‘datix’, which enabled staff to raise concerns. Staff used greatix to ensure relevant people received positive feedback relating to something they had done. Many staff throughout the emergency department told us of times when they had received feedback though greatix and told us how this made them feel proud and valued

 A range of medicines to manage Parkinson’s disease was available on the Clinical Decisions Unit (CDU) at the Glenfield Hospital. These medicines are time sensitive and delays in administering them may cause significant patient discomfort. These medicines were available to be ‘borrowed’ by other wards within the hospital and the nurses we spoke with were aware of this facility. The formulations of these medicines may sometimes cause confusion and pharmacy had produced a flowchart to ensure staff selected the correct formulation.

During our visit to Ward 23 at the Royal, a patient was refusing to eat. The meaningful activities facilitator sat and had their dinner with the patient. They told us by making it a social event they hoped the patient would eat.

Within oncology and chemotherapy, a 24-hour telephone service was available for direct patient advice and admission in addition to a follow up telephone service to patients following their chemotherapy at 48 hours, one week and two weeks post treatment.

The trust had introduced a non-religious carer to provide pastoral support in times of crisis to those patients who do not hold a particular religious affiliation .Also to provide non-religious pastoral and spiritual care to family and staff.

Midwifery staff used an innovative paper based maternity inpatient risk assessment booklet which included an early warning assessment tool known as the modified early obstetric warning score (MEOWS) to assess the health and wellbeing of all inpatients. This assessment tool enabled staff to identify and respond with additional medical support if required. The maternity inpatient risk assessment booklet also included a situation, background, assessment, recommendation (SBAR) tool, a sepsis screening tool, a venous thromboembolism (VTE) assessment tool which also had a body mass index chart, a peripheral intravenous cannula care bundle, a urinary catheter care pathway and
assessment tools for nutrition, manual handling and a pressure ulcer risk score. This meant that all assessment records were bound together.

 A new computerised individualised dosing system was in operation on the renal wards.

The trust recognised that families, friends and neighbours had an important role in meeting the care needs of many patients, both before admission to hospital and following discharge. This also included children and young people with caring responsibilities. As a result, the ‘UHL Carers Charter’ was developed in 2015.
On ward 1 at the General, a flexible appointment service was offered for patients. In order to help patients who had other personal commitments, for example work commitments, staff would work flexibly sometimes starting an hour earlier in the day to enable the patient to receive their care at a time and place to meet their needs.

The development of a pancreatic cancer application to support patients at home with diagnosis and treatment. This will potentially assist patients and family members face the diagnosis and treatment once they have left the hospital.

A ‘Pain aid tool’ was available for patients who could not verbalise and/or may have a cognitive disorder. This pain tool took into account breathing, vocalisation, facial expressions, and body language and physical changes to help determine level of patient comfort.
1. The eight core services are:

  • Urgent and Emergency Services/Medical care
  • Surgery
  • Intensive/Critical Care
  • Maternity and Gynaecology
  • Children & Young People
  • End of Life Care
  • Outpatients and Diagnostic Imaging

The 5 domains that are rated are:-

  • Caring
  • Responsive
  • Safe
  • Effective
  • Well-led

2. When was the inspection? The announced part of the inspection took place between the 20 and 23 June 2016, but they inspected critical care between 25 and 27 July 2016. The CQC also carried out unannounced inspections on 27 June, 1 and 7 July 2016.

You can see the full report by clicking on the following link:

CQC Report – Leicester Royal Infirmary – Published 26 January 2017