Fleetwood Hospital

⚠ The trust did not always provide care and treatment based on national guidance and evidence-based practice. Several policies and guidelines in different services required updating. Several key clinical guidelines had not been reviewed including, ‘non-invasive ventilation’; chronic obstructive pulmonary disease’ and ‘stroke’ pathways. Other pathways were not in place.

⚠ Staff did not always feel respected, supported and valued. We were concerned about the culture within Blackpool Victoria Hospital. There was limited understanding of the importance of culture. In hospital based services there were low levels of staff satisfaction, high levels of stress and work overload. Staff did not feel …

⚠ When something went wrong, people were not always told and did not consistently receive an apology.

⚠ The service did not always consider patients’ individual needs, care was not tailored to individual patients. The service was not always inclusive and did not always take account of patients’ individual needs and preferences. Staff did not always make reasonable adjustments in the care and treatment of patients’ or help …

⚠ Staff did not always follow the principles of the mental capacity act and best interest decisions were not always undertaken or documented. Staff did not always support patients to make informed decisions about their care and treatment. They did not always follow national guidance to gain patients’ consent. They did …

⚠ The service did not always consider patients’ individual needs, care was not tailored to individual patients. The service was not always inclusive and did not always take account of patients’ individual needs and preferences. Staff did not always make reasonable adjustments in the care and treatment of patients’ or help …

⚠ Staff did not always assess the risks to patients appropriately nor act on them. Staff did not always complete and update risk assessments for each patient and they did not always remove or minimise risks.

⚠ Leaders did not always run services well using reliable information systems and managing risk competently. The service vision and strategies were not clear, and it was not apparent how these would be achieved. Leaders did not always operate effective governance processes throughout the service and with the wider hospital. Staff …

⚠ The service did not always have enough staff to care for patients and keep them safe. The service did not always have enough medical staff, 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 …

⚠ The service did not always have enough staff to care for patients and keep them safe. The service did not always have enough medical staff, 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 …

⚠ The service did not always take into account patients’ individual needs. Care was not consistently tailored to individual patients. We were concerned that people were unable to access the care they needed. The service did not always take account of patients’ individual needs and preferences. Staff did not always make …

⚠ Staff did not always follow the principles of the Mental Capacity Act. They were unclear on how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They did not follow best practice and trust policy around the mental capacity act and deprivation …

⚠ Staff did not effectively complete and update risk assessments for each patient and did not always remove or minimise risks. Staff did not always identify or quickly act when patients were at risk of deterioration.

⚠ The service did not manage safety or medicines well. Systems and processes used to prescribe, administer, record and store medicines were not always robust. The service was still not following the self-administration policy, an issue identified at our last inspection.

⚠ The service did not always report safety incidents and did not always learn lessons from them. Although there were governance processes in place, staff at all levels were not clear about their roles and accountabilities and did not have regular opportunities to meet, discuss and learn from the performance of …

⚠ Staff did not keep good care records. Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up-to-date or stored securely.

⚠ The service did not have enough staff to care for patients and keep them safe. The service did not have enough staff to keep patients safe from avoidable harm and to provide the right care and treatment.

⚠ Staff did not consistently keep good care records. Records were not consistently accurate, up-to-date, stored securely and easily available to all staff providing care.

⚠ Staff did not consistently assess risks to patients, act on them. Staff did not consistently act to remove and minimise risks or identify and quickly act upon patients at risk of deterioration.

⚠ Staff did not always give patients pain relief when they needed it. Staff did not always give pain relief in a timely way.

⚠ Leaders used systems to manage performance, but it was not always clear what action had been taken to mitigate risk. Some risks had remained on the register for some time with no resolution, and it was not always clear when action to mitigate risk had been taken or whether these …

⚠ Facilities and premises in critical care and the high dependency unit were not always appropriate for the services being delivered. The design of the environment and available facilities in the critical care unit and high dependency unit did not follow national guidance. The geographical separation of the units made the …

⚠ The service did not have enough allied health professional staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Medical staffing levels did not always allow for sustainable and effective working rota’s and practices which was …

⚠ Although staff knew about and understood the standards for mixed sex accommodation and knew when to report a potential breach, managers reported in critical care that not all breaches were reported because they occurred so frequently.

⚠ The service was failing to manage services to meet key performance measures. The services did not have systems and processes in place to effectively monitor and prioritise patients awaiting transcatheter aortic valve implantation (TAVI). During the inspection we identified risks which were not on the risk register; for example, with …

⚠ Patients were frequently and consistently not able to access services in a timely way for assessment or diagnosis, and experienced unacceptable waits for some treatments. Urgent (two-week) cancer referral performance had declined; particularly in relation to urgent assessment for suspected breast cancer, which had fallen to unacceptable levels.

⚠ Patients were frequently and consistently not able to access services in a timely way for assessment or diagnosis, and experienced unacceptable waits for some treatments. People experienced unacceptable waits for some treatments; for example, performance for patients receiving their first cancer treatment within 62 days of an urgent GP referral …

⚠ Leaders didn’t consistently act on risks and identify and implement actions in a timely manner to reduce their impact. During the inspection we identified risks which were not on the risk register; for example, with respect to monitoring and oversight of patients who required transcatheter aortic valve implantation.

⚠ Staff did not always develop holistic, recovery-oriented care plans in collaboration with patients, families and carers. Care plans did not always reflect the assessed needs. Of the eleven care plans were reviewed, four did not reflect all the patient’s identified mental health needs and only one included the patient’s own …

⚠ Children who did not require urgent care waited too long to start treatment. Some children were waiting for over 30 weeks. Patients who did not require urgent care had long waits to start treatment.

⚠ 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, …

⚠ 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 receive treatment when they needed it and therefore did not received the right care promptly. …

⚠ Waiting times for a paediatric general anaesthetic in the south region were excessive. Children could not access the service when they needed it and therefore did not receive the right care promptly. Paediatric waiting times, for general anaesthetic, from referral to treatment and arrangements to admit, treat and discharge patients …