Clifton 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 understand the service’s vision and values. Staff did not always feel respected, supported and valued. We were concerned about the culture within Blackpool Victoria Hospital. When something went wrong, people were not always told and did not consistently receive an apology. There were levels of bullying, …

⚠ 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 care provided was not always in line with best practice and the effectiveness of the service was not always monitored. Staff did not always follow the principles of the mental capacity act and …

⚠ Staff did not always follow the principles of the mental capacity act and best interest decisions were not always undertaken or documented.

⚠ The service did not always consider patients’ individual needs, care was not tailored to individual patients.

⚠ The design, maintenance and use of facilities, premises and equipment did not always keep people safe. 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 operate effective governance processes throughout the service and with the wider hospital. Staff did not have regular opportunities to meet, discuss and learn from the performance of the service. Leaders and teams did not use systems to manage performance effectively. They did not always identify and …

⚠ 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 and treatment.

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

⚠ The service did not always take into account patients’ individual needs and preferences. Staff did not always make reasonable adjustments to help patients access services, particularly for those with complex or additional needs. Care was not always coordinated.

⚠ Staff did not always support patients to make informed decisions about their care and treatment, nor follow national guidance to gain patients’ consent. 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 …

⚠ 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.

⚠ 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 manage patients safety incidents well. Staff did not always recognise and report incidents and near misses. Although managers investigated incidents, lessons learned were not always shared with the whole team and the wider service and there were risks that incidents could reoccur.

⚠ 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 keep patients safe from avoidable harm and to provide the right care and treatment.

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

⚠ 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 pain relief in a timely way.

⚠ 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 had been effective.

⚠ 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 general running of the services, patient care and staffing workload challenging.

⚠ 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. The critical care unit did not meet the standards for the provision of pharmacy, physiotherapy, dietetics and …

⚠ 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 services didn’t have systems in place to sufficiently 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 respect to monitoring and oversight of patients who required transcatheter aortic valve implantation.

⚠ Urgent (two-week) cancer referral performance had declined; particularly in relation to urgent assessment for suspected breast cancer, which had fallen to unacceptable levels.

⚠ 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 showed significant deterioration.

⚠ There were governance processes in place. However, these were not always used to successfully manage risks and improve performance. Leaders did not consistently 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, …

⚠ 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 goals.

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

⚠ 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 or local commissioning targets. Young people and families found it difficult to receive treatment when they needed it and therefore did not received …

⚠ Paediatric waiting times, for general anaesthetic, from referral to treatment and arrangements to admit, treat and discharge patients were excessive in the south region.