Chief Inspector of Hospitals rates Southport and Ormskirk NHS Trust as Requires Improvement

England’s Chief Inspector of Hospitals has given an overall rating for Southport and Ormskirk NHS Trust as Requires Improvement following an inspection by the Care Quality Commission.  

Inspectors found that the trust provided services that were caring. But the trust required improvement for providing safe, well led, effective and responsive care. Maternity services and the North West Regional Spinal Injuries Centre were found to be Inadequate.

During the inspection in November the team of inspectors and specialists including doctors, nurses, managers and experts by experience, visited Southport and Formby District General Hospital, Ormskirk District General Hospital and community services which serve Southport, Formby and West Lancashire. The inspection included the North West Regional Spinal Injuries Centre.

Full reports including ratings for all of the provider’s core services are available at:

Ormskirk District General HospitalHealthwatch Lancashire has been engaging with residents across West Lancashire and with patients in Ormskirk District General Hospital to gather patients’ compliments, comments and concerns. This feedback is provided to Southport and Ormskirk Hospital NHS Trust through patient engagement meetings to identify areas where patients feel things are working well or where improvements can be made.

Gill Brown, Healthwatch Lancashire Chief Executive, said: “Healthwatch Lancashire is currently working with Southport and Ormskirk Hospital NHS Trust, helping to improve services by gathering information by talking to patients and recording their journeys as they undergo their treatment and care.”

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“It is clear that Southport and Ormskirk NHS Trust has a number of issues it has to address.

“Across the trust we saw many examples that showed that staff were caring, compassionate and treated patients with dignity, even when they were working under significant pressure.

“We found some members of staff remain with a feeling of not being valued. The staff we met spoke of a hierarchy of importance within the trust, with greater attention and priority given to the Southport and Formby site, followed by Ormskirk and the Community Services.

“It is a matter of concern that we found maternity services at Ormskirk and the North West Regional Spinal Injuries Centre at Southport to be Inadequate. Staffing levels on the North West Regional Spinal Injuries Centre were significantly lower than national guidelines. The lack of suitably qualified, skilled and experienced staff to meet the needs of the patients must be resolved.

The inspectors found that skill levels in maternity were below those needed to provide a consistently safe service. Some staff were being used for duties above their level of competency. Too few doctors had been trained to manage emergency situations in the maternity service.

The inspectors found that staffing and skill mix levels in A&E services were below those needed to provide a consistently safe service.

“The trust must make sure that robust systems are in place to ensure that incidents are reported and that feedback is provided back to staff that have reported the incidents. The trust must also ensure that there is cross organisational learning from incidents, complaints and issues.   I expect the trust to prioritise these areas for improvement.”

Across the trust there was a lack of capital planning for equipment replacement, which was having an impact on the service. Inspectors were told that the age of hospital equipment was an issue in operating theatres. Although there was a maintenance plan and capital equipment was purchased on an annual basis, there was no forward replacement plan.

CQC has told the trust that it must make improvements including:

  • At Southport and Formby District General Hospital, the trust must ensure adequate nurse staffing levels and an appropriate skill mix in all areas but notably the emergency department
  • The trust must ensure equipment used in the theatres is fit for purpose and older equipment is replaced under a planned replacement schedule
  • Medicines management must meet national standards in the critical care unit and in the emergency department
  • At Ormskirk District General Hospital, the trust must ensure adequate medical and nursing staffing levels and an appropriate skill mix in all areas notably maternity
  • The trust must ensure medical and senior nurse cover out of hours is safe and fit for purpose
  • In Community Adult Services, the trust must complete the staffing review for district nursing and establish a clear plan for the management of increasing workloads
  • The trust must ensure that there are suitably qualified, skilled and experienced staff to meet the needs of the patients using the North West Region Spinal Injuries Centre

The reports also highlight several areas of good practice including

  • Inspectors saw an outstanding example of staff taking full account of both spiritual and physical care appropriate to the religious and cultural beliefs of people nearing the end of life and their families.
  • The development of the Community Emergency Response Team
  • Compassionate improvements and re-design of the outpatient departments to reduce anxiety for young children and patients with a learning disability.
  • Specialist paediatric nurses were employed to support children with diabetes and respiratory conditions, which included nurses visiting schools to give support and training to teaching staff

The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

On Thursday 7 May the Care Quality Commission presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

Trust response to CQC Chief Inspector of Hospitals report

The Care Quality Commission (CQC) Chief Inspector of Hospitals inspected services at the Trust between 12 and 14 November 2014. As is usual practice, the team also made an unannounced inspection between 10pm and 1am on 20 November.

Responding to their report published today, Jonathan Parry, Chief Executive, said: “At the end of the inspection in November, the Care Quality Commission inspectors said we had ‘fantastic, caring and proud staff’.

“I am delighted that the pride staff have in the care they give shines through in the good ratings given by the inspectors – and it is clear from the many positive comments they report that patients think so too.

“The inspectors gave good ratings too for the dignified care we give patients who are dying; many services at Ormskirk hospital, including children and young people’s services; and community services for children and young families.

“They also noted areas of outstanding practice including the Community Emergency Response Team’s work with patients to reduce avoidable hospital admissions; the excellent service of the mortuary team; and the work of the children’s diabetes and respiratory teams.

“Seventy per cent of NHS trusts inspected are rated ‘requires improvement’. We welcome the CQC report and we will be working hard over the months ahead to address the issues the inspectors have brought to our attention.”

Responding to the CQC rating for maternity services at Ormskirk hospital and the North West Regional Spinal Injuries Centre at Southport hospital, Simon Featherstone, Director of Nursing and Quality, said:

“It is a privilege so many mums choose us to safely delivery more than 2,700 babies each year. So I welcome today’s CQC report which highlights how we can make this valued and vital service even better.

“Ninety-nine per cent of our mums get one-to-one care at the birth of their baby and our outstanding record for safe deliveries speaks for itself.

An integrated care organisation

“So, it’s not surprising families were very complimentary about our maternity service when the inspectors visited, saying staff were ‘fantastic’ and ‘very caring’. They also said they would ‘not go anywhere else’ to have their babies and would recommend the unit to friends and family.

“We have a fully staffed maternity team and are addressing the skills mix including recruiting new team members to work in maternity and gynaecology theatres.

“The Trust has also asked the Royal College of Obstetricians and Gynaecologists to independently review the service so the Trust, staff and patients can be satisfied it meets the very highest standards.

“Mums-to-be already booked in with us or women thinking about choosing Ormskirk hospital should call our midwife team on 01695 656786 if they have any concerns or would like to know more about the services we provide. There is much more information on our website; alternatively, Google ‘Ormskirk maternity’.

“At the North West Regional Spinal Injuries Centre we are investing £300,000 in nine new nurses as well as recruiting a matron. This follows a review of staffing that began in July and was continuing when the inspection team visited in November.

“We anticipate this significant investment in nursing will address many of the issues the inspectors raised.

“It will also allow us to develop services such as our ground-breaking community rehabilitation programme which builds patients’ confidence and speeds their journey to independence.”