Liverpool hospitals told to take immediate action to keep people safe

The Care Quality Commission (CQC) has published reports following two inspections at Liverpool University Hospitals NHS Foundation Trust. The CQC told the trust to take 'immediate action' to improve the safety of some of its services and worked with NHS England and NHS Improvement in order to ensure additional support for the trust.

The first inspection on 8 September was partly prompted by a series of ‘never events’ at the trust. These are serious patient safety incidents which are preventable when guidelines are followed. In light of this, CQC’s inspection considered whether urgent and emergency care, surgery, and medical services were safe and well-led across both of their hospitals; The Royal Liverpool University Hospital and Aintree University Hospital. This inspection also looked at whether the trust was well-led overall.

Following this inspection, CQC received assurances from the trust that changes were being made to improve patient safety and CQC monitored them closely during this time.

However, CQC then received further concerns from patients, relatives and staff working at the trust, indicating that people’s basic needs, such as nutrition and hydration were not being consistently met on every ward. There were also concerns that infection prevention and control guidelines were not always being followed. As a result, CQC inspected again on 28 October to look at these issues.

Ted Baker, Chief Inspector of Hospitals said:

"During our inspections in September and October, staff at Liverpool University Hospitals NHS Foundation Trust were working hard to provide care to patients in very challenging conditions. A significant number of staff were absent from work for COVID-19 related reasons – this, coupled with the fact that the region had one of the highest rates of COVID-19 infections in the country at the time meant there was enormous pressure on their capacity.

“Given this pressure, the decision to inspect during this period was a difficult one. However, both staff and patients told us they were concerned about the safety of care being delivered at the Royal Liverpool University Hospital and Aintree University Hospital and we had a responsibility to investigate these concerns. I would like to thank the staff who raised concerns with us, and to reassure them they did the right thing - as a result, the trust is receiving more support to ensure that patients get consistently safe care.

“Our inspectors found that there was a lack of effective systems to ensure all patients received adequate nutrition and hydration. Staff didn’t always follow national infection prevention and control guidelines, which presented a risk of increasing infection transmission rates within the trust.

“We reported our findings to the trust leadership team, who have provided a detailed response with immediate actions they have already taken to mitigate risk to patients, alongside further details of their continuing actions to improve the safety and quality of medical care services.

“The trust are also receiving additional support from the regional and national NHS England and NHS Improvement teams including in relation to infection prevention and control and mitigating nurse staffing levels. Alongside this, support has been secured for the senior leadership team to focus on improvement priorities as agreed by the trust board.

“We will continue to work positively with the trust and its strategic partners to ensure that patients are offered the best possible care in these extremely challenging times.”

Staffing shortages due to absence affected all services at the trust when CQC inspected. At Aintree University Hospital, although managers regularly reviewed and adjusted staffing levels and skill mix, medical services did not always have enough nursing staff with the right training and experience to meet and manage patient need.

At the Royal Liverpool University Hospital site, frequent staffing shortages meant there were occasions when staff were unable to meet the basic care needs of patients. This lack of capacity also meant that staff were not always able to provide emotional support to patients to minimise their distress.

Across the two inspections, the CQC identified other concerns, including:

• At the Royal Liverpool University Hospital and Aintree University Hospital, inspectors found that not all patients requiring dietetic review received this in a timely way, including some with significant nutritional needs. Through a review of information, inspectors were not assured the trust had a robust system in place to manage patients’ nutritional and hydration needs – patients requiring one-to one supervision did not always receive adequate support for their food and drink needs.

• Staff completed but did not always update risk assessments for each patient to safely manage and mitigate the risks. They did not always follow all the systems that were in place to identify and take action where patients were at risk of deterioration. Medical staff did keep records of patients’ care and treatment that were clear and easily available to all staff providing care, however they were not always up-to-date or stored securely.

Steve Warburton, Chief Executive Officer, Liverpool University Hospitals NHS Foundation Trust, said:

“We welcome the CQC’s report and we are committed to listening to our patients and staff when it comes to continuing to improve the safety and quality of care in our hospitals.

“I am pleased that the CQC has acknowledged the hard work of our great staff in the face of the unprecedented challenges Covid-19 has placed on our hospitals. Equally, I am proud of our staff’s open and honest approach to these inspections to enable us to make our services as safe as possible.

“Using the report findings we will continue to learn and improve as an organisation following the merger of the Royal Liverpool and Broadgreen University Hospitals and Aintree University Hospital in October 2019. We are also taking the required action as part of our quality improvement journey, which is essential to fulfilling our ambition to provide great care for every patient.”