CQC carried out an unannounced inspection of the trust’s urgent and emergency care, surgery and medical care services due to continuing concerns about the quality and safety of some services. Inspectors also looked at how well-led the trust was.
Following this inspection, the overall rating for the trust is requires improvement. It is also rated requires improvement for being safe, effective and responsive, inadequate for how well-led it is, and good for being caring.
The trust was created on 1 October 2019 following a process of acquisition, in which Aintree University Hospital NHS Foundation Trust acquired Royal Liverpool and Broadgreen University Hospitals NHS Trust. When this happens, in order to improve the quality and safety of care, ratings at trust level are not combined for up to two years. Therefore, the overall ratings following this inspection are based only on the ratings for Aintree University Hospital and how well-led the trust is overall. Previous ratings for other services cannot be directly compared with those now in place.
Due to the significant concerns identified during this inspection, CQC wrote to the trust to impose conditions on their registration under Section 31 of the Health and Social Care Act 2008. These conditions require the trust to take urgent action to ensure people are not exposed to further risk of harm. Full details of the conditions imposed can be found in the report.
Ted Baker, chief inspector of hospitals, said:
“When we inspected services at Liverpool University Hospitals NHS Foundation Trust, we were concerned that the trust’s leadership team had a lack of oversight of what was happening on the frontline.
“There were significant issues with patient access and flow through the emergency department and this was affecting the ability for staff to deliver safe care and treatment. We observed lengthy delays and poor monitoring putting patients at serious risk of harm. We were particularly concerned about how long people were waiting to be admitted onto medical wards and by the absence of effective processes to prioritise patients for treatment based on their conditions.
“There weren’t always the right number of staff with the right skills and training, to treat people effectively or keep them safe in the trust’s emergency departments and on medical wards.
“Staff on the frontline were working hard to provide services in the face of significant pressure. We saw that staff treated patients with compassion and kindness and took into consideration their individual needs, helping them understand their conditions and providing emotional support to families and carers. Additionally, although we saw some collaborative teamworking, there was variation in positive culture and staff experience, at all levels of the organisation with a lack of cultural integration between the two hospital sites.
“Since the inspection, the trust has responded proactively. Changes have been made within the trust’s senior leadership team and we have seen evidence of improvement with plans in place for further action. Going forward the trust must assure us they have robust oversight and effective processes in place to support staff to deliver the consistently high-quality care they want to give and mitigate any risks to keep people safe.
“We will continue to monitor the trust closely and will return to check on their progress.”
Sir David Dalton, Interim Chief Executive of Liverpool University Hospitals NHS Foundation Trust, said:
“As a new senior leadership team, we accept the Care Quality Commission’s inspection findings and are working closely with them to respond to, and address, the issues identified in their report.
“The report is very clear that responsibility lies with the Trust’s senior management and ineffective systems and processes, which have not enabled staff to achieve the high-quality of care I know they are committed to delivering.
“We are proud that the inspectors repeatedly noted the kindness and compassion shown by our staff when caring for patients. In the short time I have been at the Trust I have been struck by the dedication and passion of our staff, who want to do their very best for our patients.
“Working together we have taken immediate action to ensure that patients are safe and cared for appropriately. Our improvement journey has already started with considerable work being undertaken across the Trust to implement the necessary changes to our ways of working to raise the standards of the quality of care.”
Sue Musson, Chair of Liverpool University Hospitals NHS Foundation Trust, said:
“Ensuring our patients consistently receive high-quality and safe care is the Trust’s absolute priority. The Board is committed to ensuring that the Trust delivers to these high standards for all of our patients. We know that our frontline staff are working incredibly hard in very challenging circumstances, and it is great to see their commitment and compassion reflected in the report.
“By working together as a Trust and with our partners across Liverpool we can deliver the quality of healthcare the people and the communities we serve deserve.”