‘Deeply concerning’ report criticises Liverpool NHS Trust

Frontline staff at Liverpool University Hospitals Foundation Trust (LUHFT), did not feel ‘respected, supported and valued’ by senior managers, according to health watchdog inspectors.

Unions said the Care Quality Commission (CQC) report revealed pressures on staff and called for a significant injection of funding and an increase in staffing numbers in the NHS.

The report, following inspections at Aintree University Hospital and Royal Liverpool University Hospital, warned patients in emergency departments were exposed to risk of harm after not always receiving timely care and treatment.

It also highlighted a percentage of staff from black, Asian and minority ethnic (BAME) backgrounds who experienced ‘discrimination, harassment and bullying’.

Why was there a report?

The CQC, which has previously raised issues about patient safety at the NHS Trust, has rated LUHFT as ‘requiring improvement overall’ following an inspection in June and July 2021.

The CQC carried out the unannounced check 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.

Report findings

CQC inspectors found the flow of patients in the urgent and emergency departments and in medical care services was not always managed, with patients spending long periods waiting for an in-patient bed.

The report also revealed:

• There were not always sufficient medical and nursing staff with the right qualifications, skills, training and experience to keep patients safe in emergency departments and medical wards.
• The organisation was inadequately led with some senior leaders appearing unapproachable to staff and failing to demonstrate the ‘necessary experience, knowledge and capacity’ to lead effectively.
• Surgery services performed worse than the national average for the percentage of cancer patients treated within 62 days.
• Provision for dementia patients was not well developed.
• Staff did not always recognise and report incidents and near misses in some services.
• CQC inspectors said there had been little change to senior leadership since the 2019 acquisition.
• The NHS Staff Survey 2020 results showed 17.9% of BAME staff experienced discrimination from a colleague or manager in the past year which was significantly higher when compared to 5.8% of white staff.

New hospital building

LUHFT was formerly called Aintree University Hospital NHS Foundation Trust.

It changed its name in October 2019 when it acquired Royal Liverpool and Broadgreen Hospitals NHS Trust.

Inspectors said one of the key challenges the Trust faced was preparing for a move to a new hospital building on the Royal Liverpool University Hospital site, due to be completed in March next year.

The CQC described a lack of clarity over who was responsible for key decisions and a ‘lack of pace, urgency and grip’ around the significant changes.

Inspectors also found confusion over the cost of the new operating model and transition to the new hospital, with different figures bandied about by executive leaders ranging from ‘cost neutral, to £700,000 to £5 million.’

Reaction to the report

Unison North West regional organiser Vicky Knight said the union had “repeatedly raised concerns” with the Trust.

She said: “The recent CQC report is deeply concerning but unfortunately not surprising. Unison has repeatedly raised concerns with the previous Trust leadership team about failing to listen to staff.

“These calls were not heeded and as a result the confidence of the workforce seems to have been lost.

“The CQC rightly identified that frontline staff in the Trust are working incredibly hard and that this could lead to unsustainable staff burnout in the long-term.

“What the NHS needs is a significant injection of funding and an increase in staffing numbers, to allow the health service to tackle the treatment backlog without putting unmanageable pressure on workers.”

Estephanie Dunn, RCN Regional Director for the North West, said: “The CQC report highlights the strong commitment, professionalism and hard work of frontline staff in the way they care for their patients. It does make it clear that they are, however, working in the face of significant pressure.

“This should act as yet another reminder to minsters that the pressures are no longer sustainable even before health and care services enter a knife edge winter.”

Frontline staff working hard

Ted Baker, CQC 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, he said although the CQC 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.

He said that since the inspection the trust had responded proactively and changes had been made to the senior leadership team.

Mr Baker added that the CQC would be monitoring the trust closely and would return to check on progress.

Trust response

David Dalton was appointed Interim Chief Executive of Liverpool University Hospitals NHS Foundation Trust in September last year, following the resignation of Chief Executive Steve Warburton.

Sir David 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.”