Outcome of recent Care Quality Commission (CQC) Inspection of Lancashire Care NHS Foundation Trust.

During this latest inspection, the CQC team visited 5 of the Trust’s 15 core services which are as follows with the related rating that has been assigned.

• Guild Lodge (good)
• The Cove (requires improvement)
• Acute mental health wards including psychiatric intensive care (requires improvement)
• Crisis services including section 136 suites (requires improvement)
• Longridge Hospital (good)

The resultant overall rating that has been assigned to the Trust is requires improvement. In the context of the Trust’s overall complement of services, 4 of the 15 core services are requires improvement when factoring in the ratings from the last visit when all services were inspected. The CQC’s new process means that they do not re-visit all services that were previously inspected. This is something that our frontline teams have expressed disappointment about as many of them have made improvements that they wanted to demonstrate to the inspection team.

Clearly, this is a disappointment although we were aware of some of the issues highlighted and had ensured that the CQC were sighted on these. We had flagged with the CQC those services that were the most challenged and as such they were the focus of the inspection.

The detail of the reports confirm that there are some key areas that we must address.

–       Recruiting and retaining staff, reducing reliance on bank and agency (safe)

–       Compliance with essential training (safe)

–       Appraisal and supervision rates (effective)

–       Senior management oversight of supervision and appraisal rates (well led)

–       Monitoring of rapid tranquilisation on mental health wards (well led)

–       Clarity of roles within the new management structures (well led)

It should be acknowledged that the continued demand for aspects of the Trust’s services, particularly mental health has been a factor that has had an impact on the ratings and this is something that we are working to address through our own solutions and with the support of commissioners. You may be aware of system pressures that led us to initiate a major incident in March. As a result of that we have now secured system wide support and a joint action plan is to be progressed to address some of the fundamental issues that we have been experiencing at a system level that the Trust has been managing the consequences of operationally.

Importantly and in the main, the inspection team saw committed and dedicated teams working hard to meet patient needs and providing good care in spite of the challenges that they were experiencing.   It is also important to assure you that the CQC did not find any issues that they felt required urgent and rapid action. They also reported that they saw evidence that the Lancashire Care Board is fully sighted on all issues and has plans in place to mitigate them. The Board also received positive verbal feedback from the inspection team with regards to its role in terms of the well led domain. It is unfortunate that the inspection team then found that a small number of our frontline teams were not as well led as they could be as this resulted in an overall rating of requires improvement for this domain.

There are some positives within the report that we are proud of, in particular that the inspection team saw evidence that we are a caring and responsive organisation. The reports also recognise the hard work of the teams at Guild Lodge in maintaining their ‘good’ rating and the progress made at Longridge Hospital to achieve ‘good’ which has pulled the Trust’s overall rating for community services up to good.

The full reports for both Trust and service level can be found at http://www.cqc.org.uk/provider/RW5 along with the detail of the actions that the Trust must take to improve (please note that the CQC has been experiencing technical difficulties with its website which could delay publication so please check back later if the reports are not available). If you have any questions or require further information on the reports please direct these to communications@lancashirecare.nhs.uk in the first instance.