All inspections: Furness General Hospital

We inspected the maternity service at Furness General Hospital on 15, 16 and 17 of July 2025 to follow up concerns we identified during our last inspection which took place in April 2023 and to make sure the care and treatment women received had improved. At our last inspection we rated maternity services as Requires Improvement overall, Requires Improvement for Safe, Responsive and Well Led, and Good for Effective and Caring. At our last inspection we identified 5 breaches in regulations.

We carried out a comprehensive, unannounced inspection of the maternity service, looking at the safe, effective, caring, responsive and well led key questions. 

We also inspected 2 other maternity services run by University Hospitals of Morecambe Bay NHS Foundation Trust.

Furness General Hospital provided obstetric and midwifery-led services along with community midwifery care and worked closely with Royal Lancaster Infirmary and other local hospitals where women and babies with complex needs received their care. The service included, early pregnancy care, antenatal, intrapartum and postnatal care. The maternity unit included both midwifery led and obstetric consultant led deliveries and combined this with triage, antenatal and postnatal care. The maternity services at Furness were all located within the South Lakes Birth Centre. There were 14 rooms which were allocated on admission and women remained in that room for the entirety of their stay in most cases. Four rooms had birthing pools and all had en suite facilities. The service also had 2 dedicated operating theatres, a special care baby unit, a transitional care facility and a bereavement suite.  

In the year April 2023 to March 2024, there were a total of 1,108 births at Furness General Hospital and 2,665 across the trust.

We visited the antenatal clinic, antenatal day unit, delivery and ward areas and obstetric theatres. We spoke with women who used the service and staff, including midwives, doctors, consultants and senior managers. In addition to this, we also held focus groups with breastfeeding women. We observed care and treatment, inspected several patients’ care records in each area we visited, and reviewed the trust’s audits and performance.

We refer to women in this report, but we recognise that some transgender men, non-binary people and people with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues.

We inspected the maternity service at Furness General Hospital on 15, 16 and 17 of July 2025 to follow up concerns we identified during our last inspection which took place in April 2023 and to make sure the care and treatment women received had improved. At our last inspection we rated maternity services as Requires Improvement overall, Requires Improvement for Safe, Responsive and Well Led, and Good for Effective and Caring. At our last inspection we identified 5 breaches in regulations.

We carried out a comprehensive, unannounced inspection of the maternity service, looking at the safe, effective, caring, responsive and well led key questions. 

We also inspected 2 other maternity services run by University Hospitals of Morecambe Bay NHS Foundation Trust.

Furness General Hospital provided obstetric and midwifery-led services along with community midwifery care and worked closely with Royal Lancaster Infirmary and other local hospitals where women and babies with complex needs received their care. The service included, early pregnancy care, antenatal, intrapartum and postnatal care. The maternity unit included both midwifery led and obstetric consultant led deliveries and combined this with triage, antenatal and postnatal care. The maternity services at Furness were all located within the South Lakes Birth Centre. There were 14 rooms which were allocated on admission and women remained in that room for the entirety of their stay in most cases. Four rooms had birthing pools and all had en suite facilities. The service also had 2 dedicated operating theatres, a special care baby unit, a transitional care facility and a bereavement suite.  

In the year April 2023 to March 2024, there were a total of 1,108 births at Furness General Hospital and 2,665 across the trust.

We visited the antenatal clinic, antenatal day unit, delivery and ward areas and obstetric theatres. We spoke with women who used the service and staff, including midwives, doctors, consultants and senior managers. In addition to this, we also held focus groups with breastfeeding women. We observed care and treatment, inspected several patients’ care records in each area we visited, and reviewed the trust’s audits and performance.

We refer to women in this report, but we recognise that some transgender men, non-binary people and people with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues.

Furness General Hospital emergency department is based in Barrow in Furness and part of University Hospitals of Morecambe Bay NHS Foundation Trust.

We carried out an unannounced assessment of urgent and emergency services on 15, 16 and 17 July 2025 due to information of concern and to follow up enforcement actions from our previous inspection.

The service was previously in breach of the legal regulations in relation to safe care and treatment and staffing. Improvements were found at this assessment, but the service was in breach of good governance due to flow issues.

We assessed this service using our single assessment framework and looked at all key questions and 24 quality statements.

We spoke with over 30 members of staff, 20 patients, relatives, and reviewed over 18 records to inform our judgements and rating for the service.

We found shortfalls in the department as it faced challenges in managing patient flow to the wider hospital. As a result, some patients spent time in areas that were not clinically appropriate.

We rated the service as good overall.

The service was in breach of the legal regulations relating to safe care and treatment. We have asked the provider for an action plan in response to the concerns found at this assessment.

Furness General Hospital emergency department is based in Barrow in Furness and part of University Hospitals of Morecambe Bay NHS Foundation Trust.

We carried out an unannounced assessment of urgent and emergency services on 15, 16 and 17 July 2025 due to information of concern and to follow up enforcement actions from our previous inspection.

The service was previously in breach of the legal regulations in relation to safe care and treatment and staffing. Improvements were found at this assessment, but the service was in breach of good governance due to flow issues.

We assessed this service using our single assessment framework and looked at all key questions and 24 quality statements.

We spoke with over 30 members of staff, 20 patients, relatives, and reviewed over 18 records to inform our judgements and rating for the service.

We found shortfalls in the department as it faced challenges in managing patient flow to the wider hospital. As a result, some patients spent time in areas that were not clinically appropriate.

We rated the service as good overall.

The service was in breach of the legal regulations relating to safe care and treatment. We have asked the provider for an action plan in response to the concerns found at this assessment.

The University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) provides hospital services across the Morecambe Bay area - an area covering a thousand square miles in south Cumbria and north Lancashire. It operates from three main hospitals - Furness General Hospital in Barrow, the Royal Lancaster Infirmary and Westmorland General Hospital in Kendal.

Furness General Hospital has a range of general hospital services, with an emergency department, critical/coronary care unit and various consultant-led services. It provides a range of planned care including outpatients, diagnostics, therapies, day case and inpatient surgery.

We carried out an unannounced inspection of maternity care and urgent and emergency care at Furness General Hospital on 15, 16 and 17 of July 2025. Maternity care and urgent and emergency care are now rated good. The rating for these services has been combined with the ratings of the other services from previous inspections.

The rating of Furness General Hospital remains requires improvement.

We found that the service did not always provide safe care and treatment as the emergency department faced challenges in managing patient flow to the wider hospital. As a result, some patients spent time in areas that were not clinically appropriate. This was a breach of safe care and treatment.

The service was previously in breach of the legal regulations and improvements were found at this assessment.

Furness General Hospital (FGH) is one of three hospital sites of University Hospitals of Morecambe Bay Foundation Trust’s and is one of the two main hospital sites. It serves the population of Furness and the surrounding areas in South Cumbria with consultant led maternity services.

At Furness General Hospital the maternity department consisted of one ward of 14 en-suite rooms where obstetricians and midwives provided antenatal, intrapartum, and postnatal care. Two maternity theatres adjoined this area and a specialist bereavement suite, a separate antenatal clinic and day assessment area. There was also a triage area on the birthing ward with trained rotational midwives providing cover.

Around 2,800 babies are delivered within Morecambe Bay Maternity services per year.

We carried out this unannounced comprehensive maternity inspection because at our last inspection we rated the service overall as inadequate. The trust was receiving mandated support as it was placed in SOF4 by NHSE. It was also in receipt of mandated maternity support.

Details of our last inspection on 20 April 2021 and the actions taken were published on 20 August 2021 and can be accessed on our website.

Our rating of this location improved. We rated it as requires improvement because:

The service had enough staff to care for women and keep them safe. Most staff had training in key skills and understood how to protect women from abuse. Staff managed safety well. Staff assessed risks to women, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Key services were available seven days a week.
Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
Leaders had improved information systems and supported staff to develop their skills. Staff were focused on the needs of women receiving care and were clear about their roles and accountabilities. The service was improving engagement with women and the community to plan and manage services. All staff were committed to improving it.
Leaders had identified and acted on cultural issues where not all staff felt respected or valued.
The service used systems and processes to administer and document medicines safely.

However:

Women receiving maternity care, who were assessed as at risk of sepsis, did not always follow the required care and treatment pathway in line with national guidance and antimicrobial medicines were not always prescribed appropriately.
The was no documented prioritisation of women requiring an induction of labour and there were delays in accessing fetal anomaly referrals. Staff did not always follow best practice guidance when monitoring the fetal heart rate and followed out of date emergency protocols.
Medical staff mandatory training including safeguarding compliance had not improved since our last inspection and staff did not know or understood the service’s vision and values, or how to apply them in their work.
The service did not always control environmental infection risk well or remove equipment when out of service. There was not always enough blood pressure monitoring equipment.

A summary of CQC findings on urgent and emergency care services in Lancashire and South Cumbria.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Lancashire and South Cumbria below:

Lancashire and South Cumbria.

Provision of urgent and emergency care in Lancashire and South Cumbria was supported by services, stakeholders, commissioners and the local authority.
We spoke with staff in services across primary care, integrated urgent care, acute, mental health, ambulance services and adult social care. Staff felt tired and continued to work under sustained pressure across health and social care.
We found demand on urgent care services had increased. Whilst feedback on these services was mostly positive, we found patients were accessing these services instead of seeing their GP. Local stakeholders were aware that people were opting to attend urgent care services and were engaging with local communities to explore the reasons for this.

The NHS 111 service which covered the all of the North West area, including Lancashire and South Cumbria, were experiencing significant staffing challenges across the whole area. During the COVID-19 pandemic, the service had recruited people from the travel industry. As these staff members returned to their previous roles, turnover was high and recruitment was particularly challenging. Service leaders worked well with system partners to ensure the local Directory of Services was up to date and working effectively to signpost people to appropriate services.

However, due to a combination of high demand and staffing issues people experienced significant delays in accessing the 111 service. Following initial assessment, and if further information or clinical advice was required, people would receive a call back by a clinician at the NHS 111 service or from the clinical assessment service, delivered by out-of-hours providers. The NHS 111 service would benefit from a wide range of clinicians to be available such as dental, GP and pharmacists to negate the need for onward referral to other service providers.
People who called 999 for an ambulance experienced significant delays.

Ambulance crews also experienced long handover delays at most Emergency Departments. Crews also found it challenging managing different handover arrangements. Some emergency departments in Lancashire and South Cumbria struggled to manage ambulance handover delays effectively which significantly impacted on the ambulance service’s ability to manage the risk in the community. The ambulance service proactively managed escalation processes which focused on a system wide response when services were under additional pressure.

We saw significant delays for people accessing care and treatment in emergency departments. Delays in triage and initial treatment put people at risk of harm. We visited mental health services delivered from the Emergency Department and found these to be well run and meeting people’s needs. However, patients experienced delays in the Emergency Department as accessing mental health inpatient services remained a significant challenge. This often resulted in people being cared for in out of area placements.

We found discharge wasn’t always planned from the point of admission which exacerbated in the poor patient flow seen across services. Discharge was also impacted on by capacity in social care services and the ability to meet people’s needs in the community. We also found some patients were admitted from the Emergency Department because they couldn’t get discharged back into their own home at night.

Increased communication is needed between leaders in both health and social care, particularly during times of escalation when Local Authorities were not always engaged in action plans.

Furness General Hospital is operated by the University Hospitals of Morecambe Bay NHS Foundation Trust. It provides emergency care to around 350,000 people across North Lancashire and South Cumbria. We visited Furness General Hospital as part of our unannounced inspection during 08 to 09 March 2022.

The Medicine care group manages medical care and the urgent and emergency department. Furness General Hospital medical care consists of general medicine and care of the elderly as well as specialities such as cardiology, oncology, and stroke. There are five medical wards at Furness General Hospital including the acute medical unit (AMU) and the coronary care unit (CCU). During our inspection of medical care and care of the elderly we visited the AMU, CCU, ward 6, the acute stroke unit, ward 7, ward 9 and the discharge lounge.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. During our visit our inspection team spoke to patients’ relatives and staff which included consultants, junior doctors, nurses, nurse consultants, pharmacists, discharge coordinators, house keepers and nursing students. We also spoke to the associate director of nursing, the associate director of operations and the clinical director.

At the inspection in April 2021, medical care at Furness General Hospital was inspected but not rated. The last time medical care at Furness General Hospital was inspected and rated was in December 2018 it was rated good all in all domains and rated good overall.

At the inspection in August 2021 urgent and emergency care was rated as requires improvement overall.

As this was a focused inspection at Furness General Hospital, we only inspected parts of our five key questions.

Furness General Hospital is operated by the University Hospitals of Morecambe Bay NHS Foundation Trust. It provides emergency care to around 350,000 people across North Lancashire and South Cumbria.

We visited Furness General Hospital as part of our unannounced inspection during 20 to 22 April 2021. We visited the emergency department as part of the inspection. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

At the last inspection in December 2018, the emergency department at Furness General Hospital was rated as requires improvement. The emergency department services were rated as good for caring and requires improvement for safe, effective, responsive and well led.

During the inspection we found areas of concern that led to a further unannounced focused inspection in medicine for the stroke care pathway.

We did not inspect all of the key lines of enquiry as our concerns were related to specific risks around the stroke care pathway. We inspected against parts of the safe, effective, caring and well-led key questions.

Following this inspection, under Section 31 of the Health and Social Care Act 2008, we imposed urgent conditions on the registration of the provider in respect to the regulated activity; Treatment of disease, disorder and injury and diagnostic screen procedures. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so. Imposing conditions means the provider must manage regulated activity in a way which complies with the conditions we set. The conditions related to the stroke pathway at the Royal Lancaster Hospital and the Furness General Hospital.

Since the conditions were imposed, the trust responded immediately and put actions in place to improve the service. These were ongoing at the time of publication of the report.

Our rating of this location went down. We rated it as requires improvement because:

Urgent and Emergency Care

We found not all staff had training in key skills or could evidence they had completed training in understanding how to protect patients from abuse. Staff in the department did not control infection risk well. The service did not always have enough medical staff to care for patients and keep them safe. Although they managed incidents, not all learned lessons were shared with staff.
Staff did not always provide care and treatment in line with best practice, there was no evidence of how managers or senior leaders measured the effectiveness of the service. We found not all patients were given pain relief when they needed it. Staff caring for patients in the department had not completed training to look after stroke patients.
All staff were committed to continually learning and improving services. However, we found no evidence on how the service improved the paediatric service. There was a good understanding of quality improvement methods and the skills to use them, but they did not always address all issues in the department.
Leaders understood and managed the priorities of the department but did not always recognise the issues the service faced. They did not always operate effective governance processes, throughout the department or identify risks. Staff did not always feel respected and supported, service leaders said they promoted equality and diversity in daily work, but this was not reflected in the staff survey results. The service had an open culture where patients, their families could raise concerns without fear, but staff said they could not.

However:

Staff offered patients food and drink if they had been in the department for a long time. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment

Medical Care

Following this inspection, under Section 31 of the Health and Social Care Act 2008, we imposed urgent conditions on the registration of the provider in respect to the regulated activities; Diagnostics and Screening and Treatment of Disorder, disease and Injury. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so. Imposing conditions means the provider must manage regulated activities in a way which complies with the conditions we set. The conditions related to the stroke services at Royal Lancaster Infirmary and Furness General Hospital. In light of this, we suspended the ratings for Medical care including care for older people.
The trust did not have an effective risk and governance system for the whole stroke pathway.
The service did not always manage patient safety incidents well. Staff recognised and reported incidents and near misses. Managers did not always investigate incidents and share lessons learned with the whole team and the wider service in a timely manner.
Local policies did not always reflect best practice guidance.
We were not assured that the trust were using the findings to make improvements and achieve good outcomes for patients. The vision and strategy for stroke care was not aligned across the trust.

However,

The service had enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them and kept good care records.
Staff provided good care and treatment and managers made sure staff were competent. Staff worked well together for the benefit of patients and key services were available seven days a week.
Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.

Surgery

The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
Leaders ran services well using reliable information systems and supported staff to develop their skills. Most staff felt respected, supported and valued. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

We found entrances to wards and fire doors were not secured.
On some wards medicine were not always consistently stored in line with trust policy.
The service performed worse than expected for some national audit indicators.
The number of staff that had completed their appraisals did not meet trust targets.
The service performed worse than national standards for waiting times from referral to treatment. The average length of stay for patients having trauma and orthopaedics surgery was worse than national average. Whilst the services had plans in place to improve this, these measures had not been fully implemented and had not yet led to any significant improvement in the services.

Maternity

The service did not always have enough midwifery staff to care for women and keep them safe. The service did not always control infection risk well. Staff did not always assess risks to women or act on them. Care records were not always easily accessible or kept up to date.
Staff did not always assess and monitor women to see if they were in pain, nor give pain relief in a timely way. Outcomes for women were not always positive, consistent nor met expectations, such as national standards, such as for Cesarean section rates.
The service used different systems for recording and administering medicines and leaders had identified this as a risk, but actions had not been taken to follow up.
Systems for sharing important safety information day-to-day were not well embedded.
Although staff completed training, Leaders did not always make sure staff were competent. Key services were not always available seven days a week.
Although leaders monitored the effectiveness of the service. they did not consistently use reliable information systems to enable them to run services well. The service did not have effective governance processes and systems to manage risk, issues and performance. There was no clear vision and values for maternity services that was understood by staff. Not all staff were clear about their roles and accountabilities. Opportunities for staff to develop their skills were limited.

However,

Staff had training in key skills, understood how to protect women from abuse, and followed systems to manage safety incidents and learn lessons from them. Staff provided good care and treatment and gave women enough to eat and drink.
Staff collected safety information and used it to improve the service and followed systems for managing medicines.
Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to relevant information.
Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
Most staff felt respected, supported and valued. They were focused on the needs of women receiving care. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.
The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

Furness General Hospital is operated by University Hospitals of Morecambe Bay NHS Foundation Trust. We inspected maternity services and services for children and young people at Furness General Hospital

We inspected the services provided by this trust as part of a focused inspection. We had concerns about the quality of services and we received concerning information about the safety and quality of the services.

Where it is considered necessary to arrange a focused inspection outside of the regular core service inspection schedule, the focused inspection covers a targeted part of the service response to a specific concern. We do not assess or report on all the key lines of enquiry (KLOEs) in a focused inspection.

As we do not rate a trust following a focused inspection, we cannot update any provider level ratings following this inspection.

Throughout the inspection, we took account of what people told us.

We found the following areas that required improvement:

The trust’s care pathway for 16 and 17 year-old patients was unclear and had resulted in delays in patients obtaining treatment. We raised this on inspection and the trust took immediate action to ensure there was a clear patient pathway with policies and procedures.
The services did not have enough medical staff with the right qualifications, skills, training and experience to be compliant with national guidance which we also found at our previous inspection. However, due to consultants working overtime and flexibility of other grades of medical staff, patients were kept safe from avoidable harm and there were sufficient staff to provide the right care and treatment.

Some staff felt there was a lack of any support and debriefing following an incident.
It was not always clear in the incident records, where an incident was graded as moderate or above, that appropriate duty of candour actions had been undertaken or recorded.
The senior leadership teams were based across the trust and were required to cover all three hospital sites. Staff told us the senior leadership team were not visible to them.
Not all staff felt respected, supported and valued. Whilst we found that staff were focused on the needs of patients, some staff raised concerns to us about the culture within the services.
There had been a deterioration in culture since our last inspection. Staff morale was low and there were strained relationships between clinicians and nursing staff.
Senior leaders did not consistently operate effective governance processes throughout the services. Not all staff at all levels were clear about their roles and accountabilities or had regular opportunities to meet, discuss and learn from the performance of the service.
The services did not manage risks, issues and performance well. Not all staff were aware of risks in their area of work.

However, we found the following areas of good practice:

The services provided mandatory training in key skills to all staff and worked towards ensuring that everyone completed it.
Staff had training on how to recognise and report abuse, and there were processes in place to escalate concerns.
Managers regularly reviewed and adjusted staffing levels and skill mix and gave locum staff a full induction.
Staff completed and updated risk assessments for each patient, took action and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
The service had enough maternity staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
Staff kept detailed records of women’s care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care
The service managed safety incidents. Staff recognised incidents and near misses. Some staff told us that managers investigated incidents and shared lessons learned with the whole team and the wider service.
The services made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
Local leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Our rating of services stayed the same. We rated them as good because:

Patients received care and treatment from staff who were caring, compassionate, respectful and maintained their dignity.
Both medical and nursing staff told us the emergency department had an open supportive culture and staff felt leaders were open, helpful and listened to their concerns.
When things went wrong, staff felt able to report them and discuss them and were confident they would receive the support they needed.
The flow of the emergency department was well managed and there were robust systems in place to monitor deteriorating patients waiting for assessment and treatment in the department.
There were paediatric nurses embedded in the emergency department and there were clear pathways for paediatric patients to wards and medical staff to the department.
Learning from complaints was embedded and there were systems in place to ensure feedback was given to staff.
Risks were identified on the risk register and reviewed regularly.
Staff were kept up to date with governance concerns via meetings and newsletters.
The trust had systems to identify capacity and demand issues. This was reviewed regularly, and concerns escalated and managed by the team.
The trust had introduced an updated version of the National Early Warning Score (NEWS2) to measure whether a patient’s condition was improving, stable or deteriorating indicating when a patient may require a higher level of care. We saw that when a patient’s score increased staff had taken the appropriate action to escalate.
The care group leadership team were visible and approachable, and managers had good oversight of their areas. Staff said they were well supported to do their job and felt comfortable sharing any concerns with their immediate line manager.
Staff told us there had been a marked improvement in the culture of the organisation and that the behavioural standards had made a positive difference.
Registered nurse staffing levels had improved since our last inspection and were good on the medical wards we visited. On the day of inspection, we found that actual registered nurse staffing levels met planned levels on most wards.
There was good multidisciplinary team working and staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
The service managed flow through the hospital well and there were no extra capacity beds open at the time of our inspection. Plans were in place to further improve flow with the reconfiguration of the acute medical unit.
The service took account of patients’ individual needs. Arrangements were in place to support the needs of patients living with dementia or with a learning disability.
The trust had a vision for what it wanted to achieve and workable plans to turn it into action, developed with involvement from staff, patients, and key groups representing the local community.

However:

We were not assured about the quality of care patients received because the trust had not performed well against Royal College of Emergency Medicine (RCEM) standards.
The department was not meeting national performance standards for patients being admitted or discharged within four hours, or moved to a ward within 12 hours of a decision to admit being made. The four-hour target performance in every month from September 2017 to August 2018 had not been met.
There were no rooms suitable to manage patients suffering from a deterioration in mental health within the ED. We had concerns about patients self-harming despite the department having ligature cutters for staff.
Patients experienced delays at handover and there had been a high number of black breaches.
Staff within the emergency department were not meeting mandatory training standards including safeguarding vulnerable adults and children. Additionally, staff had not undergone additional training to ensure they had the additional skills and competencies to look after children and not all staff had undergone an annual appraisal within the last 12 months.
There was no designated room meeting the PLAN standard to ensure patients living with a mental health condition were in a safe and suitable environment within the emergency department. The trust had no plans to create a room that met PLAN standards.
Patients living with a mental health condition, waiting for beds at psychiatric facilities sometimes waited significantly longer than 12 hours in the department.
Five specialties were below the England average for RTT rates (percentage within 18 weeks) for admitted pathways within surgery.
The department was failing to meet performance targets. They failed to meet the standard for inpatients waiting more than 12 hours from the decision to admit until being admitted in nine out of 12 months.
The department only had one resuscitation room, although there were plans to rectify this and building work had started to increase the number of resuscitation rooms at the time of our inspection.

We carried out a follow up inspection between 11 and 14 October 2016 to confirm whether University Hospitals of Morecambe Bay NHS Foundation Trust (UHMB) had made improvements to its services since our previous comprehensive inspection, in July 2015. We also undertook an unannounced inspection on 26 October 2016.

To get to the heart of patients’ experiences of care and treatment, we always ask the same five questions of all services: are they safe, effective, caring, responsive to people’s needs, and well-led? Where we have a legal duty to do so, we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

When we last inspected this hospital, in July 2015, we rated services overall as 'requires improvement'. We rated safe, effective, responsive, and well-led as 'requires improvement'. We rated caring as 'good'.

There were seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These were in relation to staffing, supporting staff, safety and suitability of premises, safe care and treatment, and assessing and monitoring the quality of service provision.

The trust sent us an action plan telling us how it would ensure that it had made the improvements required in relation to these breaches of regulation. At this inspection we checked whether these actions had been completed.

We found that the trust had made the required improvements and rated Furness General Hospital as 'good' overall, with caring rated as 'outstanding' and safe rated as 'requires improvement'.

Our key findings were as follows:

There had been significant improvements across most services at this hospital since our last inspection in July 2015.
In medical and end of life care services, there were a number of outstanding examples of compassionate care and emotional support shown by all levels and disciplines of staff, who did not hesitate to go the extra mile to make a difference for patients and their loved ones.
Leadership of the hospital was good, managers were available, visible, and approachable; staff morale had improved significantly and they felt supported. Staff spoke positively about the service they provided for patients.
There had been significant investment in leadership within end of lfe services.
Staff knew the process for reporting and investigating incidents using the trust's reporting system. They received feedback from reported incidents and felt supported by managers when considering lessons learned.
The hospital had in place infection prevention and control policies which were accessible, understood and used by staff. Patients received care in a clean, hygienic and suitably maintained environment.
The trust reported no incidences of MRSA between September 2015 and May 2016. Eight cases of clostridium difficile were reported in the same period.
We saw that patients were assessed using a nutritional screening tool, had access to a range of dietary options and were supported to eat and drink.
Nursing and medical staffing numbers had improved since the last inspection. However, there were still several of nursing and medical staffing vacancies throughout the hospital, especially in medical care services and the emergency department. The trust had robust systems in place to manage staffing shortfall as well as escalation processes to maintain safe patient care.
The hospital had improved compliance against mandatory training and appraisal targets in most services. Local support and supervision of junior staff had improved, and many areas had developed their own unit-specific competencies for training and development purposes.
There had been an improvement in record-keeping standards throughout the hospital, however, we identified some ongoing areas for improvement around legibility and trigger-levels for early warning of deterioration, particularly in in medical care services and the emergency department.
The trust’s referral to treatment time (RTT) for admitted pathways for surgery services had improved since the last inspection. Information for September 2016 showed an improvement in the trust’s performance, with 75% of this group of patients treated within 18 weeks, against the England average of 75%.
Access and flow, particularly in the emergency department and medical care services, remained a challenge. The emergency department's performance had been deteriorating over the preceding 12 months. The Department of Health’s standard for emergency departments is that 95% of patients should be admitted, transferred or discharged within four hours of arrival in the A&E. The trust breached the standard between October 2015 and September 2016. Lack of beds in the hospital resulted in patients waiting longer in the emergency department. Delays in obtaining suitable community care placements were causing access and flow difficulties, particularly in medical care services.

We saw several areas of outstanding practice including:

The medicine division delivered outstanding Referral to Treatment (RTT) outcomes across all specialisms despite pressures on the service overall.
The Listening into Action programme had delivered some clear, effective and significant quality improvements for the organisation and for patients across the hospital.
There were many examples of public engagement in the development and delivery of maternity services, such as co-designing the new maternity unit, interviews for recruitment of new staff, including midwives and matrons, and the development of guidelines and strategies.
The service was one of three trusts which were successful in securing funding to pilot a maternity experience communication-improvement project. This was a patient-based training tool for multi-professional groups in maternity services. The project had the potential to be adopted nationally if learning outcomes and measurable improvements could be made for women who were using maternity services.
The bereavement team, Chaplaincy and specialist palliative care team worked together to promote compassionate care at the end of life. A particular innovation relating to this had been the development of death cafés. A death café provided an opportunity for people to talk more openly about death and dying. The trust had held death cafés for the public as part of 'dying matters week' and also had used them to support staff to talk more openly about death and to promote better communication with patients and relatives at the end of life.
There were a number of innovations relating to compassionate care for patients at the end of life. This included the use of canvas property bags with a dragonfly symbol so staff knew that thosecollecting them had been recently bereaved. In addition, bereavement staff sent out forget-me-not seeds to family members following the death of a loved one. Families were also able to get casts of patient’s hands. This was a service provided by an external organisation with funding provided by the trust.
The trust had adopted the dragonfly as the dignity in death symbol. This was used as a sign to alert non-clinical staff to the fact that a patient was at the end of life or had died. A card with the symbol could be clipped to the door or curtain where the patient was being cared for. By alerting all staff this meant that patients and family members would not have to face unnecessary interruptions and non-clinical staff knew to speak with clinical staff before entering the room. An information card had been produced for non-clinical staff explaining the difference between the dragonfly symbol (dignity in death) and the butterfly (dementia care).
A remembrance service was held by the Chaplaincy every three months for those bereaved. We were also told that ‘shadow’ funeral services had been delivered within the trust when patients had been too unwell to attend funerals of loved ones.
Relatives were sent a condolence letter by the bereavement service a few weeks after the death of a loved oneand support was offered at this time.
The trust had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

In urgent and emergency care services:

Monitor performance information to ensure 95% of patients are admitted, transferred or discharged within four hours of arrival in the emergency department;
Ensure patients do not wait longer than the standard for assessment and treatment in the emergency department.

Action the hospital SHOULD take to improve

In urgent and emergency care services:

Ensure observations are recorded appropriately to allow the assessment and early recognition of the deteriorating patient;
Ensure nursing documentation is completed in accordance with the trust policy;
Continue to ensure that staff complete mandatory training in accordance with trust policy;
Continue to ensure equipment checks are completed consistently in accordance with trust policy;
Ensure the regular update of patient group directions in accordance with trust policy.

In medical care:

Ensure all nursing and medical clinical documentation is completed legibly, in full and in accordance with recognised professional standards;
Ensure multi-factorial falls risk assessments are completed in all cases where risk is indicated and that this is evidenced in the electronic patient record or in the medical notes;
Ensure robust divisional oversight of the respiratory unit at Furness General Hospital (FGH) due to shortfalls in substantive senior medical presence onsite, vulnerability of senior medical staffing and reliance upon senior locum contracts;
Ensure that, where medicines are stored in fridges, temperature ranges are recorded in accordance with policy to ensure that the safety and efficacy of the medicine is not compromised;
Ensure all staff complete all elements of their mandatory training requirements and ensure accurate compliance figures are maintained;
Ensure all staff benefit from the appraisal process and that appraisals are completed on an annual basis in accordance with local policy;
Ensure action plans put in place to address shortfalls in local and national patient outcome audits findings are monitored and reviewed in a reasonable time-frame to ensure compliance is measured;
Ensure there is a review of patient comments and Patient Led Assessment of the Care Environment (PLACE) findings regarding food quality, and consider measures which may be implemented to improve nutritional care;
Ensure staff awareness and knowledge of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) is underpinned by consideration of procedural competence in making such application, to avoid potential legislative breaches;
Ensure all patients are aware of alternative treatment options (including risks and benefits) in addition to recommended treatment options;
Ensure the number of patient bed moves after 10pm is kept to a minimum to avoid patient and family anxiety and distress;
Ensure the remit of the nurse-led ambulatory care unit is fully understood by all key personnel to ensure its safety and efficiency in delivering patient care;
Ensure the effectiveness of the new governance framework is measured and adaptationsare made accordingly;
Ensure the effectiveness of current staff engagement themes and consider other formats which may support divisional strategy and staff harmony;
Ensure reasonable measures are put in place to support staff wellbeing and ensure all staff know what support is available to them.

In surgery:

Continue to improve Referral to Treatment Times (RTT) for patients and continue to implement trustwide initiatives to improve response;
Prioritise hip fractures (within 48 hours);
Ensure all transfers between locations are performed in line with best practice guidance and policy. Where practice deviates from the guidance, a clear risk assessment should be in place;
Continue to engage staff and encourage team-working to develop and improve the culture within the wards and theatre department;
Continue with staff recruitment and retention;
Improve the completion of NEWS;
Improve environmental cleanliness;
Improve the monitoring of fridge temperature and take action if temperatures exceed the expected range;

In critical care:

There was no provision for dedicated critical care pharmacy cover at the FGH site, despite recommendation of such by GPICS (2015). The critical care unit should take action to create plans that adhere to this guidance;
The unit should take action to improve physiotherapy staffing and be clear about how it supports rehabilitation for patients in line with GPICS (2015);
Patients discharged from critical care should receive a ward follow up visit by critical care nurses within 36 hours of discharge, planned as part of the appointment of a supernumerary coordinator and in accordance with the GPICS (2015) standard;
The unit should continue to monitor discharges out of hours, and develop actions to improve (reduce) the number of FGH critical care discharges out of hours.

In maternity and gynaecology:

Ensure that outcome measures are developed to monitor the effectiveness of the strategic partnership with Central Manchester and Lancashire NHS Trusts;
Ensure that care records (including cardiotocograph (CTGs)) are legible, complete, timed and dated;
Continue to monitor the cultural assessment survey for obstetrics and gynaecology and improve values around organisational culture.

In services for children and young people:

The hospital should ensure there is a review of all children and young people’s mortality and morbidity;
The hospital should ensure that documentation refers to Gillick competency and that staff are properly trained and confident to assess Gillick competency;
The hospital should continue to ensure that communication takes place with partner agencies about the placement of CAMHS patients.

In outpatients and diagnostic imaging:

The trust should continue to build relationships and develop closer team working for medical staff in radiology and breast services across all locations to develop a one trust culture;
The trust should continue to ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed in order to meet the needs of the patients. This is particularly in relation to radiology, dermatology and allied health professionals;
The trust should continue work to ensure that all premises used are suitable for the purpose for which they are being used, are properly used, are properly maintained and are appropriately located for the purpose for which they are being used. This is particularly in relation to services provided from medical unit one;
The trust should ensure that it meets referral to treatment targets in outpatient clinics and that it addresses backlogs in follow up appointment waiting times.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Furness General Hospital is one of three locations providing care as part of University Hospitals of Morecambe Bay NHS Foundation Trust. It provides a full range of hospital services including emergency care, critical care, a comprehensive range of elective and non-elective general medicine (including elderly care) and surgery, an oncology unit, a neonatal unit, children and young people’s services, maternity services and a range of outpatient and diagnostic imaging services.

University Hospitals of Morecambe Bay NHS Foundation Trust provides services for around 360,000 people across North Lancashire and South Cumbria with over 700 beds. In total, Furness General Hospital has 239 beds.

We inspected University Hospitals of Morecambe Bay NHS Foundation Trust as part of our comprehensive inspection programme in February 2014. Following our inspection in February 2014 we rated the Furness General Hospital as ‘Requires Improvement’ overall. We judged the hospital as ‘Inadequate’ for safe, ‘Requires Improvement’ for responsive and well led and ‘good’ for effective and caring. CQC was specifically concerned about nursing staffing shortfalls, particularly in the critical care and high dependency units as well as medical wards in this hospital. Patient records, including risk assessments and care planning documentation were not always accurately and comprehensively completed. We also found the trust’s governance and management systems were inconsistently applied across services and the quality of performance management information required improvement.

We carried out this inspection to see whether the hospital had made improvements since our last inspection. We carried out an announced inspection of Furness General Hospital between 14 and 17 July 2015.

Overall we rated Furness General Hospital as ‘Requires Improvement’. We have judged the service as ‘good’ for caring, and ‘requires improvement' for safe, effective, responsive and well-led care.

Our key findings were as follows:

Cleanliness and infection control

The trust had infection prevention and control policies in place which were accessible to staff.
We observed good practices in relation to hand hygiene and ‘bare below the elbow’ guidance and the appropriate use of personal protective equipment, such as gloves and aprons, while delivering care.
‘I am clean’ stickers were used to inform staff at a glance that equipment or furniture had been cleaned and was ready for use.
Overall, patients received care in a clean, hygienic and suitably maintained environment. Staff were aware of and applied infection prevention and control guidelines.
In surgical services,. between April 2014 and February 2015, there had been seven avoidable cases in the surgical and critical care division at Furness General Hospital. On one ward there had been three cases in two months. This had resulted in additional information regarding control of this infection and hand hygiene being provided to all staff during the safety huddles.
According to the submitted and verified intensive care national audit and research centre data (ICNARC), the unit performed as well and sometimes better than similar units for unit acquired methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile infection rates.

Nurse staffing

Care and treatment were delivered by committed and caring staff who worked hard to provide patients with good services.
The trust had actively recruited nursing staff from overseas to try to improve staffing levels. However, vacancy rates remained high and shortfalls were covered by bank and agency staff. Senior staff said that they tried to use the same bank and agency staff to ensure that they had the required skills to work on the ward. Agency staff were given an induction before commencing work on the wards.
Nurses recruited from overseas were supernumerary while they awaited registration with the Nursing and Midwifery Council. However, in surgical services there was a lack of clarity about their role and responsibilities.
Staffing establishments had improved since the last inspection however on some wards nurse staffing remained a challenge, particularly within medicine. A review of staffing within medicine showed that the skill mix did not always fall in line with the trust’s ‘red rules’ initiative. The principles of this initiative included: one registered nurse should deliver care to no more than eight patients and the minimum skills mix on a ward should be 60% registered nurses to 40% health care assistants.

Medical staffing

Medical treatment was delivered by skilled and committed medical staff.
The trust had identified areas where medical staff shortages presented risk to patient care and treatment and were working hard to recruit and retain consultants.
Recruitment of consultants was a challenge particularly in Emergency and urgent care services, and respiratory and gastroenterology.
In surgical services, 21% of medical staff posts were vacant in May 2015. This had resulted in increased locum medical cover with the highest use being in the urology speciality where 55% of medical cover was by agency staff in May 2015.
There were ongoing vacancies within the radiology service. Managers said they were actively recruiting and had introduced the use of extended roles for advanced practitioners to help manage the case load. The service leads felt there had been some improvements in staffing but the recruitment of experienced radiology staff remained a challenge.
There was a sufficient number of medical staff to support outpatient services. The majority of clinics were covered by specialist consultants and their medical teams.

Mortality rates

The trust was highlighted as a ‘risk’ for the in-hospital mortality indicator - Cerebrovascular conditions in the CQC Intelligent monitoring report May 2015.
Mortality and morbidity meetings were held weekly or monthly and were attended by representatives from all teams within the relevant divisions. As part of these meetings, attendees reviewed the notes for patients who had died in the hospital within the previous week. Any learning identified was shared and applied.

Nutrition and hydration

Patients had a choice of nutritious food and an ample supply of drinks during their stay in hospital. Patients with specialist needs in relation to eating and drinking were supported by dieticians and by the speech and language therapy team.
The patient records we reviewed included an assessment of patients’ nutritional requirements based on the malnutrition universal screening tool (MUST).
Where patients were identified as being at risk, there were fluid and food charts in place. However, the recording of fluid balance charts was inconsistent.
Parents told us there was a good selection of food on the menu for children and young people. Children were also offered snacks and food was available as it was required.

There were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Ensure that all premises used by the service provider are clean, secure, suitable for the purpose for which they are being used, properly used, properly maintained and appropriately located for the purpose for which they are being used. This is particularly in relation to services provided from critical care and outpatients.
Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed in order to meet the needs of the patients. This is particularly in relation to medical care, children and young people's services, and radiology, dermatology and allied health professionals.
Ensure that staff receive appropriate support, training, supervision and appraisal to enable them to carry out the duties they are employed to perform, particularly in Accident and Emergency, medical and surgical services and Children and Young People's services.
Ensure that staff understand and act in accordance with the requirements of the Mental Capacity Act 2005 and associated codes of practice.
Ensure referral to treatment times in surgical specialities improve.
Ensure that staff follow policies and procedures around managing medicines, including intravenous fluids particularly in children and young people's and critical care services.
Ensure that risk registers clearly identify all risks within the division, the actions taken to mitigate those risks and demonstrate timely review, particularly in medical care.
Maintain securely an accurate, complete and contemporaneous record in respect of each service user, including medical and nursing, and food and fluid charts, particularly in medical and surgical services.

In addition the trust should:

In urgent and emergency services:

Take action to improve waiting times and ambulance handovers.
Ensure action plans following CEM audits clearly state the steps required to secure improvement.
Improve staff engagement, knowledge and awareness of the strategy for the service.

In medical care services:

Ensure there are clear plans in place to reduce the number of falls occurring within the service.
Improve the management of people with a stroke in line with national guidance.
Consider improving arrangements for clinical supervision to ensure they are appropriate and support staff to effectively carry out their responsibilities, offer relevant development opportunities and enable staff to deliver care safely and to an appropriate standard.
Take action to reduce the number of patients staying on medical wards that are not best suited to their needs and to reduce the number of moves between wards.

In surgical services:

Ensure all staff understand the process for raising safeguarding referrals in the absence of the safeguarding lead.
Reduce and improve re-admission rates.
Ensure all procedures are performed in line with best practice guidance. Where practice deviates from the guidance, a clear risk assessment should be in place.

In critical care services:

Ensure that there is timely access to medical care for patients out of hours and that any delays do not result in patient harm.
Consider how it is going to improve performance in reducing the number of delayed and out of hours discharges of patients from critical care.
Ensure that any delayed discharges from critical care do not result in a breach of the government’s single sex standard.
Ensure that all entries in patient records are appropriately signed and dated.
Consider the provision of a supernumerary clinical co-ordinator on duty 24/7.
Consider how it intends to respond to the latest Health Building Notes guidance for critical care units in planning its vision and strategy for the service.

In maternity and gynaecology services:

Ensure that the actions of the Kirkup recommendations are implemented within timescales and embedded across the trust.
Ensure there are clear lines of responsibility and accountability at ward manager and matron level within maternity so that staff feel supported and barriers to communication and change are removed.
Implement the recommendations of and monitor compliance with, the PHSO Report 'Midwifery supervision and regulation: recommendations for change' (2013) with regard to Trust/Midwifery Supervisory investigations, so that parent(s) receive a joint set of recommendations and a single timeframe resulting from the investigation.
Ensure that the ‘Five steps to safer surgery’ (World Health Organisation) is embedded in obstetric theatre practice.
Ensure that a physical test is carried out in line with trust policy to ensure that the infant abduction procedures work correctly and that staff understand how they work.

In children and young people’s services:

Ensure that there are clearly defined and formalised job plans in place for consultant paediatricians.
Consider reviewing the investigation process of patient safety incidents with full consideration given to the reporting of the professional’s account of events and concerns.
Ensure that there are measures in place to monitor the effectiveness of joint working within medical staff teams.

In end of life care services:

Ensure there is a clear and accessible system in place to identify and monitor risks within end of life care services.
Continue to take action to improve those areas identified by the NCDAH.
Ensure all DNACPR forms are completed to the appropriate standard.

In outpatients and diagnostic imaging:

Continue to build relationships and develop closer team working to develop a one trust culture.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We found that staff at the hospital were committed to providing safe and effective care for patients. There were good examples of compassionate and person centred care across all the core services.

The hospital was clean and patient waiting areas had been upgraded to make them more welcoming and comfortable.

Despite the trust positively recruiting 135 additional staff, we identified staffing difficulties in a number of services that were having an adverse impact on patient care.

We found that the nurse staffing levels in the Critical Care Unit /High Dependency Unit (CCU/HDU) were unacceptably low. We also found that medical cover was inappropriately organised. We raised this with the trust at the time of our inspection and requested written confirmation of the immediate actions the trust had taken to address this shortfall.

There were also concerns regarding the staffing levels and skill mix on the medical wards at this hospital.

Staffing levels in the accident and emergency department and paediatrics had been recently reviewed and business cases were in development to secure additional staffing for both departments as a result of identified shortfallsThe Paediatric staff business case was presented to the Executive Directors Group (EDG) meeting on 28th January 2014. The business case required further work and when re-presented at EDG on 18th February 2014 it was approved. Recruitment subsequently commenced.

Specialist support services for people at the end of life were good and patients spoke highly of the care they were given by the palliative care and oncology teams; however the specialist service is only available during office hours.

Outpatient departments are still experiencing difficulties with obtaining patient records in time for clinic appointments and for scheduling appointments.

Staff are well-led at the frontline and have confidence in their managers to raise issues of concern, however, staff have less confidence in the Executive Team as management responses and improvement actions were seen as lacking vigour and pace.

The trust governance and management systems are inconsistently applied across services and the quality of performance management information requires improvement. We also found that performance information and learning from incidents was not effectively used to drive changes and Improve practice.

There have been improvements in both the maternity and A&E services as a result of targeted and focused work by the trust, and patients are positive about their experiences of these services.

We visited the Furness General Hospital (FGH) to check that improvements had been made to cleanliness and hygiene following an inspection that found the hospital non compliant with Outcome 8, cleanliness and infection control.

We spoke with people who used the service (patients) and asked if they were satisfied with the care they received, they told us:

"Yes I'm being looked after."

"I am impressed with nurses, cleaners, everybody! They're working non stop."

"The standard of care is excellent."

"It's alright."

We found that the University Hospitals of Morecambe Bay Trust had made the required improvements to achieve compliance with cleanliness and infection control, specifically within its accident and emergency department.

We had also received information of concern from a member of the public about a specific ward at the hospital. On inspection of the ward we found that patients were being looked after to an appropriate standard. We did identify areas that required improvement around palliative care, however the Trust was already aware of some of the issues and were working towards improving practices.

This inspection focused purely on the maternity service at Furness General Hospital and The Royal Lancaster Infirmary. We have written a report for each separate location and therefore to get an overview of the maternity service provided by The University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) both reports should be read in conjunction with each other.

All the women we spoke with who were using the maternity services at Furness General Hospital expressed satisfaction with the care and support they had received. We were told that midwives were 'Understanding'. One person told us that staff had 'Gone out of their way to explain and talk me through it'. People told us, and we observed, that their privacy was respected. Curtains were drawn around beds for privacy and staff asked permission to enter.

Medical and midwifery staff we spoke with were aware of the processes to raise and escalate any concerns or incidents. They expressed confidence in using this system. We found that learning from 'near misses' was being shared. A regular staff newsletter and information posters in clinical areas on the lessons learned from the analysis of incidents helped make sure all staff were kept informed.

We found that staffing and skill mix on the different wards was being continuously reviewed. We saw that staff had moved around the service to help make sure service provision and quality of care was maintained. Women were at times diverted to other Maternity units to enable provision of safe care.

Alterations had been made to the location and facilities of the Special Care Baby Unit (SCBU) at FGH. We found that staff recruitment remained a problem in the long term for this unit. In the short term an effective service was being provided by staff working additional hours.

We visited the A&E department at Furness General Hospital as part of a review following an investigation into the emergency care pathway undertaken in 2012 under section 48 (1) (2) (a) of the Health and Social Care Act 2008 which enabled the CQC to look at the provision and commissioning of health care more widely beyond the 16 outcomes within the essential outcomes of quality and safety.

During the review we found that patients were not cared for in a clean, hygienic environment within the A&E department. Health and social care providers are required to follow the guidance laid out in the Department of Health's publication: The Code of Practice for health and adult social care on the prevention and control of infections and related guidance. This guidance forms part of outcome 8: cleanliness and infection control underpinned by Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

This unannounced inspection along with a second one at the Royal Lancaster Infirmary (RLI) on the 13 August 2012 focussed on the accident and emergency department including the medical assessment unit (MAU).

During our visit to Furness General Hospital (FGH) we spoke with six people using the service and three of those had come into hospital via the A&E department. The people we spoke with were complimentary about the care they had received from staff in A&E.

Another person told us 'They (A&E staff) have been wonderful' and 'the nurses have infinite patience' and 'the food is very good.'

Another said 'I can't fault anything.'

As part of our inspection we spoke with stakeholders such as the local council's Overview & Scrutiny Committee who have a duty to look more closely into public services outside their own organisation, which includes local NHS hospitals. They said they had not received any concerns from the public about the accident and emergency departments in recent months. They told us they had regular meetings with senior staff at University Hospitals of Morecambe Bay Trust which kept them up to date with any changes in service provision at the trust. They were fully aware of the issues in the past that had led us to issue a warning notice.

We also spoke with the Local Involvement Networks (LINks) who had also not recently received any issues or concerns from the public about the emergency departments.

We inspected FGH to check compliance with a warning notice served in February 2012 and to follow up compliance actions from the last inspection report. We had issued warning notices and compliance actions across FGH and RLI for the provision of emergency care.

A separate report has been written for RLI. Although the previous reports highlighted some different issues for each site there were common themes identified across both so it is beneficial to read this report in conjunction with the one for RLI.

This report concerns the Furness General Hospital maternity unit.

Women we spoke with were all pleased with the level of care they had received.

One woman told us "I have no problems. I am happy with the service. I have been given lots of explanations and information. I have had no problems or concerns about lack of privacy or dignity."

As part of our inspection we spoke with local stakeholders such as the local councils Overview & Scrutiny Committee who have a duty to look more closely into public services outside their own organisation which includes local NHS hospitals. They said they had not received any concerns from the public about Furness General Hospital or the Royal Lancaster Infirmary maternity units in recent months. They told us they had regular meetings with senior staff at University Hospitals of Morecambe Bay Trust which kept them up to date with any changes in service provision at the trust.

We also spoke with the Local Involvement Networks (LINks) who had not received any issues or concerns from the public about the provision of maternity services at University Hospitals of Morecambe Bay.

We inspected Furness General Hospital (FGH) maternity unit to check compliance with a warning notice served in August 2011 and to follow up compliance actions from the last inspection report. We had issued a warning notice and compliance actions across FGH and Royal Lancaster Infirmary Hospital (RLI) maternity units. A separate report has been written for FGH. Although the previous report highlighted some different issues for each site there were common themes identified therefore it is beneficial to read this report in conjunction with the one for RLI.

The trust had made good progress in addressing our concerns contained in the warning notices and compliance actions from last year. It was evident that the trust was working with staff to develop a safe, women centred, evidence based maternity service. Good practice points were noted across both The Royal Lancaster and Furness General Hospital sites.

Clinical staff involved in the inspection gave us honest, helpful and well considered explanations. They were able to support their answers with robust examples and both written and verbal evidence. They demonstrated excellent skills in relationship building throughout the two days and were warm and welcoming.

Work is still ongoing, which is to be expected, around cultural change, staffing levels and data management systems but significant progress has been made to address these.

We conducted an on site investigation into the emergency pathway at Furness General Hospital (FGH) on 20th February 2012 under the powers of section 48, Health and Social Care Act 2008. The remit of this investigation was to review the urgent care pathway. An investigation differs from a responsive compliance review in that it normally necessitates a much wider and deeper look at a range of concerns potentially across all locations within a single provider such as an NHS hospital. During the investigation the team identified a number of concerns that demonstrated a breech in the regulations.

The investigation team collected feedback from a wide number of people living in the local

area who had used the services provided by the trust. This will be reported in more detail in the investigation report which is due to be published in July.

People reported varying experiences when they received treatment and care at the hospital.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

We focused during our visits upon the experiences of the women using the maternity services across the Trust and on getting their opinions on the care and support they had received. We talked with mothers, their relatives, clinicians and midwifery practitioners and people expressed a range of largely positive views. Mothers we talked with confirmed that there were good levels of information provision across all three maternity units with mothers being given choice about the kind of care available to them.

The mothers we talked to told us that they understood their care and treatment and told us they were kept up to date about what was happening and given explanations about what was happening during their pregnancies and also during labour so they could make informed decisions. All the mothers we talked with expressed satisfaction with the care and support they had received from the midwives during their stay on the maternity units. All those mothers we talked to on the post natal wards told us the midwives had 'always' asked them what they wanted during their labour and given them explanations. All those we talked to confirmed that once in established labour they had not been left on their own by midwives. We were also told that doctors and consultants spent time with them and explained why changes to their plan were needed.

One mother told us staff had been 'brilliant' and had 'acted quickly when things changed' and that 'all the options were discussed with us'. Another commented on the fact that they had felt able to ask their consultant questions 'all the way through being pregnant'.

Another mum who had been transferred between units told us 'It was a very quick response, and they (staff) explained as much as they could'.

Mothers also commented that they could see staff were busy at times during their stays and one in Furness General Hospital told us 'They were very busy when I came in, despite that they were always there for me'.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

All Inspections

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Importantly, the trust must:

Cleanliness and infection control

Nurse staffing

Medical staffing

Mortality rates

Nutrition and hydration

Professor Sir Mike Richards