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LeadershipNov 25, 2022

Leicester physios praised over support for junior colleague and surgery patients in critical report

Physiotherapists and nurses at Glenfield Hospital in Leicester made sure that a fledgling doctor felt supported, according to a Care Quality Commission (CQC) inspection report on University Hospitals of Leicester NHS Trust that was published yesterday (24 November).

The revelation appears in a section of the report dealing with the prevailing culture at Glenfield’s surgery services during an inspection in June, which was prompted by concerns over waiting times for elective surgery and cancer.

Among other concerns, the CQC found that the number of patients awaiting elective surgery were breaching 104 weeks. ‘Cancer performance was also a challenge with 31 and 62-day waits continuing on a downward trend, which provided special cause for concern.’

However, the CQC inspectors, who also looked at how well led the trust was overall in September, were clearly impressed by what they heard from the doctor who was at an early stage in their career.  ‘A foundation year doctor on ward 31 told us they felt very supported as a junior by seniors and also the nursing staff and physiotherapists. They contrasted this with experiences in other areas and hospitals. They also said they were supported to progress to their desired speciality.’

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The supportive approach of physios was one of the positive findings in the CQC report

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Where appropriate patients were given pre-operative physiotherapy and exercise programmes to ensure they were fit for surgery and better able to carry out their post-operative rehabilitation [CQC]

Health promotion

The help that physiotherapists gave patients who were about to have surgery also receives positive comments. ‘Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle.

‘Where appropriate patients were given pre-operative physiotherapy and exercise programmes to ensure they were fit for surgery and better able to carry out their post-operative rehabilitation.’

Patients received practical support and advice on leading healthier lives, the report continues. ‘The service had relevant information promoting healthy lifestyles and support on wards. The nature of much of the surgery provided by the unit meant patients needed to change aspects of their lifestyle either to prepare for or to take best advantage of the planned treatment.'

The report states: ‘Patients told us that this was discussed in depth pre-operatively and they were given good support and guidance. Printed material relevant to healthier living generally as well as specific to surgery was available on the unit.’

Staff survey results

This upbeat section of the report contrasts with a summary of the results of a staff survey, which included negative comments such as ‘dissatisfaction’, ‘burnout’, ‘work-related stress’, ‘low health and wellbeing’, and ‘emotional exhaustion’. ‘There was also a desire to get back to normal after the stressful and distressing times during Covid-19,’ the report notes.

Overall rating: ‘requires improvement’

The rating for the trust overall – as well as for being ‘responsive and well-led’ – declined from ‘good’ to ‘requires improvement’. ‘Being safe’ remains rated as ‘requires improvement’ and ‘caring and effective’ remain rated as good.  

Meanwhile, Glenfield Hospital was rated as ‘requires improvement’ overall and for ‘being safe, effective’ and ‘well led’. Its responsiveness declined from ‘good’ to ‘requires improvement’, while ‘caring’ retained its rating of ‘good’.

Sarah Dunnett, CQC head of hospital inspections, said there had been changes within the leadership team during the inspection. 'Staff felt the new team were already having a positive impact on the organisation and they were visible and approachable for patients and staff. Although some action had been taken to improve the culture, not all cultural issues had been fully addressed yet.'

But she said the new team must take 'urgent action' to reduce the significant referral to treatment delays for people waiting for elective surgery. 'People need to be seen much faster, to increase the chance of better outcomes. Leaders are aware of the problem and are looking at how to address these delays as a priority.  

‘At Glenfield Hospital, many wards didn’t have enough nursing staff to be able to spend time with their patients and meet their individual needs. There was a high reliance on bank and agency nurses who didn’t always have time to get to know the patients. Although, there was enough staff to keep patients safe.

‘We found staff treated patients with compassion and kindness. They also helped patients understand their conditions and provided emotional support to them, their families and carers.'

Ms Dunnett added: ‘Leaders know what improvements are needed, especially around waiting times and the culture throughout the organisation. We hope the trust makes rapid improvements and we will return to check on progress.'

What did the trust say? [added 26 November]

Responding to the CQC's findings, Richard Mitchell, the trust chief executive, said: 'We fully accept the findings in the CQC’s report and welcome the recommendations for improvement.

'Patient safety is our number one priority and we are pleased to remain ‘Good’ for caring. This reflects the dedication and commitment our colleagues show every day in difficult circumstances.

'We have been open and honest about the challenges we face in providing consistently timely and high-quality care at UHL. These include the number of patients waiting for elective treatment as a result of the pandemic. Through focussed action, we have dramatically reduced the number of people waiting over 104 weeks for care. Whilst we still have a huge amount to do, we are making progress.'

Mr Mitchell added: 'The report recognises the important in-roads made in terms of leadership, culture and processes over the last year – as well as a dramatic improvement in our financial governance. We are also on-track to receive our highest staff survey response rate this year, reflecting our commitment to ensuring that colleague experience is at the heart of improvement.

'UHL is committed to implementing all the recommendations made in the report, with oversight provided by the trust board. We will be working closely with communities, colleagues and partners as we continue to improve UHL as a place to receive care.'

To see the full version of the report, visit: https://www.cqc.org.uk/press-release/cqc-publishes-report-following-inspection-university-hospitals-leicester-nhs-trust

Author: Ian A McMillan
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