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

A summary of this hospital appears in the overall summary above.

We carried out this comprehensive inspection because United Lincolnshire Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was one of 11 trusts placed into ‘special measures’ in July 2013 after Sir Bruce Keogh’s review into hospitals with higher than average mortality rates.

We inspected Lincoln County Hospital, Pilgrim Hospital, Grantham and District Hospital and County Hospital Louth. We did not inspect the other services provided at John Coupland Hospital or Skegness and District Hospital as these are not operated as part of the acute sites. The announced inspection at County Hospital Louth took place on 30 April 2014.

Overall, this hospital was found to require improvement, although we rated it good in terms of having caring staff.

Our key findings were as follows:

• The surgery service was able to demonstrate good outcomes for patients.
• Mandatory training attendance was poor.
• There was a disconnect between the trust management and the staff at County Hospital Louth.

Feedback from people who use the service, those who are close to them and stakeholders is consistently positive about the way staff treat people at County Hospital Louth.

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

Importantly, the trust must:

• Ensure that staff receive appropriate training in order to undertake their role.

We would normally take enforcement action in these instances, however, as the trust is already in special measures we have informed the Trust Development Agency of these breaches, who will make sure they are appropriately addressed and that progress is monitored through the special measures action plan.

In addition the trust should:

• Ensure that the staff are aware of the various functions of the trust.

On the basis of this inspection, I have recommended that the trust remain in special measures.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Patients told us staff always asked for their consent before commencing care and treatment. They told us staff spoke with them in a language they understood. One patient said, "Nothing is too much trouble." We found details in the care notes of when consent had been sought from patients'. Staff understood what to do if patients did not have the capacity to give consent.

The care notes documented the care and treatment given to patients'. Patients' told us all their care needs were being met. One patient said, "I've been coming here two or three times a year for the last twenty years. It's always been very good, you can't fault it." Staff were able to explain the treatments being given to patients and knew which section of care notes to record treatment and care given.

Patients were happy with the standard of cleanliness at the hospital and told us staff wore protective clothing when attending to their needs. We saw a high standard of cleanliness being maintained within the hospital. Staff were proud to display the high ratings obtained in recent infection prevention checks. One patient said, "It looks smashing here."

Equipment was well maintained and staff received support from other departments within the trust in helping them maintain equipment checks. All equipment which had been cleaned had been labelled to say it was clean. Staff told us they were assisted to maintain their training needs in the use of equipment and how to complete certain treatments.

People told us what it was like to be a patient in County Hospital, Louth. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

The ward we visited looked after patients who had undergone pre-arranged operations. It did not care for patients who needed emergency procedures.

Patients told us they were treated with dignity and respect. One patient told us, “The slightest thing and they pull the curtains.”

Patients told us they had choices about the food they ate and we saw they always had water to drink which was put close to them so they could reach. If they missed a meal, staff were able to get food from the kitchen for them at any time.

Patients told us they felt safe on the ward and felt confident to speak with staff if they wanted to raise any concerns.

Staff on the ward were experienced and patients felt confident in their ability to care for them. We saw there were enough staff to meet the patients’ needs.

We saw records were stored securely and were fit for purpose.

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 carried out a comprehensive inspection in 2014 because United Lincolnshire Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. The trust was one of 11 trusts placed into ‘special measures’ in July 2013 after Sir Bruce Keogh’s review into hospitals with higher than average mortality rates. We returned in February 2015, and found that significant improvements had been made to services. We inspected only the areas which were found to require improvements at our previous inspection.

We inspected Lincoln County Hospital, Pilgrim Hospital, Grantham and District Hospital and County Hospital Louth. We did not inspect the other services provided at John Coupland Hospital or Skegness and District Hospital as these are not operated as part of the acute sites. The announced inspection at County Hospital Louth took place on 30 April 2014.

In April 2014 the hospital was found to require improvement, although we rated it good in terms of having caring staff.

We returned on 2 March 2015, and found that improvements had been made to services elevating the hospital to a rating of good although formal governance processes were not embedded in the nursing teams in both surgery and outpatients.

Our key findings were as follows:

• The surgery service was able to demonstrate good outcomes for patients.
• Mandatory training attendances had improved in surgical services and the outpatients department.
• The link between trust management and the staff at County Hospital Louth had improved.
• Feedback from people who use the service, those who are close to them and stakeholders is consistently positive about the way staff treat people at County Hospital Louth.

However, the hospital should make improvements to clarify and embed the link into the governance systems in place within the trust.

Professor Sir Mike Richards

Chief Inspector of Hospitals