University Hospitals of Leicester NHS Trust is one of the biggest acute trusts in England. Formed in April 2000, it is a teaching trust which provides specialist and acute services to a population of around 1,000,000 patients patients throughout Leicester, Leicestershire and Rutland. The Trust’s nationally and internationally-renowned specialist treatment and services in cardio-respiratory diseases, cancer and renal disorders reach a further two to three million patients nationally.

The trust operates acute hospital services from three main hospital sites:

• Leicester Royal Infirmary

• Leicester General Hospital

• Glenfield Hospital

Glenfield Hospital is situated on the outskirts of Leicester, approximately three miles from Leicester City Centre. It has approximately 440 beds and offers a range of inpatient and outpatient services including nationally recognised medical care for heart disease, lung cancer and breast care. Glenfield Hospital provides medical care, surgery, critical care, end of life care and outpatients and diagnostic services for children, young people and adults.

We served a warning notice under Section 29A of the Health and Social Care Act 2008 in December 2017. The warning notice was served as we found evidence to suggest the quality of health care in relation to management of insulin for diabetic patients’ required significant improvement. We carried out an unannounced focused inspection on 29 May 2018 to follow up actions taken following the issue of the warning notice and to see if significant improvements had been made.

We inspected the safe domain in the core service of Medicine at this location. We did not inspect any other core services or wards at this hospital.This was a focused inspection. Information for the location as a whole can be found in our previous report published in March 2018. This can be accessed at http://www.cqc.org.uk/sites/default/files/new_reports/AAAH1561.pdf.

Our key findings were as follows:

• There had been improvements in the care of patients with diabetes since our last inspection, however, further improvement was required in the monitoring and embedding of the actions taken. Staff did not always ensure trust policy was followed in the administration of insulin.Patients with recorded high blood glucose levels did not always receive their prescribed insulin, the reasons for this were not always clearly documented.

• Staff did not always follow trust policy in regards to control of substances hazardous to health (COSHH). We found chlorine based solutions and tablets in unlocked rooms.

• Safety Thermometer results were not displayed consistently by all wards and departments.

• We saw that ‘I am clean’ were not always attached to equipment that was clean and ready for use.

• We found nurse pull cords and light pull cords in showers and toilets that could pose a ligature risk.

• We found scalpels and razors were not stored securely and could be accessed easily by patients or a member of the public.

• On two occasions we observed that confidential patient records were not stored securely

However:

• Incidents were reported and managed effectively and learning was identified and shared.

• Wards and departments were visibly clean, there was good use of personal protective equipment and good hand hygiene practice.

• Risk assessments had been completed for patients with a known or suspected infectious disease.

• There was sufficient equipment to deliver safe care. Equipment was services regularly and well maintained.

• Medicines were stored safely and staff understood their responsibilities around medicines management.

• Nursing assessments and care plans were fully completed, up to date and regularly reviewed.

• Systems and processes were in place to assess and respond to patient risk including escalation of the deteriorating patient and management of patients with sepsis.

• There were sufficient nursing and medical staff to deliver safe care and on call systems in place when advice or support was required.

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

Importantly, the trust must:

• Ensure that all staff follow the prescription and trust guidance when monitoring patients blood glucose levels and administering as required insulin.

• Ensure staff are up to date with mandatory training.

In addition the trust should:

• Ensure scalpels and razors are stored securely so that they can not be accessed by patients or the public.

• Ensure confidential patient records were are stored securely

Professor Ted Baker

Chief Inspector of Hospitals

Patients were protected against the risks associated with medicines because the trust had appropriate arrangements in place to manage medicines. Provision of suitable medicine storage was in place and security had improved. There were regular audits of compliance and staff reported and escalated issues promptly.

Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One patient told us: “Generally the wards here are good, and ward 26 and 27 are very good. Here I have total confidence in the staff. Staff are fabulous, very, very kind, they understand what you need. ”

Staff received timely appraisals, were informed of developments and consulted on any proposed improvements. There were a range of meetings and mechanisms whereby staff received information about developments, met members of the trust board and shared their views.

Patients felt confident to make a comment or a complaint about the care and treatment they received. There was a robust procedure followed when formal complaints were received. Access and availability of information about the role of the patient information and liaison service (PILS) and the complaints procedure could be improved.

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

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