An embattled hospital trust will remain in special measures, despite making marked progress in the last 18 months, after inspectors found four of its five criteria were below the required standard.
The health and social care regulator, the Care Quality Commission, found United Hospitals Lincolnshire NHS Trust (UHLT) had issues across its four hospitals, with one in particular rated as "inadequate" overall.
The urgent and emergency care facilities at Pilgrim Hospital in Boston (pictured) were described as being of "significant concern", with inspectors troubled by patient handover delays, risks to children's safety, and staffing issues.
The inspection highlighted progress had been made within the trust, which also looks after Lincoln County Hospital, County Hospital Louth, and Grantham and District Hospital, meaning its overall rating improved from "inadequate" to "requires improvement".
But the trust will remain in special measures so "it can receive the support it needs to make further improvements".
Professor Ted Baker, the chief inspector of hospitals, said: "During our inspection we found staff were caring and committed to helping patients, but we were disappointed to find that insufficient improvement had been made at Pilgrim Hospital in Boston since our last inspection in October 2016, and our overall rating of the hospital remains inadequate.
"Pilgrim Hospital's urgent and emergency care was of significant concern, and we have rated it as inadequate in all the key questions we ask when inspecting - is the service safe, effective, caring and well-led?
"Services for young people at Pilgrim Hospital are also rated Inadequate overall and it is clear that much work is needed.
"However, we also found a number of examples of outstanding practice at the trust."
The inspection report, based on unannounced visits to the four hospitals between February and April, showed a catalogue of concerns.
It found there were periods of under-staffing or inappropriate skill mix, and a heavy reliance on agency, bank and locum staff.
Medicines were not always stored correctly, and disposed of safely, and in some cases were out of date.
Elsewhere, inspectors found several examples where patients' privacy and dignity needs had not been met appropriately.
The report said: "One patient, who had not had a drink for several hours, told us they had refused a drink because they did not want to have to climb off a trolley in the central area of the department to go to the toilet.
"We observed another patient refuse their medicines because the medicines would increase their need to go to the toilet.
"Staff told us they were too busy to provide the compassionate care they wanted to.
"We were told by upset staff, how a patient had opened their bowels in a vomit bowl because staff had been too busy to take them to the toilet."
But there were also examples of positive experiences for patients across the trust, including providing finger food for those with dementia so they could help themselves to snack and reduce the risk of malnutrition, while stroke ward staff arranged for a long-term patient to carry out a wedding ceremony on the unit.
ULHT chief executive Jan Sobieraj said: "This report shows real progress and shows everyone, our patients, staff and stakeholders that we are clearly moving in the right direction to improved and sustained quality of care.
"I'm extremely proud of all our staff, who have worked together and taken on board the challenges we face, there is more work to do but we are in a better place than we were a year ago that's for sure."
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