Members of the board at the Royal Liverpool Hospital have been accused of lacking urgency and pace in preparing to transfer services to the much-delayed new building.
The board of the NHS trust running both the Royal and Aintree Hospitals was severely criticised yesterday in a scathing report by an inspection team from health watchdog the Care Quality Commission (CQC).
While the report praised the commitment and compassion of frontline staff, it found that "out-of-touch" leaders were failing to address broken systems and risks to patients.
READ MORE: 'Out of touch' city hospital bosses slammed by CQC over dangerous A&E failures
The inspection, which focused on risks to patients in each hospital's A&E department, took place between the end of June and July 26 this year and was followed days later by the resignation of then chief executive Steve Warburton.
One of the concerns highlighted was a "lack of pace, urgency and grip" of the "significant changes to service provision" needed to move over to the new hospital - a handover due to take place in March 2022.
The CQC inspectors wrote how they had been told by Mr Warburton and his board colleagues that the trust was "sighted on the priorities" for the handover and a six phased approach was in place.
But what they saw and heard painted a different picture, including on one occasion when inspectors asked who had been designated the Senior Responsible Officer (SRO) for the handover, and were given three different names.
The team expressed concerns that "there was a lack of clarity regarding who was accountable and responsible for key decisions".
The CQC report stated: "Whilst the trust had continued to work closely with external parties to manage the risks associated with the construction phase, one of the most significant risks now facing the organisation was the transition to the new hospital.
"The Trust had a significant amount of work to do ahead of the transition to the new hospital and the new models of care, with a fast approaching handover date for the new hospital.
"Although this work had commenced as part of the New Hospital Board, service integration plans were not fully co-ordinated and there were gaps in overall scrutiny and assurance.
"There was a lack of clarity around the cost of the new operating model and transition to the new hospital. Three different figures were suggested by different executive leaders as cost exposure to the hospital, ranging from cost neutral, to Â£700,000, to Â£5 million."
When asked about the concerns over the handover, a spokesman for the trust told the ECHO: "The new Royal Liverpool University Hospital is an integral part of delivering on the promise of better healthcare for the people of Liverpool.
"We continue to work towards a handover of the building in Spring 2022 and an opening of the new hospital in late summer 2022, with the overriding priority being the safe delivery of clinical services and patient care."
Elsewhere in the report the inspection team concluded that lengthy delays and poor monitoring in A&E were putting patients at risk of harm.
Senior leaders were described as "lacking the experience and knowledge" to effectively lead the organisation, while frontline staff described executives as "not visible" and "out of touch".
Mr Warburton and other members of the senior leadership team, who ran Aintree Hospital before its board merged with the Royal Liverpool Hospital in 2018, were accused of showing "bias" towards the Fazakerley site and the two hospitals were not well integrated.
Ted Baker, the CQC's chief inspector of hospitals, said: "When we inspected services at Liverpool University Hospitals NHS Foundation Trust, we were concerned that the trustâ€™s leadership team had a lack of oversight of what was happening on the frontline.
â€œThere were significant issues with patient access and flow through the emergency department and this was affecting the ability for staff to deliver safe care and treatment.
"We observed lengthy delays and poor monitoring putting patients at serious risk of harm. We were particularly concerned about how long people were waiting to be admitted onto medical wards and by the absence of effective processes to prioritise patients for treatment based on their conditions.
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â€œThere werenâ€™t always the right number of staff with the right skills and training, to treat people effectively or keep them safe in the trustâ€™s emergency departments and on medical wards."
Mr Baker praised the efforts of frontline staff, and noted that while leadership had been rated 'inadequate' and the trust was rated overall as 'requires improvement', it had been rated 'good' for being caring.
Mr Warburton was replaced by interim chief executive Sir David Dalton, and Liverpool University Hospitals NHS Foundation Trust highlighted that it had also appointed a new medical director and chief nurse since the inspection.
Speaking in response to the report yesterday, Sir David said: "As a new senior leadership team, we accept the CQC's inspection findings and are working closely with them to respond to, and address, the issues identified in their report.
"The report is very clear that responsibility lies with the Trustâ€™s senior management and ineffective systems and processes, which have not enabled staff to achieve the high-quality of care I know they are committed to delivering.
"We are proud that the inspectors repeatedly noted the kindness and compassion shown by our staff when caring for patients. In the short time I have been at the Trust I have been struck by the dedication and passion of our staff, who want to do their very best for our patients.
"Working together we have taken immediate action to ensure that patients are safe and cared for appropriately.
"Our improvement journey has already started with considerable work being undertaken across the Trust to implement the necessary changes to our ways of working to raise the standards of the quality of care."
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