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Provider: The Pennine Acute Hospitals NHS Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 1 March 2018

Our rating of the trust improved. We rated it as requires improvement because:

  • We rated safe, effective and responsive as requires improvement, caring and well led as good.
  • Our ratings for all three hospitals had improved. We rated North Manchester General Hospital, The Royal Oldham Hospital as requires improvement and Fairfield Hospital as good.
  • In rating the trust we took into account the current ratings of services not inspected this time.
  • Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • We rated well-led at the trust level as good.
Inspection areas

Safe

Requires improvement

Updated 1 March 2018

Our rating of safe improved. We rated it as requires improvement because:

  • Although staffing levels had improved, the trust still did not have enough staff of the right qualifications, skills, and training. Staff numbers across the trust were lower than planned in medical care, surgery, critical care and children and young people services.
  • Services did not always keep up to date and accurate records of patients’ care to ensure that risks to patients were consistently assessed or action taken to reduce those risks.
  • In maternity, staff did not effectively use the National Maternity Early Warning Score to monitor patients at risk of deteriorating.
  • In surgery the World Health Organisation Surgical Safety Checklist was not consistently completed in line with national guidance.
  • Checking and maintenance of equipment was not consistent in surgery and maternity.
  • Not all staff in theatres were trained in appropriate levels of resuscitation to provide safe emergency care and treatment to patients in theatre.

However:

  • The trust controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The trust had effective processes in place for the safe management of medicines in most of the services we inspected.
  • The trust generally managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Effective

Requires improvement

Updated 1 March 2018

Our rating of effective stayed the same. We rated it as requires improvement because:

  • Not all staff fully understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Consent was not always obtained or recorded in line with relevant guidance and legislation. There was a lack of consistency in how people’s mental capacity was assessed and not all decision-making was in line with guidance and legislation.
  • The management of pain was not consistently recorded, monitored or actioned. This was particularly noted for patients with a cognitive impairment where the assessment of pain was more complex.
  • Some services did not always make sure that staff were competent for their roles; not all staff had completed their appraisals.

However:

  • The trust provided care and treatment to patients based on national guidance and evidence of its effectiveness.
  • In services staff gave patients enough food and drinks to meet their needs and improved their health. They used appropriate feeding and hydration techniques and made adjustments for patients’ religious, cultural and other preferences.
  • Most services monitored the effectiveness of care and treatment and used the findings to improve. They compared local results with those of other services to learn and continue improving.
  • Staff from different departments and disciplines worked together as a team for the benefit of patients.

Caring

Good

Updated 1 March 2018

Our rating of caring stayed the same. We rated it as good because:

  • All managers and staff treated patients with compassion, dignity and respect.
  • All patients and carers said staff did everything they could to support them and more.
  • Staff involved every patient in decisions about their care and treatment. Staff made sure to consider all aspects of a patient’s wellbeing, including the emotional, psychological and social.

Responsive

Requires improvement

Updated 1 March 2018

Our rating of responsive stayed the same. We rated it as requires improvement because:

  • Not all national targets to ensure that patients could access the services when they needed them were being met. Patients were delayed from discharge and bed moves at night took place on a regular basis, which was not in line with trust policy.
  • Some services did not consistently take into account patients’ individual needs. Patients with complex needs such as a learning disability, dementia or mental health needs were not easily identified in order for staff to provide additional person centred support
  • Most services treated concerns and complaints seriously and investigated them, but it was not always apparent that learned lessons from the results were shared with all staff.
  • Waiting times for certain specialities in surgery was a challenge with operations being cancelled for non-clinical reasons. Reasons for cancellation included cases where beds were not available or surgical lists over ran.

However

  • The trust showed improvement in working closely with commissioners and other external bodies to make sure it planned and delivered services according to the needs of local people.
  • Managers and staff understood and followed procedures to manage access to treatment, particularly at times of increased need.
  • Compared to the last inspection urgent and emergency care had showed an improving picture in meeting national targets.

Well-led

Good

Updated 1 March 2018

Our rating of well-led improved. We rated it as good because:

  • There had been significant changes to leadership and management structures since our last inspection. Most staff we spoke with talked positively about local leadership.
  • The leadership teams had an understanding of the current challenges and pressures impacting on service delivery and patient care.
  • There was a supportive and open culture which was focused on learning and improvement.
  • Services were improving the way they engaged with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • There was evidence of service improvements and innovations to benefit the local population.

However

  • Governance frameworks were being established, but this was work in progress.
  • Services were developing effective systems for identifying risks, planning to eliminate or reduce them and coping with both the expected and unexpected but this was at various stages of development across the services.
Checks on specific services

Community health inpatient services

Good

Updated 12 August 2016

Overall rating for this core service: Good

We rated this service as good because:

Staff were aware of the trust’s safeguarding policies and procedures. Safeguarding training formed part of the trust’s mandatory training programme and 100% of staff working in community inpatients had completed level two and three safeguarding adults training.

Admission procedures included appropriate risk assessments of key areas of health and personal care needs, including: tissue viability, nutrition screening, moving and handling, infection, continence and risk assessments for falls. We saw that the risk assessments were regularly reviewed according to the level of risk and appropriate action was taken in response to the risks identified.

There was effective teamwork and clearly visible leadership within the services. Staff were positive about the culture within the community inpatient services and the level of support they received from their managers. The management team understood the key risks and challenges to the service and how to resolve these.

The consultants at the Floyd Unit were part of Greater Manchester neurology rehabilitation network where there was MDT representation. This ensured consistency across Greater Manchester and allowed for benchmarking best practice.

Patients and their relatives spoke positively about the care and treatment provided. They told us they were treated with dignity, empathy and compassion. Staff ensured patients or their relatives were involved in their care and supported them with their emotional and spiritual needs.

However, there were a number of areas where improvements could be made:

Cleaning staff were present on a daily basis, with a list of cleaning duties; however, they did not keep records to show what cleaning had taken place. This meant there was no way of establishing whether all cleaning duties were being regularly completed.

Staff could access information such as policies and procedures from the trust’s intranet. However staff at Tudor Court and Wolstenholme did not have access to IT systems. This was due to server problems at Tudor Court following the transition from the local authority and staff not being issued with login details at Wolstenholme. Plans were in place to address this.

Within the records at each of the community inpatients units, there was no evidence of a formal mental capacity assessment completed by medical staff.

Incidents were reported using an electronic reporting system and staff were familiar with the policy around incident reporting. However, staff at Tudor Court and Wolstenholme were not able to report incidents on the electronic reporting system as they did not have access to the trust computer system. This was due to the transition over from local authority to the trust in September 2015. The trust was in the process of addressing this but there was no date of when this would be introduced. This was not identified as a risk on the departmental risk register.

Community health services for adults

Good

Updated 12 August 2016

Overall rating for this core service Good

We Community services for adults at The Pennine Acute Hospitals NHS Trust as good because:

  • Staff delivered care that was caring, compassionate and supportive of patients and their families.
  • The service worked effectively and engaged with other professionals to ensure patients received the required level of care and support.
  • Staff appraisals were completed and staff had sufficient clinical supervision.
  • Staff spoke positively about the support they were given by seniors and management.
  • Staff worked effectively with hospitals, GPs and specialists to seek advice when needed.
  • When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.
  • Staff were observed providing care to patients with kindness, compassion and dignity
  • Safety was a high priority and there was measurement and monitoring of safety and performance within the service.
  • Risks were appropriately managed and identified.
  • We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness guidance.
  • There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
  • Patients could access the care and treatment they required in a timely way.
  • There were strong areas of innovation and the service had won a number of awards for innovative practice.

However:

  • Data from the NHS Friends and Family Test showed that the percentage of patients who would recommend the service to their friends and family was below the England average for the 2015/2016 period at 85%.

Community health services for children, young people and families

Good

Updated 12 August 2016

Overall rating for this core service Good O

We rated the community children and young people services at the Pennine Acute Hospitals NHS trust as ‘Good’.

This was because: -

  • The level of incidents reported showed low risk of harm and safe systems for care and treatment of patients. Staff understood how to report incidents.

  • There were enough suitable skilled, competent staff with the right mix of skills to meet patients’ needs. Patients were treated in clean and suitably maintained premises. Patient records were complete and accurate.

  • Care and treatment was based on national clinical guidelines and staff used care pathways effectively. The services participated in clinical audits to look for improvements to the service. Audit records showed most patients experienced positive outcomes following their care and treatment and appropriate actions were taken to improve compliance with best practice standards. Some staff experienced difficulties in accessing trust-wide IT systems. This was being addressed by providing staff with additional computers enabled with access to trust-wide systems.

  • Services were planned and delivered to meet the needs of local people. There were systems in place to support vulnerable patients. Most patients received care and treatment in a timely manner. However, a significant number of patients did not attend (DNA) their scheduled appointments in the community orthoptics and audiology services. Staff followed up patients that did not attend by sending letters to them and to other health professionals involved in their care, such as their general practitioners (GP’s).

  • Patients and their relatives spoke positively about the care and treatment they received. They were treated with dignity and compassion. They were kept involved in their care and they were supported with their emotional needs.

  • The service delivery was based on the trust values and core objectives and staff had a clear understanding of what these involved. There was clearly visible leadership in place through local team leaders and staff were positive about the culture and support available.

End of life care

Good

Updated 12 August 2016

Overall rating for this core service: Good

We rated community end of life care services at The Pennine Acute Hospitals NHS Trust as good because:

  • Staff delivered end of life care in the community setting that was caring, compassionate and supportive of patients and their families.
  • The service had a comprehensive framework and strategy for end of life care.
  • The advanced care plan document developed to replace the Liverpool Care Pathway in July 2014 was comprehensive and person-centred.
  • The trust had appointed a board member with a specific lead role for end of life care and staff were aware of whom this executive lead was.
  • Safety was a high priority and there was measurement and monitoring of safety and performance within the service.
  • Risks were appropriately managed and identified.
  • We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness guidance and priorities of the dying person, particularly personalised care.
  • There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
  • The training for staff involved with the delivery of end of life care was appropriate and provided on a regular basis.
  • The end of life care team worked effectively and engaged with other professionals to ensure patients received the required level of care and support.
  • Staff appraisals were completed and staff had sufficient clinical supervision.
  • Staff spoke positively about the support they were given by seniors and management.
  • A consultant with a responsibility for end of life and was co-located with the end of life care team provided good clinical leadership and support to the palliative care team.
  • Staff worked with local hospices, hospitals, GPs and specialists to seek advice when needed.
  • When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.
  • Staff were observed providing care to patients with kindness, compassion and dignity.