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Salford Royal Hospital Outstanding

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 August 2018

A summary of services appears in the Overall summary section above.

Inspection areas

Safe

Good

Updated 24 August 2018

Effective

Good

Updated 24 August 2018

Caring

Outstanding

Updated 24 August 2018

Responsive

Outstanding

Updated 24 August 2018

Well-led

Good

Updated 24 August 2018

Checks on specific services

Medical care (including older people’s care)

Good

Updated 24 August 2018

Our rating of this service went down. We rated it as good because:

  • There were systems and process in place to keep people safe. Mandatory training and safeguarding training rates met the trust target. Medicines were managed well and medical staffing was good.
  • The service used evidence based care and practice and audits were carried out to monitor patient outcomes. Action plans were implemented if necessary. There was evidence of strong multi-disciplinary working and team working. Staff were competent and appraisals were completed.
  • Staff were caring and patients were treated with dignity. Psychology services were available for patients as necessary. Patients and their relatives were involved in decisions about their care.
  • Systems and processes were in place to support admission avoidance and to ensure that patients were treated in the most appropriate place for their care needs. Access and flow was good. Activities were provided on many wards to support patient rehabilitation and patients with a cognitive impairment were well supported.
  • Managers were experienced and there was evidence of leadership development. Quality systems continuously improved service delivery.
  • Senior managers were aware of the risks to the service and these were recorded on the risk register as appropriate.

However:

  • Nurse staffing rarely met the planned numbers for some wards. Patient safety was not affected by staffing levels. The service was looking at innovative ways to recruit staff to all wards and there was a focus on some of the wards with low staffing levels.
  • Nursing records were sometimes incomplete with gaps in recording.
  • The recording of fridge and room temperatures were not always completed.

Services for children & young people

Good

Updated 27 March 2015

Overall, we have rated this service to be good. The service was delivering care that was safe, effective, caring and responsive to the needs of children and their families. There was, however ,some disparity between the overall strategy and vision with regards to the provision of care to children at Salford Royal Hospital, and further work was necessary to strengthen this to ensure the service remained viable for the future. The disparity was in part, due to the existing clinical and operational structures of the hospital. We found that where services routinely treated children, such as the PANDA unit, which was managed by the children’s services directorate within the Salford Health Care division, the governance arrangements, risk management and the measurement of performance was suitably robust.  But this was not necessarily the case for the relatively low number of children who attended the hospital annually to undergo routine day surgery. While a senior clinician was accountable for overseeing the delivery of care to all children, this oversight was not sufficiently apparent for children requiring surgery.

The low number of children who underwent general anaesthetic at the hospital meant that anaesthetists and other staff in the operating theatres were at risk of not having the necessary regular and relevant paediatric practice sufficient to maintain their core competencies. The trust had acknowledged this as an area of concern in 2013, and had instigated a range of initiatives to reduce the potential risk to children. This included commencement of scenario-based training, as well as ensuring that two qualified anaesthetists were present for any child undergoing a general anaesthetic. The service had good incident reporting systems, which staff were able to describe in detail. Staff were aware of their responsibilities to report incidents. Lessons were learned where incidents had taken place. The department was visibly clean. There were systems in place to ensure that patients were protected from the risk of harm associated with hospital acquired infections. Staff undertook regular training to ensure they could recognise and respond to the needs of vulnerable patients.

There was evidence that staff used a range of local and national clinical guidelines to assist in delivering evidence-based care. The service was recognised as being a leader in the provision of diabetes care to children and young people. Patient outcomes and clinical practice were audited to ensure that practice was consistent. Where there had been deviations from clinical guidelines, or where auditing had identified variations in clinical practice, action plans were utilised to ensure a more standardised approach to care delivery. Within the Salford Health Care children’s services directorate, we observed strong and effective multi-disciplinary team working among those involved in providing both acute and community-based care to children and their families.

We observed children being looked after in a caring and compassionate manner. Parents and some children spoke about their care and how involved they were with planning it, and how information was shared with them so they could be fully informed about what would happen to them. Parental involvement was encouraged where children were under16 years of age, in line with national recommendations; this reduced the impact of hospitalisation on younger children.

The commissioning arrangements of children’s services at Salford Royal Hospital meant that there were no inpatient facilities. Where children required hospital care lasting more than 24 hours, there were arrangements in place to ensure that they were transferred to an appropriate facility. There were arrangements in place to ensure that when young people required hospital care or admission, this was done in line with local hospital policy and only where the requirement to provide care had been appropriately risk-assessed. Some improvements were required to ensure that there was age-appropriate information available for children scheduled to undergo surgery.

Staff reported that leadership at a local, ward-based level was good; managers were reported to be supportive of their staff and people spoke positively about working at Salford Royal Hospital. Staff visions and behaviours were aligned to the trust-wide vision of ensuring that patients received safe, clean and personal care every time. A small minority of staff who worked within the day surgery unit reported that improvements could be made to ensure that they received the necessary amount of sustained and consistent support from managers.

Critical care

Good

Updated 24 August 2018

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

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • Completion rates for mandatory and safeguarding training were high across the service. Staff were able to identify and knew how to report safeguarding concerns and incidents, which were appropriately investigated. There was governance oversight of incidents and complaints. Learning from these was shared with staff and teams across the service.
  • The service’s environment, layout and facilities supported the delivery of good quality care and helped staff to maintain appropriate levels of cleanliness and hygiene. Hospital acquired infection risks were appropriately managed.
  • Patients received comprehensive risk assessments and were closely monitored for signs of deterioration. Staff escalated care to medics appropriately and quickly.
  • Care and treatment was evidence based. The was effective multidisciplinary working within the teams that took account and assessed patients’ capacity to consent to treatment.
  • The service collected data across a range of patient outcome measures, and benchmarked itself against similar units.
  • Staff were kind and compassionate in the care and treatment provided to their patients. Staff involved people in decisions and ensured people understood the care and treatment provided to them, and supported people emotionally when appropriate.
  • The service worked with local commissioners in planning the services offered to people, and took into account individuals’ needs. People could access the service when they needed to and there were sufficient staff and resources to provide care 24 hours a day, seven days a week.
  • The leaders of the service understood the challenges the service faced, and had a vision and plans for development to achieve full compliance with national and local policy and guidance.
  • A positive and supportive culture was evident within the service which encouraged engagement with staff, patients and the public.

However,

  • We were not assured there were sufficient staff trained in safeguarding vulnerable children level three to support those occasions when older teenagers were cared for on the unit.
  • The service did not have sufficient numbers of allied health professional staff to provide dedicated dietetic or speech and language therapy support for pods A to C.
  • We were not assured that staff practices in relation to recording the decision to discharge a patient to the ward only when a bed was available for imminent transfer, or the service’s mixed sex accommodation escalation policy within the unit was in line with national guidance. As such, we were not assured that single-sex breaches were being appropriately reported internally and externally.

End of life care

Outstanding

Updated 27 March 2015

The hospital's Specialist Palliative Care(HSPC) team provided face-to-face support seven days a week, with the hospice providing out-of-hours cover. There was strong clinical leadership of the HSPC team resulting in a well-developed, strong, motivated team. A strong bereavement team was available to support carers and families following the death of their relative. The teams worked well together to ensure that end of life policies were based on individual need and that all people were fully involved in every part of the end of life pathway.

Relatives of patients receiving end of life care were provided with free car parking and open visiting hours. Families were offered ‘keepsakes’ including fingerprints, photographs and locks of hair. Families were given the choice of how their relative was moved to the mortuary. Relatives received their family member's belongings in canvas bag with a ‘swan logo’, which highlighted to staff that people carrying the bag may need extra support. There was excellent spiritual/religious awareness across the hospital and facilities were in place to support the different cultures and religions of the people of Salford.

End of life care was embedded in all the clinical areas and staff we spoke to were passionate about end of life care and the need to ensure that the wishes and preferences  of their patients and families were met as they entered the last stage of their life. Palliative care link nurses were introduced onto the wards to champion good end of life care.

There was a multidisciplinary team (MDT) approach to facilitate the rapid discharge of patients to their Preferred Place of care(PPC) or Preferred Place of Death(PPD). Patients were discharged within a six-hour window.

Patients were cared for with dignity and respect and received compassionate care.

Medicines were provided in line with guidelines for end of life care.

Surgery

Good

Updated 24 August 2018

Our rating of this service improved. We rated it as good because:

  • The service provided mandatory training to staff and made sure the majority completed it. Staff understood how to protect patients from abuse and could articulate the process they would follow.
  • The service used safety monitoring results well, and had implemented plans to improve its compliance with the surgical safety checklist.
  • There were good examples of multidisciplinary working to benefit patients, especially on the wards, during theatre huddles and handovers.
  • Staff had good knowledge of their responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005 and could provide examples where they had provided excellent support to patients with mental ill health.
  • Staff cared for patients with compassion and kindness. We observed some excellent patient care particularly on the intestinal failure ward. Staff ensured that patients understood the care they would receive, and helped to minimise their distress.
  • There was a positive culture in the service and staff generally felt supported in their roles. There was a clear vision for what the service and its staff wanted to achieve.
  • The service had good governance arrangements with weekly and monthly meetings to discuss directorate specific concerns, and processes to escalate risk.

However:

  • Some of the premises were not suitable and equipment was not always maintained.
  • The service did not consistently store medicines well.
  • Services were not always effective when benchmarked against national averages.
  • Not all staff were aware of the role or purpose of the Freedom to Speak up Guardians, there was some concerns about the culture in theatres.

Urgent and emergency services

Good

Updated 24 August 2018

  • The service provided mandatory training in key skills to all staff.
  • Staff understood how to protect patients from abuse and had training on how to recognise and report abuse.
  • The service controlled infection risk well. The service had suitable premises and equipment.
  • The service effectively assessed the risk to patients and took action where appropriate.
  • The service deployed the right numbers of nurses and medical staff with the right qualifications, skills, training and experience to keep people safe.
  • Staff kept appropriate records of patients’ care and treatment. The service prescribed, gave and recorded medicines well.
  • The service managed patient safety incidents and monitored safety well.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff gave patients enough food and drinks to meet their needs and improve their health. Pain was assessed and managed by staff caring for patients.
  • The service made sure staff were competent in their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The service supported patients by promoting healthier lifestyles.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The service planned and provided services in a way that met local people and some individual people’s needs and people could access the service in the way they needed it.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The service had managers at all levels with the right skills and abilities to run the service, providing high-quality sustainable care.
  • The service had a vision for what it wanted to achieve and we saw evidence of actions to achieve it.
  • Managers promoted a positive culture that supported and valued staff, free from bullying, harassment or discrimination, creating a sense of common purpose based on shared values.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The service collected, analysed, managed and used information well to support all of its activities, using secure electronic systems with security safeguards.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively
  • The service took action to improve services by learning from when things go well and when they go wrong.

However:

  • Waiting times to admit, treat and discharge patients did not consistently meet national targets.
  • Although the right numbers of medical staff were deployed, the service was reliant on locums to fill gaps in the rota, particularly overnight and at weekends.
  • The service did not always maintain appropriate records to demonstrate equipment was checked in line with trust policy.
  • We identified that patient privacy and dignity were not always respected.
  • Entertainment for children in the children’s section of the main waiting area was minimal.

Outpatients

Good

Updated 24 August 2018

  • Environmental concerns raised at the previous inspection had been addressed at the time of this inspection.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • The department had plans for dealing with major incidents and staff understood their roles.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The service prescribed, gave, recorded and stored medicines well.
  • The service provided care and treatment based on national guidance.
  • Patients had access to food and drinks whilst waiting for their appointment.
  • Pain was assessed and managed by staff caring for patients.
  • Doctors, nurses and healthcare professionals from different specialities supported and worked together as a team to improve patient care.
  • The service supported patients by promoting healthier lifestyles.
  • Care was delivered in a compassionate way and staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Feedback from patients confirmed that staff treated them well and with kindness.
  • Patients could access the service in the way they needed it.
  • The service had managers at all levels with the right skills and abilities to run the service, providing high-quality sustainable care. Specialist clinics were well-led, organised and responsive.
  • Individual clinics used a systematic approach to continually improve the quality of its services to create a service in which clinical care would flourish.

However:

  • Some staff raised concerns about bank staff being left to run clinics alone without working there before.
  • All staff had received safeguarding training but some staff lacked understanding of how to escalate or follow-up safeguarding concerns.
  • The main outpatient area was less responsive to meeting the needs of patients.
  • Because of a management vacancy in the main outpatient’s department the leadership team needed to ensure it had the capacity to deliver the quality of its service.
  • Senior managers acknowledged there were staff satisfaction issues in the main outpatient’s department. We heard some staff describe the culture in the department as an ‘us and them’ culture and felt that staff morale was low.
Other CQC inspections of services

Community & mental health inspection reports for Salford Royal Hospital can be found at Salford Royal NHS Foundation Trust.