Fairfield General Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

We assessed 7 quality statements.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

The service did not take effective or timely action to support people who are most likely to experience inequality in experience or outcomes, particularly in stroke rehabilitation. The repeated use of escalation beds in rehabilitation areas reduced access to therapy and negatively affected patient experience and outcomes. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

However, the service had systems and processes in place to support person‑centred care. Staff made reasonable adjustment to meet the needs of people with dementia, learning disabilities, autism and sensory impairments. The service enabled people to be involved in their care and provide feedback through accessible information and feedback processes.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service supported ‘John’s campaign’, which supports the rights of people living with dementia to have a carer to advocate for them and be with them whenever they most need it.

The service had link nurses for specialities such as mental health conditions, physical disabilities, autism, dementia and bariatric patients. We observed a bariatric patient with an appropriate bed and equipment.

Patient feedback was gathered through an initiative called ‘observe, listen and act’ (OLA) with a focus on listening and acting on patient experiences. The team included staff from the patient experience team and a volunteer observer. Data from the most recent OLA feedback showed that the average score across the medical wards was 92% for person centred care.

We reviewed results from quality matron checks completed between November 2025 and December 2025 across 9 medical wards. The communication element included questions around personalised care plans and patients being asked what matters most to them. For 5 of the 9 wards, most of the questions had been RAG rated green (90% target). For the remaining wards, 67% to 83% of questions met the target.

The service used the SWAN model, a nationally recognised model of care that supports compassionate, dignified care for patients at the end of life (EOL). Discreet symbols were used on patient boards and on side‑room doors to indicate when patients were receiving end‑of‑life care, which supported privacy and dignity.

Quality matron checks for the EOL element included questions about the provision of SWAN end‑of‑life boxes and spiritual care boxes and individualised care plans. For the majority of wards, 100% of the questions had been RAG rated green.

Staff told us that doctors were readily available for review and escalation when required. A range of supportive resources were available for patients and families, including faith boxes, knitted hearts, fingerprints, and hair lockets.

Nursing staff completed learning disability and autism training as part of mandatory requirements. We reviewed training compliance data for nursing staff across 10 medical wards and specialities including respiratory, stroke, cardiology, endoscopy and care of the elderly. Overall compliance for the eLearning component was 100% which exceeded the trust target of 90%. However, compliance for medical staff across similar areas showed a compliance of 79%, below the trust target.

The service was in the process of embedding a 3 yearly renewal cycle for this training in accordance with national standards. However, the trust had not yet implemented the face-to-face element of the training that some staff were required to undertake in line with national requirements. Leaders told us that the trust were working with system partners to plan the delivery of this training component.

Staff knew about resources they could use to improve holistic care such as ‘hospital passports’ for patients who are autistic or had a learning disability. This resource is designed to help patients, and their family communicate their needs to doctors, nurses and other healthcare professionals. There was a ‘reasonable adjustment’ document for staff to use for patients who were admitted without a ‘hospital passport’. This highlighted patients’ needs in areas such as communication, how they express pain, mobility, sensory and what is important to them.

The service also had a learning disabilities oversight document which provided a structured daily checklist for ward managers and nurses‑in‑charge, with oversight from the lead nurse. Staff could flag patient needs on the electronic patient record system and on patient boards.

The trust had a service user strategy in place that included training and resources to support staff in meeting the needs of patients who were deaf or had reduced hearing.

Staff understood the communication needs of patients with a disability or sensory loss and saw evidence of communication boards being used. We saw communication needs posters on the wards, and posters provided staff with information on ‘easy-read’ resources and online tools that use images to support communication. Patient leaflets were available on wards and could be accessed online in different languages. Staff we spoke with knew how to request support from verbal and written language interpretation services and British Sign Language. The trust’s website was accessible in over 200 languages and had accessibility tools to change text size.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Stakeholders and partners described a strong integration between acute, specialist, and community services, with coordinated discharge planning and appropriate referrals to external and carers’ support services.

The service had a full capacity protocol, escalation procedures and a bed management meeting took place a number of times each day to address and escalate risks that could impact on patient safety, such as low staffing and patient flow and capacity issues. Staff also carried out huddle meetings and held discussions during handovers where specific patient needs were discussed.

The full capacity protocol provided guidance for staff around escalation during periods of high demand. The protocol stated temporary escalation spaces could be utilised when the department reached operational pressures escalation level (OPEL) 3 and prolonged use of non-designated escalation spaces could be used if the department operated at OPEL 3.5 or above.

Staff and managers told us that maintaining the flow of stroke patients was a challenge, and both stroke rehabilitation wards were always at full capacity. The service covered a large footprint in Greater Manchester, with patients being transferred from North Manchester, Oldham, and Rochdale providers. Managers told us work was underway to mitigate these issues, including through a review of their estates and ward configurations.

Patients could access a Hospital at Home (virtual ward) service to support choice and personalised care, providing short‑term acute care and monitoring at home as an alternative to hospital admission. The service supported admission avoidance and earlier discharge, with care provided for up to 14 days and a 72‑hour rapid response option for hospital admission if needed.

The service operated a general respiratory Referral Assessment Service (RAS) for adults aged 16 and over, providing advice and triage for routine and urgent referrals, including asthma, COPD and interstitial lung disease. Clear referral criteria and guidance on required investigations were in place for GPs.

The service provided specialist outpatient assessment for complex lung conditions, with access to investigations such as CT and lung function testing. A structured referral process ensured appropriate investigations were completed and timely appointments provided, in line with national best practice.

We reviewed 16 patient records across 4 medical wards to look for timely reviews and plan of care. Records showed that where appropriate, all patient’s had been seen by a consultant within 14 hours of admission and had been appropriately reviewed. Records included a documented medical history, evaluation and plan of care. Appropriate referrals had been made to allied health professionals (AHP) and relevant clinical pathways had been completed. We found most records were structured, legible, complete and up to date, with few errors or omissions.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The Accessible Information Standard (AIS) is a legal requirement introduced in 2016 to ensure that adults and children who have a disability, impairment or sensory loss receive information in a way that they can access and understand, and any communication support that they need is identified, recorded and provided. The service was compliant with the AIS standards. For example, staff could access a trust-wide interpretation and translation service. The service had an up‑to‑date and comprehensive interpretation and translation policy that provided clear guidance for staff on accessing this service.

We saw notice boards across the medical wards that included information for staff, patients and visitors. Information leaflets were readily available. Information leaflets could be provided in different languages or other formats, such as braille or easy read format, if required. Staff could access a variety of resources such as communication books, picture books or QR codes that could be scanned for information. Information about the medical wards was accessible on the trust’s website.

Most patients said they were involved in planning their care, and relatives told us they were updated about changes to care during visits or via telephone. Feedback included “If I have any questions, staff always answer them or go away and come back and find out the answer”. However, some patients told us that they had not been given clear explanations about their plan of care, how long they might remain in hospital, or the next steps in their treatment.

We observed a doctor explain scan results and next steps clearly and sensitively to a patient and relative. The doctor was polite, informative, and allowed sufficient time for questions. When the patient raised a query about medication on discharge, the doctor provided an initial explanation and appropriately contacted the pharmacy team to request a ward visit for further support.

Patient feedback was gathered through an initiative called ‘observe, listen and act’ (OLA) with a focus on listening and acting on patient experiences. The team included staff from the patient experience team and a volunteer observer. Data from the most recent OLA feedback showed that the average score across the medical wards was 86% for the communication metric against a 90% target.

The Palliative Support Line operated on weekdays to provide advice and signposting for anyone in Bury affected by a life‑limiting illness, with staff using their palliative care expertise to direct callers to appropriate support.

Information around performance, safety incidents, audits and complaints was shared with staff during daily huddles and routine staff meetings.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

We identified a regulatory breach in relation to complaints during our previous inspection in August 2022. We found significant improvements had been made in relation to this breach during this inspection.

The service had processes in place for patients to share feedback at all stages of their care. This included digital platforms such as QR codes and SMS, as well as paper-based and verbal feedback routes. Patient experience groups were also held monthly to review learning and share improvements from patient feedback. Patients we spoke with knew how to give feedback about their experiences of care.

We also saw information posters about the patient advice liaison service (PALS) process on how to make a formal complaint.

We looked at patient feedback data for the medical division between August 2025 and January 2026. The data included responses from 3414 patients and the average score showed that 92% of patients had selected ‘very good’ or ‘good’ for the ‘listen and involve’ metric.

Patient feedback was gathered through an initiative called ‘observe, listen and act’ (OLA) with a focus on listening and acting on patient experiences. The team included staff from the patient experience team and impartial volunteer observers. At the time of our assessment all 12 wards were RAG rated green overall (90% or above).

Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. At handover meetings, staff routinely referred to the psychological and emotional needs of patients, their relatives and carers.

Staff understood the policy on complaints and knew how to handle them. Ward managers and more senior staff had a clear knowledge of how complaints were reviewed and fed back. They demonstrated a clear understanding of the factors contributing to complaints and the improvements made in response.

The service had a patient advice and liaison service (PALS) and complaints handling policy in place that was in date. At the time of our assessment, the division of medicine received a total of 154 complaints over the previous 12 months. Data showed that the division had closed 100% of complaints that were due to be closed for most of the months.

During our assessment we reviewed 3 recent complaint responses completed by the division. We saw that the complaint responses included apologies and the complaints were investigated thoroughly. The complaints had been investigated by appropriate staff such as a lead nurse and overseen by the divisional director of nursing. We saw that an action plan and learning was included in a response where the complaint had been upheld. All complaint responses included information on how to book a local resolution meeting (LRM) with relevant managers at the service. The responses included how to escalate the complaint to the Parliamentary and Health Service Ombudsman (PHSO) if the complainants were not satisfied with the response. There was also an option to provide feedback on their experience of the complaint process.

The complaints policy outlined that the aim was to resolve formal complaints within 25 working days of receipt of the complaint. We saw that 2 complaint responses had met this target and 1 had taken 30 days.

The service recorded the lessons learnt from complaints. We saw that improvements had been identified around communication, including clearer information sharing with patients, managing expectations about referrals and waiting times, and ensuring concerns were shared across wider teams for learning.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

We requested information about the number of patients placed on wards that were not best suited to meet their needs (also known as outliers). We were told that acute and speciality medical beds made up the vast majority of the inpatient bed base at the hospital, and as a result the service did not routinely have medical outliers on a day‑to‑day basis.

During periods of escalation, the bed escalation plan was activated to open up to 8 additional medical beds within the surgical area, with nursing care provided by surgical staff and medical oversight retained by the general medical team. The trust advised that this had not been enacted since December 2024.

Staff told us discharge delays were mainly due to a lack of suitable care placements and complex social needs. At the time of our assessment, the main reasons for days kept away from home were capacity constraints (50%), particularly limited home‑based and bed‑based rehabilitation and reablement services, and delays within the care transfer hub (25%) related to pathway decisions and outstanding referrals.

The service monitored patients without criteria to reside using the term “days kept away from home” (DKAFH) to emphasise system responsibility. This described patients who were medically ready to go home but remain in hospital while ongoing care or support is being arranged. DKAFH patients were tracked through a live app and performance dashboard. Data showed improvement in 2025/2026, with fewer patients and bed days without criteria to reside compared to 2024/2025, and most months meeting the target of fewer than 45 patients.

In 2024/2025, average daily bed days lost regularly exceeded targets, ranging from 495–1115. Performance improved in 2025/2026, with bed days lost reducing to 406–784 and several months meeting the target of fewer than 500.

DKAFH data was validated daily by the integrated discharge team (IDT) and shared across hospital, community partners, and Greater Manchester (GM) forums. Leaders told us that significant system-wide work had improved understanding of discharge pathways and reduced delays.

The IDT was based in the hospital and staff told us that the team visited wards regularly, attended board rounds, and participated in cross‑locality meetings to provide updates and escalate issues as needed. Longest‑stay patients were reviewed weekly with (integrated care board) ICB colleagues, and complex cases had weekly walkarounds. Multidisciplinary team (MDT) meetings were held to support timely discharge, and weekly Long Length of Stay (LLoS) meetings reviewed all long‑stay patients.

The acute respiratory care unit (ARCU) had carried out an audit of discharge delays in June 2025 to better understand the scale and causes of delayed discharges for medically fit patients on this ward. The audit included patients over 10 consecutive days who remained in hospital more than 24 hours after being medically fit. Data showed that over the 10‑day period, a total of 96 bed‑days were lost and an average 10 lost bed‑days per day. The audit found that 80% of delays were caused by three factors: awaiting 24‑hour package of care (32%), awaiting social care assessment (29%) and awaiting rehabilitation (19%).

An action plan had been implemented to reduce avoidable delays. This included medical teams initiating social care assessment referrals one day before the expected discharge date, and social workers assessing patients within 12 hours of receiving the referral to support timely discharge and improved patient flow.

Ward 18 (acute medical and dementia) provided care to patients specifically for those with dementia. The ward had recently moved from another ward location to increase patient numbers to 22 and had a dementia hub. Funded establishment for HCAs had also been increased, and the ward also had a patient activity coordinator 7 days a week. We observed patient feedback about the dementia hub that highlighted how the activity area helped keep patients stimulated and provided a calmer, less clinical environment.

Patients living with dementia had access to post treatment support through the dementia discharge front runner service. This provided short‑term support for patients living with dementia following discharge from hospital or attendance at accident and emergency (A&E). The service offered up to 3 weeks of free support to help patients and their families transition back to their place of residence.

The front runner service worked collaboratively with the local council’s technology enabled care (TEC) service to enable early access to technology‑enabled support without the need for a formal assessment. Supportive care devices included door sensors, bed and chair sensors, movement monitors and smoke detectors.

We scored the service as 1. The evidence showed significant shortfalls. Leaders did not take effective or timely action to support people who are most likely to experience inequality in experience or outcomes.

Access to equitable stroke rehabilitation care was poor, which negatively affected patient experience and outcomes. Psychological support was commissioned only for ward 20 (male stroke rehab ward) with no psychological support commissioned for ward 21 (female stroke rehab ward). The absence of clinical psychology provision for the female ward had been on the divisional risk register since 2021. The inequitable service model was recognised as a high risk, and leaders had identified adverse impacts on rehabilitation progress, length of stay, and patient outcomes. At the time of our inspection, little progress had been made to update or change the service level agreement. As of January 2026, the service was due to present a staffing proposal to address the risk.

Ongoing pressures on stroke inpatient flow also impacted on equity in experience and outcomes. The use of escalation beds, environmental constraints preventing bariatric patients from accessing rehabilitation wards, and limited multidisciplinary input on the acute stroke ward meant some patients were unable to receive the same level of rehabilitation support. This risk had been added to the divisional risk register in 2022 and was rated as a significant risk. As of January 2026, a stroke flow collaborative was planned over the next 12 months to improve inpatient flow.

During our assessment, ward 21 had 8 escalation beds in use. This included the use of the rehabilitation gym room, which reduced the availability of physical therapy for patients admitted to this ward. Data shared by the service showed that escalation into the gym room occurred for 61 days in 2025.

Staff told us that the use of escalation beds in the gym room limited their ability to deliver effective rehabilitation care. They described the placement of patients on the ward as unfair and inappropriate, as a lack of space meant assessments and therapy sessions were frequently missed. Staff said patients were aware of the impact, with some becoming distressed after being unable to access the gym and experiencing slower rehabilitation progress. During our assessment, staff were unable to complete a planned kitchen assessment for a patient as the area was being used for a staff meeting.

Staff reported that missed appointments were routinely escalated and documented, including the reasons such as lack of space or inability to use the gym. However, they said this had not resulted in feedback or changes. Staff told us the environment was a significant barrier to delivering equitable care and achieving effective patient outcomes.

We shared our concerns with managers and leaders, and they acknowledged that repeated use of escalation beds had placed significant pressure on nursing staffing, rehabilitation resources, and the ward environment. During our assessment, a further risk was added to the risk register and rated as high due to the increasing risk of compromised quality of care and patient experience. Controls included the existing staffing escalation plan, completion of Safe Care reviews 3 times a day with the ability to flag risks, and oversight from a 24‑hour site team.

Staff were able to describe the processes for embedding equity including how they ensured they did not discriminate, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions.

Most staff across the medical division had completed mandatory training in equality, diversity and human rights and training compliance and had met the 90% target. Staff were able to give examples of how they respected the individual wishes of people with protected characteristics, such as those with a disability or mental health needs and patients with communication or language difficulties.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including about their care and plan their future care while they had the capacity to do so.

Staff utilised advanced care plans for palliative and end of life care patients and followed the SWAN model of care to promote dignity, respect and compassion at the end of life. Staff were able to give examples of how they were able to facilitate the prompt discharge of patients who wished to receive their end of life care away from a hospital. Staff could access a specialist palliative care team, including for bereavement and counselling support. A multi-faith chaplaincy service was available for spiritual or religious support to patients and relatives of all faiths and beliefs.

For the national audit of care at the end of life (NACEL) 2024, out of 10 metrics, most were better than the national average.

Staff on the discharge unit told us that historically, if patients deteriorated and required end-of-life care they would need to be transferred back to a medical ward. To improve patient experience, staff on the unit had started to complete training to support patients on end‑of‑life and palliative care, including syringe driver training. The palliative care team had also provided training on communication with families and care pathways. The aim was to amend the admission process so that patients could then receive appropriate care on the unit without needing to be moved.

Patient records we reviewed showed that ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) was documented and discussions with the patient and family members was evident. We saw evidence that patients were placed on appropriate clinical pathways which supported care planning for complex needs, end of life care and alcohol withdrawal.