Royal Oldham Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as requires improvement. We assessed 6 quality statements.

Staff comprehensively assessed people, so the care and treatment provided met their needs. This included both their mental and physical health and any personal circumstances that needed to be considered. Staff worked in a strong culture of evidence-based practice. Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care.

However, risk assessments were not always carried out in a timely way, fluid balance and nutrition charts were not always completed and there was no access to a nutrition team. Some staff and partners felt that discharges could be improved by better multidisciplinary working and some patients did not feel fully informed about their plans of care. National audits carried out had mixed outcomes and the hospital appeared not to have participated in some national audits. Wards that had been assessed as performing poorly did not have robust action plans in place to monitor improvements.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most patients felt they had been assessed appropriately and their needs had been fully considered. Patients said they felt involved in the assessments undertaken.

Staff were involved in the assessment of patient’s needs and provided support where needed to maximise their involvement.

Staff understood patients’ communication needs required assessment.

Staff kept assessments up to date and understood patients’ current needs.

Patients were assessed using a range of assessment tools. We reviewed 10 care records and found all had appropriate risk assessments including falls, moving and handling, pressure damage, venous thromboembolism (VTE), and bed rails. However, internal audits showed compliance for risk assessments being completed in a timely manner was variable. For example, the GMU risk assessed 50% of patients for moving and handling and bed rails within 6 hours in August 2024.

There were some concerns raised regarding the CFM in relation to how patients’ needs were assessed. Information on CFM is reported under the safe systems, pathways and transitions and governance, management and sustainability quality statements.

Patients told us staff informed them of good practice which was relevant to their care.

Patients and relatives we spoke with said their nutrition and hydration needs were met. Patients told us there was a wide range of food choices which met specialist nutrition and hydration needs.

Staff told us they followed policies and guidelines to deliver care. Staff showed us how they could view the trust’s intranet system on the wards.

Staff explained any changes to practice or policies were discussed regularly in team huddles and the practice-based educators would implement training when required. Staff were able to provide recent examples of guidance/practices being updated.

Some staff, such as dieticians, told us they were not able to follow best practice guidance for observing patients for 45 minutes after eating because they did not have the workforce to do this effectively.

Dieticians told us fluid balance and nutrition charts were not always completed which made it difficult for them to complete their assessments.

Staff, including some from T4, told us it was difficult to maintain nutrition and hydration charts for patients due to demands on staff. Leaders were aware of performance regarding nutrition and hydration processes and were completing monthly walk arounds with the dietician and governance lead to review if documentation had been completed.

Staff were aware of the MEED guidance and an eating disorder dietician had been employed by the trust, however felt the guidance and advice, although clear, was unrealistic and impractical in an acute setting. For example, staff told us MEED guidance required staff to monitor patients following mealtimes. However, staff felt they did not have the workforce to fulfil this.

The endoscopy service was not awarded Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation when it was assessed in September 2023 and some key actions were still outstanding in April 2024.

Staff supporting patients with non-invasive ventilation (NIV) were appropriately trained.

Most of the policies we reviewed were in date and had a review date, however the adult observation practice policy was last amended in 2018 and should have been reviewed in 2021.

Pathways and guidelines reviewed were found to be in line with national guidance.

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.

The service performed worse than the trust target of 90% for inpatients being screened using the MUST within 12 hours of admission. In July 2024, 3 wards did not achieve the target for screening within 24 hours.

The division had identified a risk in relation to complaints and incidents within the last 12 months linked to nutrition and hydration and a review of incidents was being undertaken.

The division did not have access to a nutrition team. Leaders were actively recruiting staff.

The trust had policies and procedures in place to support patients with eating disorders which referenced the MEED guidelines. There was a consultant allocated to patients who had eating disorders to provide wrap around support. The overall compliance rate for staff trained in supporting patients with eating disorders for the division was 90%.

A system for patients requiring support with their nutrition and hydration needs was in place but patient feedback from April 2023 and April 2024 showed that the red tray system was not being utilised effectively for 5 out of 7 of the wards.

Wards had protected mealtimes, which allowed nurses, HCA’s and sometimes volunteers to be available to support patients.

Patients generally felt staff and teams worked well together, however some told us information was not always passed on about them or their care plan in the way they would have expected. We were told information was sometimes not conveyed well to staff when patients moved between wards or had come from the emergency department.

Overall, nursing staff, HCA’s, AHP’s and medical staff told us they had good working relationships with their fellow professionals across the division.

Nursing staff spoke highly of the working relationships between them and the transfer of care team, the dieticians and most provided positive feedback about the mental health liaison service.

Some staff felt the exclusion criteria for a referral to physiotherapy was too strict which had led to them not referring or overexaggerating on referrals to ensure patients were seen. They recognised this was due to a shortage of physiotherapists.

Staff felt more multi-disciplinary team (MDT) meetings were needed to support more timely discharges. We were told gastroenterology did not have access to a nutrition team which meant some patients, who required support with eating and drinking, were not being discussed in MDT meetings. Staff told us under representation of nutrition and dietetics on the ward was leading to delays in supporting patients with dislodged nasogastric tubes. Ward staff were hoping for funding for a nutrition nurse and dietician training post to become available.

Mental health liaison staff, and staff from an independent ambulance crew, told us information was shared between teams and services which ensured continuity of care. They said they had good working relationships with the medical division staff overall but that an increased understanding, amongst the hospital staff, of mental ill health could be beneficial.

Ambulance staff we spoke to told us ward staff were helpful in ensuring patients were ready to be supported by them when being discharged.

Two care homes told us the division did not always work effectively with them. The first told us the division can often contact them multiple times to ask the same questions about a patient who usually lives at the care home. The second stated there had been ‘numerous occasions’ where they had to speak to the hospital to repeat information about residents, who were being admitted to the hospital, as they felt it had not been handed over appropriately.

We observed staff working well together. We attended board rounds and witnessed a variety of staff providing detailed input for each patient which included discharge planning.

The board rounds were attended by a physiotherapist, a nurse, a member of the transfer of care team and all grades of doctors. The team were observed to work well together in reviewing all patients and ensuring appropriate plans and pathways were in place.

We observed patient records which clearly documented input from the MDT.

We witnessed an example of staff from the mental health liaison service and the trust working together to support a patient with mental health issues and de-escalating a challenging situation.

A pulse survey from quarter 2 of 2024-2025 highlighted 67% of 58 staff on the medicine division felt teams supported one another compared to the trust’s average of 76%. In addition to this, 60% felt the team worked well together and 51% felt disagreements were dealt with constructively which were both worse than the trusts average.

The division had access to alcohol services, mental health services and physiotherapy services 7 days a week. Speech and language therapy and tissue viability nurses were available 5 days a week.

Handovers were completed at the end of every shift. They were completed using the SBAR (situation, background, assessment, recommendation) communication tool.

Patients we spoke to felt staff supported them to manage their own health, care and wellbeing needs by.

We spoke with liver nurse specialists who explained how they attend all board rounds to find out more about the patients they were supporting.

Staff told us patients who required support with alcohol or smoking were referred to appropriate services.

Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle.

The division had relevant information promoting healthy lifestyles and support on the wards. Information leaflets were readily available for patients and their families and carers. However, some leaflets did not display up to date information about the trust.

The division had regular audits completed by the patient experience team which led to observe, listen and act reports. The most recent audits showed over 90% of patients were aware of the importance of being active in aiding their recovery.

Patients we spoke to told us they had felt better since being admitted on to the wards.

Managers told us the division took part in national and local audits and that outcome data was formally reviewed and action plans developed to improve indicators which did not meet expected national outcomes.

Staff told us managers reviewed outcome data to identify the need for improvements. For example, audit data showed there had been a higher than usual number of falls on T4, therefore managers ensured ward staff received additional support with regards to falls prevention.

The division participated in some relevant national audits including the dementia audit, the national adult asthma audit, the national heart failure audit and the myocardial ischaemia national audit (MINAP) However, the trust did not provide evidence the division participated in some of the audits we would have expected them to. For example, the trust did not provide evidence of national bowel or lung cancer audit submissions.

The division completed various local audits including some on the management of suspected metastatic spinal cord compression, secondary prevention in acute coronary syndrome and a protocol introduction for switching intravenous antibiotics for oral use.

The division undertook audits as part of the trust’s nursing accreditation and assessment system. The nursing accreditation and assessment system audits measured the quality of nursing care delivered by individuals and teams and provided evidence teams were meeting the Care Quality Commission’s (CQC’s) fundamental compassionate care standards. The nursing accreditation and assessment system audits measured 13 standards covering areas including patient safety, infection control, safeguarding, medicines management and several other key care standards.

The hospital performed worse than the national average on more indicators than not on the asthma audit, national asthma and COPD audit and heart failure audit. Action plans were in place for audit results which identified some cause for concern in relation to the key standards of care being provided. These included action plans for dementia care and asthma care for adults.

Reassessments of the nursing accreditation and assessment system audits were not carried out in a timely manner for any of the wards we received data for. For example, the GMU scored a rating of red in January 2023 which should have triggered a reassessment for March 2023, however the next assessment was in November 2023. The GMU scored a rating of red again and were only reassessed following that in August 2024.

The GMU consistently performed poorly on the nursing accreditation and assessment system audits with 3 consecutive ratings of red. The data provided showed which standards needed improving but there were no action plans attached to the documents. We would expect the division to have action plans and to be monitoring areas for improvement.

Performance data from 2023/2024 quarter 4 highlighted concerns about the efficiency and quality of care. The average length of stay for admissions into selected medical specialties was consistently above benchmarks. Key metrics showed prolonged stays for conditions like pneumonia, pulmonary embolism, and atrial fibrillation. Emergency readmission rates for pulmonary embolism were among the worst nationally which suggested issues with discharge processes or post-discharge care. Whilst some metrics had improved slightly over time, sustained underperformance suggested inefficiencies causing risks to patient outcomes and experience.

All patients we spoke to told us they had consented to being an inpatient and to any treatment they had.

They told us their treatment plan had been explained to them in a way they could understand so they could make informed decisions about whether to proceed with treatment.

Staff understood the key principles of the MCA. Staff recognised the need for patients to consent to treatment based on all the information available. They were aware that if patients lacked capacity to give consent, that decisions would be made in their best interests, taking into account patients’ wishes, traditions and culture.

Staff explained how to access the relevant paperwork online for DoLS. They were aware of the policy and how they would get advice on the MCA and DoLS.

During our assessment, we reviewed 10 sets of records in relation to DoLS and MCA’s and found they were all completed appropriately and demonstrated compliance with legal requirements, including thorough assessments of mental capacity, evidence of best interest decisions, and appropriately authorised DoLS applications.

The trust completed an annual audit for patients with ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) documentation in place. This was led by the clinical audit team with support from the DNACPR task group. December 2023 audit results for the hospital showed good compliance with standards such as the DNACPR form being countersigned by a consultant within 72 hours (100%), the records being clearly dated, timed, and signed (96%) and the person and relevant others had been consulted/informed about decisions (96%).

The trust completed an audit which measured how compliant staff were with the MCA. The audit reviewed the 5 key standards of the MCA. Hospital audit data for the start of 2024 showed 90% compliance for the first 3 standards, 79% for the 4th standard and 83% for the fifth standard. The resulting report completed in May 2024, included action plans for each of the trust’s acute hospitals to address shortfalls in compliance.

Staff received training in the MCA and DoLS. This was included in the safeguarding training. Compliance rates are reported under the safeguarding quality statement.

We reviewed 4 DoLS applications which were completed accurately and were up to date.