Royal Oldham 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

We rated responsive as good. We assessed 7 quality statements.

Staff understood the diverse health and care needs of people and the local communities. Appropriate, accurate and up-to-date information was provided in formats tailored to individual needs. People could access the care, support and treatment they need when they need it. The service actively sought out and listened to information about people who were most likely to experience inequality in experience or outcomes. Care, support and treatment was tailored in response to this. 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.

However, although staff understood the importance of person-centred care, they did not feel they had the time or resource to ensure person centred care was always given. Patients did not always know how to give feedback about their experiences of care and support including how to raise any concerns or issues. Some patients felt that communication from clinicians was limited and complaints were not always responded to in a timely way.

This service scored 68 (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 understood their condition, care and treatment options, including any associated risks and benefits. They told us staff provided advice, and reasonable adjustments had been made, where necessary, for them to receive the most appropriate care and treatment.

Patients and those close to them, including carers and dependents were regularly involved in planning and making shared decisions about their care and treatment so it was centred around them and their needs.

Between 22 July 2024 and the 22 August 2024 34% of patients strongly agreed and 22% agreed their additional needs were met by staff. Thirty per cent of patients surveyed did not have any additional needs which required meeting.

Staff understood the importance of person-centred care, in that healthcare should be focused on the individual, rather than just treating the medical condition. However, staff did not always feel they had the time or resource to ensure person centred care was taking place. For example, staff told us they were supposed to support patients changing sanitary pads hourly and if requested, but this was often impractical due to the demand placed on them.

Staff knew about resources they could use to improve holistic care such as ‘this is me documents’ and ‘health passports.’ They told us these documents were not always completed due to demand placed on them.

Staff told us how they made reasonable adjustments where necessary to ensure patients receive the most appropriate care and treatment. Staff told us how they supported patients to continue practicing their faith, including an example of a patient with a strong faith being supported to attend the prayer room daily.

Staff provided further examples of how they supported patients with difficulties hearing or communicating. Pictorial signs, technology or assistance from interpreters or translation services were used to support them.

Patients care plans fully reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act.

Patient records had patient centred individualised assessment of care needs and care plans appropriate to needs. Care plans reflected the individual needs of the service user including de-escalation techniques, if bay tagging was required and if they were at risk of falling. Most patients who were at risk of malnutrition had an appropriate care plan in place.

There was evidence family and carers had been involved in the planning of their care. Handover minutes provided clear treatment plans which were individualised for each service user.

Traffic lights care plans were in place for patients with learning difficulties. The care plan was adapted to support the unique needs and challenges a person with learning difficulties will face.

The nursing accreditation and assessment system audits, at the time of the assessment, for person centred care showed 50% of wards were green, 37.5% amber and 12.5% red. Most wards and areas performed well, however ward T4 scored amber or red consecutively for their last 3 assessments.

We saw ‘this is me’ documents which are used to provide healthcare professionals with essential information about a person’s history, preferences and daily needs to ensure personalised and compassionate care however these were not always completed.

There was an instance whilst we were on F6 which we observed a patient who had been left unattended to for a number of hours. The patient was apprehensive to understand the next stages in their treatment and felt ignored.

There were some concerns raised regarding the CFM in relation to person centred care. Information on CFM is reported under the safe systems, pathways and transitions and governance, management and sustainability quality statements.

Patients told us their care met their health needs.

Patients said their care was reviewed by the nurses, consultants and further professionals involved in their care including dieticians and physiotherapists.

They said other services they were involved with, such as the physiotherapy and the speech and language teams, were flexible and joined up with the division.

Staff were aware of the need to report breaches of the standards for mixed sex accommodation.

Staff told us they could access emergency support for patients with mental health problems, learning disabilities and dementia 7 days a week.

Senior staff were aware of the challenges for the hospital and the community. Senior leaders explained how deprivation in the area had contributed to more young people enduring long term health conditions such as chronic obstructive pulmonary disorder and explained how the division was trying to meet these challenges, an example of this being more respiratory beds being commissioned, as well as the respiratory wards being co-located.

Partners told us the trust was an ‘integral member’ of the integrated care partnership which aimed to improve outcomes for local communities. Partners also told us the division considered people’s diverse culture and specific needs, choices and preferences.

Leaders for the division planned and organised services, so they met the changing needs of the population.

Leaders worked closely with community stakeholders, including commissioners to review any changes.

Progress was being made to improve the layout of the wards. This included work to co-locate respiratory wards to support streamlining service user care, ensuring specialised staffing and expertise is available, enhancing collaboration, learning and sharing resources.

The division had systems which ensured patients in need of additional support got it. Specialist lead nurses were accessible. Other support included speech and language therapy, physiotherapy, dieticians and mental health support.

The division had access to the integrated care team who supported with patients’ discharges from hospital.

There was no dedicated non-invasive ventilation unit which can lead to variations in care quality and difficulties managing the support for patients with specific breathing requirements.

There were some concerns raised regarding the CFM in relation to care provision, integration and continuity. Information on CFM is reported under the safe systems, pathways and transitions and governance, management and sustainability quality statements.

Most patients told us the advice they got from staff was accurate, up-to-date and was provided in a way they could understand. However, some patients felt communication from staff was limited and often needed to prompt them to provide an update regarding their care

Staff told us information was tailored to meet the individual needs of patients. They were aware of how to access interpreters and translators. Staff provided examples for patients on the wards who they had made reasonable adjustments for. One staff member explained how they were using electronic tablets and pictures to support a service user whose first language was not English and had additional complex needs.

Staff told us they received training in information governance and confidentiality, and they could easily access information such as care records, policies and guidance relevant to their role.

Staff were aware of the importance of managing information responsibly and confidentially

The division made adjustments for people with disabilities, communication needs, and for people whose first language was not English.

Information we reviewed about patients met data protection legislation requirements.

Information such as policies and guidance were available on the trust’s intranet.

Information was provided to patients and their families in various formats. The wards had service user information leaflets and information boards which people could access. However, we did not see a wide range of leaflets provided in different languages or more accessible formats such as a larger font for those who were visually impaired.

Patients did not always know how to give feedback about their experiences of care and support including how to raise any concerns or issues. We asked 12 patients how they would raise concerns, and we received a mixed response. Some said they would ask their relatives to find out, some would speak to staff themselves, and others understood how to access the patient advice liaison service (PALS).

Patient experience audit data showed patients knew how to make a complaint but that they were not always aware of the PALS process.

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. We were told complaints were tracked and triaged and the deputy director of nursing had oversight of these. Complaints were investigated by the lead nurses.

Senior leaders understood the importance of involving patients, their families and carers in the complaints process to promote improvements in patient safety and experience.

Staff told us learning from complaints and other feedback from patients was fed back to them via newsletters and daily safety huddles or handovers. Staff were able to tell us about the most prevalent complaints for the ward which they worked on and how they used patient feedback to improve daily practice.

In total, the division received 131 patient advice liaison service (PALS) enquiries and complaints in the six-month period from 1 March 2024 to 31 August 2024. Data showed 84% of PALS cases were responded to within 5 days. However, compliance with complaints response timescales was 59% with the target being 80%. We were told complaints compliance had been impacted by staff availability but that the trust were in the process of recruiting more staff.

Information about the PALS team was not always displayed in patient areas of the wards.

Some of the wards had ‘you said’, ‘we did’ posters which gave recent examples of how the division had responded to patient feedback. However, some of the posters were quite dated, such as on F10 which referenced a complaint and action raised in June 2023.

During our assessment we reviewed 3 recent complaint responses completed by the division. These showed the complaints were investigated and responded to thoroughly and in an open and transparent way.

The division provided some examples of actions taken in response to complaints. One example was a poster being displayed on the AMU to remind patients and staff of the importance of being quiet whilst patients were sleeping. Another example related to a complaint about a patient’s discharge home without physiotherapy support in place. The physiotherapy team now attended board rounds earlier in the day so that they could identify and prioritise patients who were likely to be discharged.

Patients we spoke with were generally pleased with the access to care, treatment and support they had experienced. Overall, patients felt staff were attentive and that tests and procedures had been timely.

Patients said they were listened to when they wanted to share their experiences.

Patients felt the physical premises were accessible.

Disabled patients we spoke to felt reasonable adjustments had been made for them and staff supported them to overcome barriers to ensure equal access.

Staff worked hard to remove any barriers to access for patients. There was a strong culture to prevent discrimination and inequalities supported by training and guidance.

Patients remained in hospital after being medically ready for discharge. Between February and June 2024, the main reasons for delayed discharge were waiting for residential home placements, bed-based rehabilitation, or non-acute NHS care. Between March and September 2024, bed occupancy averaged 88%, with 20% of patients staying over 6 days, 9% over 14 days, and 5% over 21 days.

Due to the pressure on medical bed availability, some patients were placed outside of general medical wards, such patients were known as ‘outliers.’ Between June and September 2024, there was an average of 17 medical outliers per day which indicated ongoing capacity challenges. However, the trust had a clear operating procedure for medical cover of outliers.

The division provided evidence of 12 critical care step downs being delayed between June and September 2024 which impacted new critically ill patients being admitted.

The trust did not always meet national targets. For example, the NHS 2024–25 annual plan required 70% of cancer treatments to be delivered within 62 days of referral. The haematology service missed this target in 4 of the first 8 months of 2024, though 82% of patients who breached the target had started on another pathway or were referred from other centres. A trust-wide review of haematology breaches was planned to address these issues.

Despite challenges, the division outperformed trajectory targets in several areas. This included referral to treatment times for patients waiting for treatment for 52, 65 and 78 weeks. In August 2024, the division had an average performance of 82% for meeting the 28-day target in relation to cancer care, which exceeded the NHS target of 77%.

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

People told us their needs and preferences were assessed and understood by staff. They told us they were treated in a non-discriminatory way.

Staff told us they treated people equally and without discrimination. They were able to give examples of how they respected the individual wishes of people with protected characteristics, such as those identifying as transgender and people with communication or language difficulties.

The provider’s equality and diversity policy outlined the processes for equal opportunities including how staff ensured they did not discriminate, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions.

Patients felt they were supported to make informed choices about their care and plan their future care.

Patients felt involved in developing personalised care plans and had discussed their wishes regarding cardiopulmonary resuscitation.

Staff and leaders supported patients to make informed choices about their care and plan their future care when they were approaching the end of their lives.

Staff were aware of the ethos of the SWAN (sign, words, action and needs) model of care which supports staff in their delivery of end of life and bereavement care. They recognised the importance of being clear, honest and compassionate when conversing with patients, their families and carers during this time. They recognised the need to take appropriate actions to ensure patients were pain free and comfortable.

Staff had access to resources to support patients who were on end-of-life care including a SWAN box which included items to support patients and loved ones both practically and emotionally.

The division utilised the SWAN approach, which was designed to provide compassionate, individualised care to patients in the final stages of life.

Side rooms were provided for patients and their families if the service user was on end-of-life care. However, we saw these were not always available straight away.

A transfer for care team were in place to support patients who needed to be transferred to a hospice for end-of-life care.

We reviewed care records for some patients who were on end-of-life care. We found the appropriate forms and referrals were completed, care plans were personalised, and anticipatory medicines had been agreed.

The nursing accreditation and assessment system audit data for the division (not including F6) showed 50% of the wards being scored green (showing good compliance), 37.5% amber (showing moderate compliance) and 12.5% as red (showing poor compliance) in relation to the expected standards for end-of-life care.

There were some concerns raised regarding the CFM in relation to planning for the future. Information on CFM is reported under the safe systems, pathways and transitions and governance, management and sustainability quality statements.