• Hospital
  • NHS hospital

Royal Bolton Hospital

Overall: Good read more about inspection ratings

Minerva Road, Farnworth, Bolton, Lancashire, BL4 0JR (01204) 390390

Provided and run by:
Bolton NHS Foundation Trust

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

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Royal Bolton Hospital can be found at Bolton NHS Foundation Trust. Each report covers findings for one service across multiple locations

24 May 2023

During a routine inspection

The Royal Bolton hospital is part of the Bolton NHS Foundation Trust.​ The Royal Bolton hospital provides a full range of acute and a number of specialist services including urgent and emergency care, general and specialist medicine, general and specialist surgery and full consultant led obstetric and paediatric service for women, children and babies.​

We carried out an unannounced inspection of the services for children and young people on 24 May 2023, as part of our continual checks on the safety and quality of healthcare services.

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

Services for children and young people

  • The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
  • The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Medicines reconciliation was not always undertaken in a timely way.
  • Mental health risk assessments including environmental assessments were not always thoroughly completed.

How we carried out the inspection

We inspected this service with two inspectors, a medicines inspector, a children’s inspector and an operations manager on site.  During our inspections we spoke with a variety of staff, including allied health professionals, nurses, doctors, clinical support workers, consultants, domestic staff and volunteers. We also spoke with patients and relatives. We visited clinical areas and non-clinical areas across the hospital site. We reviewed patient records, regional and national data and other information.  

We held several staff focus groups to enable staff to speak with inspectors. The focus groups included nursing staff, allied health professionals, junior doctors, and consultants.  

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection. 

24 November 2022

During an inspection looking at part of the service

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at the Royal Bolton Hospital.

We inspected the maternity service at Royal Bolton Hospital as part of our national maternity inspection programme. The service provides care to the populations of Bolton, Wigan, Bury and Salford. Royal Bolton Hospital has approximately 5,500 deliveries each year. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

23rd and 24th November 2022

During an inspection looking at part of the service

We carried out this unannounced focused inspection of the medical and emergency department services at The Royal Bolton Hospital.

Bolton NHS Foundation Trust provides hospital and community health services in the North West sector of Greater Manchester, delivering services from the Royal Bolton Hospital and providing a wide range of community services from locations across Bolton.

Royal Bolton Hospital provides acute care to the populations of Bolton, Salford, Wigan and Leigh.

It is estimated to have a catchment population of 1,000,000; compared with a resident Bolton population of 285,000.

The emergency department is described as a type 1 (consultant-led 24-hour service with full facilities for resuscitating patients). The total attendances in October 2022 were 11250 compared with 11673 in October 2021. There are separate adult and paediatric emergency areas, a minors’ area, a same day emergency care unit (SDEC) which was re-launched (September 2022) and a pilot urgent treatment centre.

The medical service consisted of 16 in-patient wards, 54 respiratory beds with a ward based non-invasive ventilation service. Coronary Care Unit, 35 cardiology beds as well as diabetes, gastroenterology, haematology, acute stroke, acute frailty, medical assessment, three care of elderly and three escalation wards.

Bolton NHS Foundation Trust was last inspected in December 2018 and January 2019, with the report published in April 2019. The overall rating was good, well led at trust level was rated outstanding. The inspection included the emergency department, Medicine and Maternity.

Whilst acknowledging the recognised national challenge faced by urgent and emergency care services, fundamental standards of care remain paramount to patient safety.

We did not rate all the domains inspected however we rated safe in the emergency department because 2 requirement notices have been served which limits the rating to requires improvement in safe. The other previous ratings of ​good​ remain and they remain good overall.

We did not rate the medicine service. The ratings of good remains.

04 Dec 2018 to 10 Jan 2019

During a routine inspection

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

  • We rated safe, effective, caring and well led as good.
  • All services were rated as good overall.
  • The only rating of requires improvement is in children and young people’s services for safe which we did not inspect at this inspection.
  • The caring domain in medicine was rated as outstanding.

March 2016

During a routine inspection

The Royal Bolton hospital is part of Bolton NHS Foundation Trust, which provides a range of hospital and community health services in the North West Sector of Greater Manchester, delivering services from the Royal Bolton Hospital (RBH) site in Farnworth, in the South West of Bolton, close to the boundaries of Salford, Wigan and Bury; and also providing a wide range of community services from locations within Bolton.

The Royal Bolton hospital site is situated in the town of Farnworth, near Bolton. For services, in particular patients requiring non-elective treatment, it is estimated to have a catchment population of 310-320,000, compared with a resident Bolton population of 270,000.

The Royal Bolton hospital provides a full range of acute and a number of specialist services including urgent and emergency care, general and specialist medicine, general and specialist surgery and full consultant led obstetric and paediatric service for women, children and babies, including level three neonatal care and 24-hour paediatric and consultant-led obstetric services .

Approximately 110,000 people attend the trust for emergency treatment every year and 72,000 patients are admitted. Approximately 310,000 attend the outpatient departments for consultations. The Royal Bolton Hospital has approximately 740 beds and employs 5200 staff.

We visited the hospital on 21-24 March 2016. We also carried out an out-of-hours unannounced visit on 6 April 2016. During this inspection, the team inspected the following core services:

• Urgent and emergency services

• Medical care services

• Surgery

• Critical care

• Maternity and gynaecology

• Children and young people

• End of life

• Outpatients and diagnostic services

Overall, we rated Royal Bolton Hospital as good. We have judged the service as ‘good’ for effective, caring, responsive and well led. We found that compassionate, caring staff provided services and patients were treated with dignity and respect. However, improvements were needed to ensure that services were safe.

Our key findings were as follows:

Leadership and Management

  • There was a positive culture and a sense of pride throughout teams in the hospital, and staff were committed to being part of the trusts vision and strategy going forward.
  • There was effective teamwork and clear leadership and communication in services at a local level. Managers and leaders were visible and approachable. Staff felt supported by their managers and there was an open culture of transparency and communication in between teams.
  • The hospital was led and managed by an executive team that were approachable and visible. Staff knew the team and felt that they were listened to and concerns were acted upon.

Access and Flow

  • Access and flow remained a challenge, and the emergency department did not at times see, treat, admit or discharge patients within four hours. Between July 2014 and November 2015 the trust met the target to admit, transfer or discharge patients within four hours for six out of 17 months. However, the total average time spent in the emergency department between January 2013 and October 2015 was below the England average, ranging between 50 and 139 minutes.
  • Plans were in place to expand the emergency department in order to accommodate the increase in patient attendances, of which notable there had been an increase in patients attending from outside of Bolton and patients being brought in by ambulance.
  • There were some pressures with access and flow across the medical and surgical wards, including patients who were medically optimised for discharge, but awaiting further care arrangements to be agreed. Access and flow issues resulted in a number of patients being cared for on a ward outside of their speciality. Between August 2015 and November 2015, data showed there had been 208 medical outliers at the hospital. There were policies and procedures in place outlining the management of these patients to ensure that patients were seen by the appropriate medical teams at the right time.
  • The trust had put a number of initiatives in place, including theatre productivity initiatives and opening additional beds to support access and flow through the hospital. There were also established escalation procedures in place, which were supported through regular bed planning meetings.
  • The overall hospital-wide bed occupancy rate between July 2013 and December 2015 ranged between 80.8% and 88%, which rose to 91% on medical wards between January and March 2016.
  • In spite of pressures, we observed that the average length of stay for elective medicine at the hospital was shorter (better) than the England average at 2.9 days. The England average was 3.8 days. For non-elective (not planned) medicine, it was shorter (better) than the England average at 5.8 days. The England average was 6.8 days.
  • NHS England data showed the surgical and gynaecology services consistently performed better than the England average for 18-week referral to treatment standards for admitted (adjusted) patients between November 2014 and January 2016.
  • Records between April 2015 and January 2016 showed the surgical services also achieved the historical 90% standard for 18-week referral to treatment standards for admitted (adjusted) patients for general surgery, ENT, ophthalmology, urology and oral surgery during this period. However, the trauma and orthopaedics specialty (84.5%) and oral surgery (77.65) did not perform as well other specialties during this period.
  • Most patients were admitted to the intensive care unit within four hours of making the decision to admit them and a consultant assessed 100% of patients within 12 hours of admission.

Cleanliness and Infection control

  • Clinical areas at the point of care were visibly clean and trust had infection prevention and control policies in place, which were accessible to staff and staff were knowledgeable on preventing infection.
  • There was enough personal protective equipment available, which was accessible for staff and staff used this appropriately.
  • Staff followed good practice guidance in relation to the control and prevention of infection in line with trust policies and procedures.
  • Between April 2015 and December 2015, the trust reported 19 cases of Clostridium difficile, 4 cases of Methicillin-resistant staphylococcus aureus (MRSA) and 18 cases of Methicillin-susceptible staphylococcus aureus (MSSA).
  • Lessons from all cases were disseminated to staff for learning across directorates .
  • There were established audit programmes in place related to the prevention of cross infection, which included hand hygiene, infections within a central line (a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products) and methicillin-resistant Staphylococcus Aureus (MRSA).

Nurse staffing

  • The trust undertook biannual nurse staffing establishment reviews as part of mandatory requirements. As part of this, key objectives were set though this work to support safer staffing.
  • The trust was in the process of implementing a daily acuity tool to further support safer staffing levels based on patients acuity.
  • There were processes in place to ensure ward staffing levels were monitored on a daily basis. Senior nurses and matrons met each week to discuss nurse staffing levels across services to ensure that that there were sufficient numbers of staff. Staffing on a day-to-day basis was reviewed as part of the trust bed management meetings.
  • However, nurse staffing levels remained a challenge, particularly in emergency, medical and the paediatric department. Nursing staffing was identified on both operational and corporate risk registers. At the time of this inspection there were 50 nursing staff vacancies across the trust and additional posts had been made available in order to support the increased requirements across the across the hospital.
  • Staffing levels were maintained by staff regularly working extra shifts and with the use of bank or agency staff. Inductions were in place for new staff in order to mitigate the risk of using staff that were not familiar with the hospital.

Medical staffing

  • Whilst most areas had sufficient numbers of medical staff to meet patients needs, which included the use of agency staff, there were pressures within the emergency department due to increased demand.
  • Increased activity in the emergency department had meant that emergency department consultants were regularly working in place of middle grade staff to ensure the department continued to function with safe medical staffing levels. We observed that medical staff were committed to maintaining patient safety and ensuring that rotas were covered.
  • A recent review by the Royal College of Emergency Medicine had recommended an increase in establishment of consultants of 6.5 WTE, which was being considered at the time of this inspection. In addition, it had been recommended to increase medical middle grade staffing by five WTE. Whilst the shifts we reviewed showed that staffing levels were safe, we were concerned that the current use of consultants to fill middle grade shifts may not be sustainable in the long term.
  • Locum doctors were also used to boost medical staffing levels, particularly in the emergency department. Between May 2014 and March 2015, the average rate of locum use in this area was high at 21.5%.
  • The trust board had recently authorised recruitment for two middle grade doctors and relaxed the cap on locum use to assist with staffing. However, managers described difficulties recruiting due to the high volume of patients attending the ED compared with other EDs.

Mortality rates

  • Mortality and morbidity reviews were held in accordance with trust policies and were underpinned by policies and procedures. All cases were reviewed and appropriate changes made to help to promote the safety of patients. Key learning Information was cascaded to staff appropriately. Monitoring arrangements were in place at board level to ensure that any findings were acted upon.
  • The Summary Hospital-level Mortality Indicator (SHMI) is a set of data indicators, which is used to measure mortality outcomes at trust level across the NHS in England using a standard and transparent methodology. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die based on average England figures, given the characteristics of the patients treated at the hospital. The risk score is the ratio between the actual and expected number of adverse outcomes. A score of 100 would mean that the number of adverse outcomes is as expected compared to England. A score of over 100 means more adverse (worse) outcomes than expected and a score of less than 100 means less adverse (better) outcomes than expected. In November 2015, the trust score was 104.
  • The sentinel stroke national audit programme (SSNAP) is a programme of work that aims to improve the quality of stroke care by auditing stroke services against evidence-based standards. The latest audit results rated the hospital overall as a grade ‘D’ which was an improvement from the previous audit results when the hospital was rated as the ‘E’. The trust had put in place actions to improve the audit results. These included a dedicated social worker on the stroke unit and further training for staff.

Nutrition and Hydration

  • Patients and people close to them attending departments had access to food and drink whilst visiting this hospital, including a café that was open out of hours and vending machines in areas such as the emergency department.
  • Patients were able to choose from a wide range of meals, which took account of their individual preferences, including religious and cultural requirements. Most patients felt that the quality of food offered was of a good quality.
  • We found that there were policies and procedures in place to support patients nutritional and hydration needs and staff across the hospital knew how to access them.
  • The hospital used part of the malnutrition universal screening tool (MUST) to assess patient’s nutritional needs. An audit of the completion of the tool was undertaken as part of the food standards assessment and the trust scored an amber rating. Nutrition champions are now in place who undertake regular audits of nutrition and hydration standards.
  • We found that patients nutritional needs were risk assessed and results were acted upon appropriately, however on some medical wards, fluid balance charts and nutrition charts had not been completed promptly.
  • There was a system in place to identify patient in needs of assistance with eating and drinking. We found that most patients received assistance with eating and drinking as needed.
  • Staff and patients had access to specialist nutritional advice from the dietician team who responded promptly to patient referrals.
  • Breast feeding support was available for mothers after discharge. Post-natal support for breast-feeding was provided by peer support workers.

We saw several areas of outstanding practice including:

  • The emergency department had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine.
  • The emergency department offered bereavement meetings were offered to those who had lost a loved one, to help them understand what had happened.
  • Emergency department Consultants were regularly working in place of middle grade staff to ensure the department continued to function with safe medical staffing levels.
  • The radiology department had a managed equipment programme in place. This meant that equipment was serviced, repaired and replaced as part of the contract in a timely way, minimising disruption to services and reducing the need for costly and time consuming business cases when equipment needed replacing. This was an innovative way of managing high cost equipment.
  • The trust were early adopters of the neonatal behaviour evaluation scale (NBES). The scale represents a guide that helps parents, health care providers and researchers understand the newborn’s language.
  • The neonatal unit were early adopters of volume ventilation.
  • The neonatal unit introduced ‘Matching Michigan’, a two-year programme designed to reduce infections in central lines, before it was rolled out as best practice. The service was nominated for an award from the Health Service Journal (HSJ) for this.
  • The neonatal unit introduced the ‘fresh eyes initiative’, which is where nursing staff look at other nurses’ patients at 1am and 1pm to promote things not being missed.
  • There was a visible person-centred culture with caring, compassionate staff who considered the needs of patients nearing their final days or hours and their families. There were systems in place to support this, including the butterfly logo. This was embedded throughout the organisation so that any staff coming into contact with bereaved families could offer care and support where this may be needed.
  • The trust had adopted the ‘butterfly symbol’, which made staff aware of a family in need (identified by the symbol). This ensured that during difficult times families were supported (for example by staff offering drinks etc.). The scheme also ensured that the deceased’s property was put into a special bag (with the butterfly symbol on). Relatives were offered a fingerprint, lock of hair and photo (from medical illustration) of the deceased patient.
  • We observed nurse interaction with patients living with dementia on the bluebell ward, using a variety of dementia friendly strategies. Staff used aids, for example dolls, computers, karaoke and a piano. Interaction was approached in a caring way, and tailored to support each patients individual needs.

However, there were also areas where the trust needs to make improvements.

Importantly, the trust must:

  • Complete mental health assessment forms in the emergency department as soon as practicable and ensure these are distributed and used where appropriate.
  • Improve appraisal rates in the emergency department.
  • In the emergency department, Improve the focus on audits, ensuring clear action plans are formulated and progress regularly tracked to improve outcomes
  • Ensure that robust information is collected, analysed, and recorded to support clinical and operational practice in medical services.
  • Must ensure that there are sufficient staff with the appropriate skills on wards.
  • Must ensure that records are kept secure at all times so that they are only accessed and amended by staff.
  • The trust must ensure that staff are up to date with appraisals and mandatory training in medical wards.
  • The trust must ensure that paper and electronic records are stored securely and are complete in outpatients areas.
  • The trust must ensure that essential safety checks are completed and records of checks are maintained to provide assurance that all steps are being taken to maintain patient safety in outpatients.

In addition the trust should:

In urgent and emergency care services :

  • Ensure building work continues at a suitable pace.
  • Improve staffing levels in the emergency department with an aim to reducing agency and locum rates.
  • Review the security arrangements for both paediatric entrances to ensure the trust is satisfied the risk is mitigated as far as possible.
  • Consider the addition of facilities appropriate for adolescents in the paediatric area
  • Review the number of computer terminals in the clinical areas to ensure this meets the needs of staff during peak periods.
  • Continue to work to improve figures in relation to Department of Health targets.

In medical care services :

  • The trust should ensure that hazardous chemicals are stored appropriately in a locked cupboard when not in use.
  • The trust should ensure that patient is discharged as soon as they are fit to do so.
  • The trust should wherever possible ensure that patients are cared for on a ward suited to meet their needs.
  • The trust should ensure that patients’ privacy and dignity is maintained at all times
  • The trust should ensure that equipment and facilities in the endoscopy mobile unit are fit for purpose
  • The trust should ensure that procedures and assessments in place to provide safe care are completed correctly. Especially comfort round and fluid and nutrition charts and assessments.

In surgical services :

  • Take appropriate actions to minimise the occurrence of never events.
  • Take appropriate actions to improve staff appraisal rates.

In Maternity and Gynaecology :

  • Consider improving the electronic patient management systems.

Children and young people’s services :

  • Review the door exit systems on the paediatric and neonatal unit to improve security.
  • Ensure all staff working with children and young people have level three safeguarding training.
  • Ensure that there is a trained Advanced Paediatric Life Support or European Paediatric Life Support nurse on each shift.
  • Ensure there is sufficient staff to match patient acuity on the paediatric unit,
  • Ensure that all paediatric staff have a good working understanding of the Mental Capacity Act and how it works in practice.
  • Ensure the risk register highlight all risks and controls that are in place and is periodically reviewed.
  • Ensure that neonatal practitioners all have current NLS training certification

In end of life services:

In relation to DNA CPR:

  • In all cases assess and record patients’ mental capacity as part of the DNA CPR assessment.
  • Document a summary of communication with the patient, welfare attorney and/or next of kin (NOK).
  • Document consent.
  • Ensure private rooms are available to break bad news to bereaved family and friends of a deceased patient

In outpatients and diagnostic imaging services :

  • The trust should ensure that medical gases are stored safely and securely.
  • The trust should ensure that letters are provided to GPs in a timely way.
  • The trust should ensure that patients are kept informed about any delays in outpatient and diagnostic imaging services and should monitor how long patients wait to be seen.
  • The trust should ensure that the recovery plan for breast screening is completed within agreed timeframes.
  • The trust should consider participating in the Imaging Services Accreditation Scheme (ISAS) and the Improving Quality in Physiological Services (IQIPS) accreditation scheme.
  • The trust should consider how to meet the need to see patients in the TIA clinic with 24 hours over weekend and bank holiday periods.
  • The trust should consider how the privacy and dignity of inpatients can be maintained in the main radiology department.
  • The trust should consider how to manage environmental capacity in the eye unit and breast unit.

Professor Sir Mike Richards Chief Inspector of Hospitals

9 September 2013

During an inspection looking at part of the service

During the inspection we visited C2, C3, D2, F3, Maternity Theatre and the Clinical Decisions Unit (CDU). We spoke with a total of 15 staff, including medical, nursing and support staff, 10 patients and four visitors.

We observed the general environment on the wards and departments visited was clean and well organised. Public corridor areas were free from clutter and were clean. Infection control links from ward and department staff had been identified and when we spoke with them we were told: 'I take this very seriously and the rest of the staff do as well' and 'I think the whole hospital is tackling this problem much better, we can get guidance from the infection control team but then it's about making sure that guidance if put into practice'.

We spoke with patients who said: 'I think this ward is very clean, you see staff washing their hands, even the doctors use that spray', 'The ward is clean, I have been here for three days and the ward is cleaned every day', 'The staff work hard to keep it clean' and 'I am very happy with the standard of cleanliness, the whole place is much cleaner'.

The trust had, since the last inspection, committed to invest in a significant increase in nursing and support staff, with a view to reducing the use of bank staff and was on track to fill vacant posts.

We found the trust had improved systems to identify, assess and manage the risks to the health and safety and welfare of the patients using the service.

29, 30 April 2013

During an inspection in response to concerns

We spent time on:B2, C2, C3, C4, D2, E4, Bolton Community Unit, Clinical Decisions Unit, Ante Natal and Post Natal wards, Central Delivery Suite and Maternity Theatre. We spoke with 25 patients, 36 staff including medical, nursing and staff with a specialist role and visitors. We sampled 22 patient records across the wards and departments visited.

Patients we spoke with were satisfied with the care and treatment they were receiving. Comments included " I cannot fault the care I have received", "I know all the bad news in the papers but I can honestly say the staff have been great, "The staff are very busy all the time, they try their best" and "I haven't seen anything that concerns me".

We found care records were person centred, maintained to a good standard and in a chronological order. All medical and nursing entries were dated, timed and signed.

Although the trust had made improvements in infection control and prevention, these have yet to be embedded across the all wards and departments, with some shortfalls seen during the visit.

A new non executive director was taking forward governance and risk management agendas at board level, however, there was acknowledgement the board needs better assurance processes and more rigorous scrutiny. There was a need to improve and expedite the learning from serious untoward incidents and in particular to disseminate across the trust, and although this had slowly begun to improve, it was still not robust .

7 November 2012

During an inspection looking at part of the service

An inspection was undertaken in August 2012 were the trust were found to be non compliant with outcome 6 and outcome 9. Compliance actions were made and the trust submitted an action plan in order to achieve compliance.

We followed up the actions undertaken and visited four wards, we spoke with 6 patients and 9 staff members. We also sampled 12 patients care records and 12 patients medication records.

We found in care plans and daily entries, discharge planning had been initiated at the point of admission. We saw timely referrals made to other health or social care providers.

We found social services or other health agencies had been contacted in a timely manner to contribute to the effective discharge of patients. Multidisciplinary meetings were arranged to ensure that all parties participated in and were informed of the continued needs of the patient.

We found the trust were in the final stages of disseminating the reviewed medicines policy across the trust. There had been some delay as the policy had been through various governance, quality and risk assurance groups, where amendments had been requested.

The trust ensured that wards had received an appendix to the policy, in regard to self administration of medicines, whilst in hospital. This ensured that patients who chose, could continue to administer medication themselves for long term medical conditions such as respiratory conditions and diabetes.

22 August 2012

During an inspection in response to concerns

Due to the current financial posiition of the trust concerns were raised in relation to the impact on patient care and welfare and quality of services. We visited 10 wards, the Community Unit, ICU, 2 Out patient's clinics and Theatres. We spoke with 20 patients across the wards and departments we visited and also with 8 visitors.We spoke with relatives and other agencies. We were told :

'They (the staff) close the curtains and I get as much privacy as possible.'

'Staff are quick to respond if asked for help, they close the curtains and I get as much privacy as possible.'

"I can't fault it", "The service they provided is to the highest standard', 'My relative always seems to be cared for when I visit.

'I have no concerns about the care up to now", 'The staff have been fantastic, their approach and care is very good.'

'Its lovely on here always tidy and clean.'

'My friend was in hospital six months ago and this is so much cleaner now than then.'

'The matron is on this ward is brilliant, nothing is too much trouble and the nurses are very efficient.'

20 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

23 April 2012

During an inspection in response to concerns

We spoke to patients on the majority of the wards that we visited. We heard comments such as 'I think the staff do a good job, they always make sure I understand what the doctor has said' and 'Sometimes the doctor in charge doesn't speak to me directly, but then the junior doctor or the nurses explain'. One patient told us that he had asked a nurse for more information about his condition. He said that the nurse showed him pictures in a book to explain his condition in more detail, and he commented 'She was very thorough. I'm really pleased'.

Patients spoke positively about the staff they had seen. Comments included 'I have no complaints about the attitude of the staff, they are fine', 'I've always found them extremely nice and nothing is too much trouble for them' and '[The staff] are cracking. I'd always come here in the future'.

When we asked patients and their visitors about the care they had received in hospital we heard comments such as 'I can't fault it', 'The service they provided was to the highest standard', and '[My relative] always seems to be cared for when I visit. I have no concerns about the care up to now'. On one ward we spoke with five patients who all said staff asked them on a regular basis if they needed anything.

When asked about the food provided in hospital we were told 'I have no complaints about the food, it's fine', and 'I have been off my food for a while but the nurses try to encourage you to eat. They do give you something different, like a sandwich or toast'.

Some patients told us that they could help themselves to food from a kitchen on their ward, and they said that fresh fruit and fruit juice was always available.

12 October 2011

During an inspection looking at part of the service

During our visit patients told us 'I can't fault the staff, they do their best for you' and 'I can't complain about any of the nurses'. We heard that people were not kept waiting when they needed assistance, with one person saying 'I press the buzzer if I need a nurse and they come quickly'. People thought that enough food was provided, but that this was not always the type of diet they preferred.

We spoke with patients who said that they were kept informed about their illnesses and treatments and we heard 'The physiotherapist has explained what she is doing with me' and "The doctor has explained what will happen when I am discharged to another unit'.

Most people thought they had been treated in a dignified manner, but one patient who used a wheelchair did not like having to be assisted to use an able bodied toilet because the disabled toilet was not in use.

13 March and 13 April 2011

During a routine inspection

We talked with a total of 24 patients and six relatives at Royal Bolton Hospital NHS Foundation Trust.

We heard that patients felt their privacy and dignity had been protected. We were told 'Nurses and doctors have explained everything to me. I understood what I was told.' A patient who had been in this hospital two years ago told us 'The care seems better now. The staff seem more attentive.'

We were told that patients had enough choice at mealtimes and special diets were catered for. We heard from patients close to discharge that other help, such as Macmillan Nurses and counsellors had been arranged for them when they returned home.

Patients made positive comments about the cleanliness of the wards, such as 'The cleaner has cleaned every inch of the ward today' and 'There is always someone cleaning, even the top of the curtain rail with a special tool.' We were also told 'There are enough staff, and plenty on at night.'

23 March and 1 April 2011

During a themed inspection looking at Dignity and Nutrition

Both wards we visited were very busy and provided care in the main to older people. Patients we spoke with were positive about the care they received and the level of involvement they had regarding decisions around their health care treatments. One patient said she was, 'very happy with staff doing their very best for me'. Two patients said they left the detailed discussions about their health care needs to a relative. The visitors we spoke with said they were generally happy with the care their relatives received and they confirmed they were kept up to date about their health. In the main staff promoted patient privacy and dignity. We did observe however one patient requesting assistance and then waiting for 15 minutes before help was provided.

Patients spoke positively about the quality, quantity and choices available at meal times. One person with diabetes said she was offered appropriate choices at meal times. Another patient said she always had enough food and the menu always contained something she liked. We were told by one patient that if she missed a meal because she was in, for example x-ray, the staff sent down to the kitchen for a meal upon her return. However health care notes did not always record fully the nutritional assessment and care needs of patients.