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Inspection Summary


Overall summary & rating

Good

Updated 26 February 2020

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

  • The hospital had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The hospital managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients 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 patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
  • Staff treated patients 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 patients, families and carers.
  • The hospital planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the trust’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 patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However

  • We found areas of the theatre suite had not been maintained in order to reduce the risks to patients
  • We observed patient records unattended in one ward area.
  • Waiting times were not in line with national standards for some surgical specialities.
  • The surgical service did not have a clear vision for what it wanted to achieve or a strategy to turn this into action. The vision and strategy were dependent on progress in regional developments within the wider health economy. Risk registers did not identify environmental risks we observed during inspection.
Inspection areas

Safe

Good

Updated 26 February 2020

Effective

Good

Updated 26 February 2020

Caring

Good

Updated 26 February 2020

Responsive

Good

Updated 26 February 2020

Well-led

Good

Updated 26 February 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 9 March 2018

Maternity and gynaecology

Good

Updated 22 June 2016

The maternity and gynaecology services at Leigh Infirmary required improvement in the effective domain but were good in the other domains.

Policies were not always clear or followed current guidelines. Staff knew how to report incidents. Lessons were shared and, however; there was no integrated trust wide learning system. All areas were visibly clean and tidy and staff followed hygiene procedures.

Daily checks of equipment were completed, but systems for monitoring the maintenance of equipment were not robust. Safeguarding processes were in place and under review. Medicines were stored in secure cupboards and daily checks completed. Records for patients receiving surgical care and termination of pregnancy were reviewed and completed appropriately.

Staff had received mandatory training relevant for their role however there was room for improvement in the uptake of Breastfeeding for midwives, basic life support training by medical staff and delirium training by all staff. Medical staffing numbers were adequate for the patient’s needs. Any shortfall in staffing levels was supported by bank nurses.

Trust guidelines were in place; however these were not always clear or adhered to. Two guidance documents for the management of termination of pregnancy gave differing guidance. Guideline reviews were not robust in that they did not always include reviewing the references on the document. The trust participated in a number of local and national audits.

Women were assessed for pain relief and supported individually postoperatively. Patients breast feeding was supported in the community, however; the numbers decreased after discharge from postnatal care.

Midwives were annually assessed by their supervisors and other staff had been appraised to be competent although midwives did not rotate.

Services were available on weekdays only. Ward two carried out elective day-case surgery and clinics were at Leigh for routine antenatal and gynaecology appointments. Community staff had limited access to records due to a lack of computers.

We observed positive interactions between patients and staff. We observed staff actively engaging with patients in a kind and compassionate way. Patients were accommodated sensitively, where possible, if a side room was appropriate. Emotional support was available if needed.

The service had been planned across the geographical location. Gynaecology clinic services were based in the women’s centre at Leigh Infirmary. The antenatal clinics were being supported by main outpatients as they are in the process of relocating to refurbished premises in the former ward one. Each maternity patient was allocated a named midwife, in the community. Antenatal clinics were available across the Wigan and Leigh areas in GP surgeries.

There were specialist midwives including public health, safeguarding and a mental health nurse. Also diversity and dementia champions were available. Any patient identified with a learning disability or mental health issue were supported on an individual basis as needed.

Midwives were not clear about the trust vision and strategy. There were regular senior meetings that were cascaded to staff but staff felt that meetings with them needed to be more formal. Staff felt that they were supported by their managers; however hospital midwives felt there were fewer opportunities for them to develop than in the community.

A trust ‘pioneering staff engagement’ programme was in place across a multi-disciplinary team with a number of innovating programmes in progress. The service had received several awards over the past two years. Policies were not always clear or followed current guidelines.

Outpatients and diagnostic imaging

Good

Updated 22 June 2016

Whilst low numbers of incidents were recorded by the departments those that were reported were graded according to risk and shared to promote learning. There was an open and honest culture amongst staff. The environment differed depending upon location. Whilst the outpatient department was dated with little natural light, the Hanover Centre was light and spacious following refurbishment in 2013. The areas we inspected were visibly clean and tidy.

Safeguarding was managed by a central team who advised and supported staff who had been trained according to the level of contact with patients and those close to them. Patient risks were managed with resuscitation trolleys in departments.

Staffing was adequate with few vacancies and little or no use of agency staff. Staff used guidelines, procedures and policies to provide care for patients. Departments undertook audits and presented findings to colleagues to promote learning and improve services.

Staff received appraisals and were given opportunities to enhance learning. Radiology services were provided seven days a week. Outpatient clinics were not routinely provided on a seven day basis but clinics were held in the evenings and occasionally on a Saturday morning to manage waiting lists.

Patient records contained the necessary information. However medical signatures were not always legible and registration numbers and printed names were not always included. Approximately ten patient records per month were unavailable for clinic appointments. Staff accessed the electronic systems or contacted GPs if information was not available.

Staff understood consent and we saw evidence that written or verbal consent was obtained when required.

Outpatient services documented standards to maintain high levels of service and these were displayed for patients and visitors.

Patients were happy with the care they received and said staff had a polite and compassionate manner. Patients felt supported by staff during appointments.

A range of initiatives were in place to meet people’s needs.

The hospital met the department of health target of providing appointments for patients within 18 weeks. Ninety seven percent of patients referred for an urgent appointment for suspected cancer were seen within the department of health target time of two weeks. On average patients received appointments within 19 days for non-obstetric ultrasound scans, and two days for x-ray.

Waiting times following arrival in clinic varied depending on the type of appointment. At the time of our inspection there were no visible delays for patients waiting to be seen. Reporting time for scan results was one to two days. However, in September 2015, 1,367 x-rays were waiting for reports to be completed across all sites. Further staff were being recruited to manage this.

Verbal complaints were dealt with at the time through communication if possible, but verbal complaints were not always recorded by staff. Those that were recorded were monitored with results shared monthly to promote learning.

Staff had ideas about how to improve services. Trust values were evident in the areas we inspected. Governance meetings were held monthly. Risk was managed through a local risk register which documented the issue, mitigation, risk score and review date of each risk.

Staff felt supported by managers and services engaged with the public, through forums and questionnaires.

Urology staff offered ‘one-stop’ appointments for haematuria patients which enabled patients to undergo biopsies during initial appointments rather than having to re-attend on another day.

Surgery

Good

Updated 26 February 2020

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

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients 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 patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
  • Staff treated patients 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 patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • 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 patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

  • We found areas of the theatre suite had not been maintained in order to reduce the risks to patients. We observed patient records unattended in one ward area.
  • Waiting times were not in line with national standards for some surgical specialities.
  • The service did not have a clear vision for what it wanted to achieve or a strategy to turn this into action. The vision and strategy were dependent on progress in regional developments within the wider health economy. Risk registers did not identify environmental risks we observed during inspection.