Royal Albert Edward Infirmary

Updated 12 August 2024

Royal Albert Edward Infirmary is a district general hospital located near Wigan town centre. It forms part of the Wrightington, Wigan and Leigh NHS Foundation Trust. It provides a full range of services including urgent and emergency care, critical care, a comprehensive range of elective and non-elective general medicine (including elderly care) and surgery (non-elective), paediatric care, neonatal care, maternity care and a range of outpatient and diagnostic imaging services.

We commenced a focused assessment of the urgent and emergency services at the Royal Albert Edward Infirmary on 12 February 2024 and carried out an onsite inspection on 5 March 2024. The inspection was unannounced.

During the inspection, we spoke with staff, leaders, people who use the service and stakeholders. We looked at care records, policies and other documents relating to the service.

The service had a positive safety-focussed culture. Safety incidents and complaints were managed well, and lessons learned. Care was planned and organised with people and stakeholders to maintain safety and continuity of care. The service controlled infection risks well. Staff planned and delivered care according to best practice and national guidance. Staff treated people with compassion and kindness. Leaders had the skills and experience to carry out their roles but did not always have resources and space to manage the priorities and issues the service faced.

However, during the inspection we identified 6 regulatory breaches where we have told the service it needs to make improvements.

We found parts of the service did not have suitable and well-maintained furnishings. Whilst the service had enough nursing and support staff, key risks relating to consultant numbers and availability had not been effectively identified and mitigated. Mandatory training compliance in some subjects was significantly below trust targets. Staff appraisal compliance was below trust targets. The service did not effectively manage risks for patients with sepsis. People did not always receive timely care and treatment. Waiting times and arrangements to admit, treat and discharge patients were worse than national standards across most indicators.

Although we found areas of concern at this assessment, until we have assessed more quality statements the rating for this service remains the same.

Updated 12 February 2024

The urgent and emergency services at Royal Albert Edward Infirmary are provided by the Wrightington, Wigan and Leigh NHS Foundation Trust. We commenced a focused assessment of the urgent and emergency services on 12 February 2024 and carried out an onsite inspection on 5 March 2024. The inspection was unannounced.

During the inspection, we spoke with staff, leaders, people who use the service and stakeholders. We looked at care records, policies and other documents relating to the service.

The service had a positive safety-focussed culture. Safety incidents and complaints were managed well and lessons learned. Care was planned and organised with people and stakeholders to maintain safety and continuity of care. The service controlled infection risks well. Staff planned and delivered care according to best practice and national guidance. Staff treated people with compassion and kindness. Leaders had the skills and experience to carry out their roles but did not always have resources and space to manage the priorities and issues the service faced.

However, during the inspection we identified 6 regulatory breaches where we have told the service it needs to make improvements.

We found parts of the service did not have suitable and well-maintained furnishings. Whilst the service had enough nursing and support staff, key risks relating to consultant numbers and availability had not been effectively identified and mitigated. Mandatory training compliance in some subjects was significantly below trust targets. Staff appraisal compliance was below trust targets. The service did not effectively manage risks for patients with sepsis. People did not always receive timely care and treatment. Waiting times and arrangements to admit, treat and discharge patients were worse than national standards across most indicators.

Although we found areas of concern at this assessment, until we have assessed more quality statements the rating for this service remains the same.

Updated 9 March 2018

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

• Staff knew what incidents to report and how to report them. Managers investigated incidents and shared lessons learned. They identified themes and monitored near misses.
• The service had systems that managed prescribing, administering, recording and storage of medicines well.
• The wards were clean and equipment was well maintained. Staff followed infection control policies that managers monitored to improve practice.
• Compliance with mandatory training and the number of staff receiving annual appraisals had improved since the last inspection.
• Doctors, nurses and other health professionals worked together to support each other and provide good care.
• Staff treated patients with compassion, dignity and respect. Patients and their relatives could also talk to managers who they saw on the wards.
• The service provided care and treatment based on national guidance and evidence of its effectiveness and managers monitored the effectiveness of the services through regular audits.
• Staff understood how to protect patients from abuse and how to assess patients’ capacity to make decisions about their care. Staff had training on safeguarding, the Mental Capacity Act, and Deprivation of Liberty Safeguards.
• Staff and managers were clear about the challenges the service faced. They explain the risks to the department and the plans to deal with them.

However:

• Nurse staffing was challenging across medical services and there were occasions when shifts were not covered as planned. There were significant improvements in recent months and the service had plans to address the issue, mitigate risk, and monitor service provision to maintain safe care on the wards.
• The service did not care for all patients in the most appropriate bed and when the service needed to move patients between beds it did not always do this during the daytime.
• Divisional risk registers did not always demonstrate that actions were taken to mitigate and manage all risks effectively.

Updated 9 March 2018

Our rating of this service improved. We rated it as good because:

• Local systems and processes reflected a culture of improvement. For example, reporting incidents, regular audits and reviews, introduction of local champions and practice development nurses to have oversight of, and improved staff competencies by supported learning.
• There had been improvements in compliance with mandatory training and the introduction of role specific compulsory training.
• The service were committed to reducing the recruitment of agency staff and instead used bank staff.
• Staff demonstrated compassionate care. Patients’ and families religious, emotional, and social needs were understood and the resources provided.
• The leadership team demonstrated a commitment to delivering good quality care. They had an understanding of priorities in their service; the challenges they might present and the changing needs of those who required the service.
• There was a culture of good governance, service improvement and staff development. There were a number of methods used by the leadership team to ensure they audited and reviewed the quality of their work. There were systems in place to help maintain standards in line with national guidance. The leadership team were supported by the trust to ensure they continued to grow and develop as a service.

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 seven 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. 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 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.

Updated 22 June 2016

We found that there were good EOL services across all five domains of Safe, Effective, Caring, Responsive and Well Led.

Incident reporting systems were in place and actions were followed up at ward level via handover. There had been no recent serious incidents related to EOL care. Anticipatory EOL care medication was prescribed appropriately and training for the use of syringe drivers was included in mandatory training for which the SPC team were 100% compliant. EOL services were adequately staffed and as well as the SPC team which was clinically led by a consultant in palliative medicine, there was a bereavement specialist nurse, a gold standards framework (GSF) facilitator and two EOL champions on each ward.

There was evidence of the service delivering treatment and care in line with best practice, including the individual plan of care (IPOC) document which facilitated support for the dying person in the last days and hours of life. The service was starting to implement the gold standard framework (GSF) and had appointed a facilitator to introduce and embed this in the two pilot wards. We saw that the service had made changes to their practice to address some of the targets not met in the last National Care of the Dying Audit of Hospitals (NCDAH), May 2014 and there was evidence that some actions were in place as a result of other clinical audits however there were not always action plans in place which met the criteria for being specific, measurable, achievable, realistic and timely (SMART). This meant there was a potential risk that some recommendations or findings from audits may not be translated into actions in a timely manner or may be missed altogether.

We saw evidence that pain relief and nutrition and hydration needs for patients were being met. The SPC team provided a seven day service and worked well, across all the hospitals, with other teams and disciplines.

EOL care services were provided by compassionate, caring staff who were sensitive to the needs of seriously ill patients. The service was delivered by staff who were committed to providing a good service and there was good clinical leadership from a consultant in palliative medicine. There was a coordinated approach across the Wigan borough to design EOL services to meet the needs of the local population. There were systems in place to prioritise EOL patients for side rooms at RAEI and this was working well. Facilities and systems were in place to minimise stress for families staying with their EOL relatives and to allow them to spend as much time as they wished with them in their last days and hours. This included the use of the swan logo which identified EOL patients and their families, enabling staff to treat them accordingly.

The visibility of senior management was good and staff felt well supported and there was an open door policy by senior staff.

Areas for improvement included completion of uDNACPR forms which were inconsistent in their quality. An action plan should be developed to address the shortcomings identified in the trust’s uDNACPR audit.

Updated 4 August 2023

Updated 22 June 2016

We found the services of the outpatients and diagnostic imaging to be good overall. Patients had clear access to the clinics and radiology, though car parking was an issue. Areas were visibly clean and waiting times for appointments were short. The departments had sufficient staff and where shortfalls existed there were plans in place to ensure continuous service. There was some weekend clinics and acute radiology services was open 24 hours a day. The outpatient waiting area was dated but the new cancer centre, opened in January 2015, was bright and spacious in comparison.

Staff at Royal Albert Edward Infirmary told us they were proud of where they worked and would recommend it as a workplace and a place to treat their family. Staff training was up to date and the trust encouraged learning. Incidents and errors were treated as a learning opportunity to keep patients safe in the future. Patients told us that staff were caring and compassionate and they were given sufficient information about their treatment.

The management were visible and approachable to staff. Audits to assess the departments were continuous and innovation and change was promoted. Staff felt supported by the managers.

Updated 26 February 2020

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

• The hospital had enough staff to care for patients and keep them safe. Staff had training in most key skills and understood how to protect patients from abuse. 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 services 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 seven 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. People could access the hospital 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 felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The hospital engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

• The use of facilities and premises did not always meet with updated standards to keep people safe and we found hazardous substances stored in unlocked rooms which were accessible to patients and visitors and there were not always effective processes in place to ensure that sundries used by staff were in date and safe to use.
• Training compliance for paediatric life support for theatre staff was low and there was a risk that there were not enough staff who had the required level of training.
• Patient records were not always stored securely and could be accessed by unauthorised persons.
• Senior leaders in the division were not always visible and approachable in the service for patients and staff.
• 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.
• Risks we identified during our inspection had not been identified and mitigated through the risk management processes.