Royal Albert Edward Infirmary

Updated 16 September 2026

We carried out a comprehensive assessment of medical care (including older people’s care) and urgent and emergency services at the Royal Albert Edward Infirmary (RAEI), which included an unannounced visit on 12 to 14 May 2026. The purpose of this assessment was to re-rate the regulated services at the location due to the age of the rating and to act on risks we identified through information of concern. The new ratings have been combined with the existing ratings of the other services delivered at this location . As a result of our assessment, the overall rating for the Royal Albert Edward Infirmary has changed from good to requires improvement.

The RAEI is a registered location of Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL), located in Wigan, Greater Manchester. The hospital has over 450 beds and is the largest location managed by the trust, being the main site of delivery for a variety of activity including diagnostic and outpatient services, inpatient medical and surgical services, maternity and children’s services, and cancer therapies. With a 24-hour Emergency Department (ED), the hospital is also the main point of access for people in the area in need of emergency and urgent services.

Leaders told us that pressures in urgent and emergency services across the trust had grown in recent years. Patients using services were increasingly complex or frail, and the estate had a comparatively smaller bed base to meet the demand, compared to other nearby trusts. The hospital was an aged estate and offered limited space to expand, and so leaders had to be innovative in how and where activity was delivered.

At the point of the assessment, the trust had recently implemented significant organisational changes, which included a divisional reorganisation and new governance and management arrangements. As such, some aspects of the changes were not fully embedded and, in some cases, leadership posts were yet to be filled.

At this assessment we identified breaches of regulations. Our detailed findings can be found in the medical care (including older people’s care) and urgent and emergency services sections of this report. An action plan will be requested upon publication of the final report.

Updated 14 December 2025

We carried out a comprehensive assessment of medical care services (including care of older people) at Royal Albert Edward Infirmary (RAEI). The assessment included an unannounced on-site visit on 12 to 14 May 2026. To support our findings, we also spoke with partners, staff and leaders remotely in the weeks following the assessment visit.

Medical care services provide diagnosis, care and treatment for a wide range of conditions, including general medicine, cardiology, respiratory medicine and gastroenterology. As part of the assessment, we visited the Medical Assessment Unit (MAU), Community Assessment Unit (CAU), Medical Receiving Unit (MRU), Ince, Winstanley, Lowton, Pemberton, Shevington, Orrell, Astley and Standish wards, the Coronary Care Unit (CCU), Acute Stroke Unit (ASU), Discharge Lounge, Endoscopy Unit and the Pharmacy Department. We also visited surgical wards where medical patients were being cared for and spoke with staff about their management.

We reviewed patients’ clinical records. We spoke with patients and their relatives, as well as members of staff across a range of roles, including nurses, doctors, ward managers, matrons, ward clerks, allied health professionals (including physiotherapists and occupational therapists), and senior managers.

We also reviewed feedback from people who contacted us about their experiences and considered performance information provided by the trust. We observed care and treatment delivery in a range of clinical areas and attended several meetings, including safety huddles, nurse handovers, ward rounds and board rounds.

During the assessment, we inspected the above areas and looked at 43 patient records, spoke with 28 patients or their families/carers, and 41 members of staff. We also spoke with 4 staff who were not employed by the service but worked in partnership with them.

We rated medical care (including older people’s care) as requires improvement.

At this assessment, regulatory breaches were identified in relation to safe care and treatment, staffing, infection prevention and control and governance. An action plan will be requested following publication of the final report.

The service was experiencing several challenges that affected the consistency of care delivery, including staffing shortages and gaps in mandatory training compliance. Pressures on patient flow resulted in some patients waiting for extended periods in environments that were not always suitable for their needs.

The service did not consistently take timely or effective action to address inequalities in access and outcomes. The use of escalation beds reduced access to regular medical reviews for some patients and negatively impacted their experience of care.

While governance and quality improvement processes were in place, they were not consistently embedded across the service. Governance arrangements were not always effective, with examples of outdated policies, incomplete audit action plans, and a lack of clear accountability. Further work was required to strengthen oversight, improve consistency, and ensure compliance with regulatory requirements. Some staff also reported limited visibility and support from senior leaders, and additional efforts were needed to ensure all staff felt confident to raise concerns and speak up.

Despite these findings, patients were generally positive about the care they received and told us they felt respected, supported, and involved in decisions about their care. Staff worked collaboratively, demonstrated compassion, and contributed to a positive learning culture. Systems were in place to support patient safety, learning from incidents and complaints, and the delivery of evidence-based care. We also observed several examples of good practice across the service.

Updated 14 December 2025

We carried out a comprehensive assessment of urgent and emergency services at the Royal Albert Edward Infirmary (RAEI). The assessment included an unannounced on-site visit on 12 to 14 May 2026. To support our findings, we also spoke with partners, staff and leaders remotely in the weeks following the assessment visit.

Urgent and emergency services at the location primarily comprises the Emergency Department (ED). Patients access the ED through either an initial triage process as walk-in patients or through the Initial Senior Assessment Triage (ISAT) area when attending by ambulance. Patients can be seen and treated in various areas dependant on their need, which include a Clinical Decisions Ward (CDW) for patients who can remain seated, a Majors area and a resuscitation area. When capacity demands, adult escalation spaces in adjoining corridors are used to hold and treat patients on trolleys.

The ED also has a Paediatric Emergency Care Centre (PECC), which has a separate children’s triage and waiting area. Adjacent to the main ED site is an Urgent Treatment Centre (UTC), which sees patients streamed from the ED and has its own waiting area, clinic rooms and treatment areas. As part of this assessment, we also inspected the Same Day Emergency Care (SDEC) and the Frailty SDEC areas, which are located at the same location but are further from the main ED site, being managed and staffed by different teams.

During the assessment, we inspected the above areas and looked at 39 patient records, spoke with 38 patients or their families/carers, and 51 members of staff. We also spoke with 5 staff who were not employed by the service but worked in partnership with them.

We rated urgent and emergency services as requires improvement.

At this assessment, regulatory breaches were identified in relation to safe care and treatment, premises and equipment, staffing levels, and governance. An action plan will be requested upon publication of the final report.

We found that the service did not have sufficient facilities or processes to manage all patients including children with mental health needs. The main waiting room also contained patients with various clinical and individual needs in close proximity and was prone to uncomfortable levels of overcrowding.

Excessively long waits for specialty beds caused issues in flow throughout the main ED. Cases of potential sepsis were not always responded to in a sufficiently timely way, and the number of consultant medical staff employed by the service were well below what national guidelines indicated.

We also found that key risks were not always acted upon, and business continuity plans were not reviewed regularly enough to reflect the current context.

However, recent transformation plans and changes demonstrated early signs of improvement in various metrics, such as average waiting times and flow across the service. The Urgent Treatment Centre (UTC) and Same-Day Emergency Care (SDEC) services were effective in supporting the work of the main ED. Admissions avoidance schemes and the Access to Community Services (ACST) Team worked well to enhance the discharge process to prevent readmissions, so that the right people could access the ED at the right time. Staff in all areas were broadly optimistic about the future and direction of the service.

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.