All inspections: Royal Albert Edward Infirmary

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.

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.

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.

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.

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.

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 Royal Albert Edward Infirmary.

We inspected the maternity service at The Royal Albert Edward Infirmary as part of our national maternity inspection programme. 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 announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

Royal Albert Edward Infirmary is a district general hospital located near Wigan town centre. It provides a full range of maternity services including both antenatal and postnatal ward with 28 beds including three single rooms. There are approximately 2000 deliveries each year, with caesarean sections and instrumental delivery rates in line with national average.

The trust has two offsite antenatal clinics; The Thomas Linacre Centre in Wigan and Leigh Infirmary; both clinics provide consultant and midwifery clinics. We did not inspect these clinics as part of this inspection.

Our ratings of the maternity service stayed the same and the ratings for the hospital remained the same. We rated safe as requires improvement and well-led as good and the hospital as good.

How we carried out the inspection

During our inspection of maternity services at Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust we spoke with 27 staff including leaders, obstetricians, midwives, and maternity support workers.

We visited all areas of the unit including the antenatal clinic, maternity triage, labour ward, birth centre, day assessment, antenatal and postnatal ward. We reviewed the environment, maternity policies and 12 maternity records. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments, recent reported incidents as well as audits and audit actions. Following the inspection, we reviewed data we had requested from the service to inform our judgements.

We ran a poster campaign during our inspection to encourage pregnant women, birthing people who had used the service to give us feedback regarding care. We analysed the results of the eight responses we had back to identify themes and trends. These reflected a mixed response describing a kind and caring workforce but with some people experiencing delays to treatment and support during their stay in the maternity unit.

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

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 in most areas 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 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 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 hospital engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

In surgery, the use of facilities and premises did not always meet with updated standards to keep people safe.
In surgery, training compliance for paediatric life support was low.
In surgery, patient records were not always stored securely.
Surgical services did not all have a clear vision and strategy as plans were dependent on progress in regional developments within the wider health economy.
Senior leaders were not always visible.

A summary of our findings about this location appears in the overall summary

Our rating of services improved. We rated it them as good.

The Royal Albert Edward Infirmary is a large district general hospital operated by Wrightington, Wigan and Leigh NHS Foundation Trust. It provides a full range of hospital services including emergency care, critical care, general medicine (including elderly care), surgery, neonatal care, children and young people’s services, maternity services and a range of outpatient and diagnostic imaging services. The hospital has 513 beds.

Urgent and emergency services and children and young people’s services at Royal Albert Edward Infirmary were previously inspected in December 2015. Urgent and emergency services were rated as ‘good’ and children and young people’s services were rated as ‘requires improvement’.

In March 2017, we carried out an unannounced inspection of these services to review specific areas of care including the assessment and observation of patients, record keeping, pathways of care for discharging or transferring patients, staff training and staffing levels.

The inspection was in response to concerns that were raised about the safety of services provided to patients. The inspection therefore focused solely on the safety of services provided. We inspected the hospital during the evening/night of 17 March 2017, visiting the following areas:

Paediatric Emergency Care Centre (PECC)
Emergency Care Centre (ECC)
Rainbow Ward

We found that these services required improvement for safety. This was because the systems and processes for recognising risks and escalating the deteriorating patient were not always adhered to, records were not always completed correctly and compliance levels in some areas of training, such as safeguarding level three, were lower than the trust target.

Our key findings were as follows:

Records were not always completed fully by medical and nursing staff. This meant there was limited evidence of the care provided to patients.
Despite tools being available to help staff manage risks to patients, they were not always used effectively. For example, in some records we reviewed we saw no evidence of clinical observations, early warning scores and risk assessments. We also had concerns that some of the guidance relating to managing risk was unclear. For example, one piece of guidance instructed staff to complete ‘routine’ observations, without clarifying the specific frequency.
Mandatory training figures for staff did not always reach the trust target of 95%. Training for safeguarding was particularly low. This posed a risk that staff may not have the necessary training to enable them to care for patients appropriately.
Dispensers storing sanitising gel were empty in the main reception area in the emergency care centre. This limited people’s ability to clean their hands effectively prior to entering the department.
A room in the emergency care centre storing major incident and chemical decontamination equipment was also used occasionally to take blood samples from patients. The room was a less than ideal environment with large items of equipment next to the trolley where patients sat to provide their samples.
Duty of candour was not fully documented in the investigation report following the never event on Rainbow ward.
Appropriate action was not always taken following completion of the Paediatric Early Warning Score (PEWS) on Rainbow ward.

However:
Following our inspection in December 2015, the trust had improved the levels of training for nurses on Rainbow ward, with higher compliance in advanced paediatric life support and tracheostomy care.
Staffing levels on Rainbow ward were also improved, with greater numbers of staff available to care for children at all times.
Staff in the Emergency Care Centre were able to explain their actions during major incidents or incidents involving hazardous substances.

In areas of poor practice the trust needs to make improvements.

Importantly, the trust must:

Ensure staff complete mandatory safeguarding children training appropriate to their role.
Ensure staff complete other mandatory training to maintain compliance in line with the trust target.
Ensure that tools to manage risk are used and recorded such as completing risk assessments and observations and taking appropriate action when triggering Paediatric Early Warning Scores (PEWS).
Ensure that patient records are accurate and complete.

In addition the trust should:

In relation to children and young people services:

Ensure duty of candour is documented following a notifiable safety incident.
Ensure cleaning schedules are consistently completed in all areas.
Ensure the expiry date is legible on all controlled drugs.
Ensure the medicine fridge thermometer is reset in line with trust policy and action taken is documented when the fridge temperature deviates from the acceptable range.
Ensure the refrigerator in the milk room is available and fit for use.
Ensure current guidelines for the management of paediatric sepsis are available for staff.

In relation to urgent and emergency services:

Ensure trust guidance is consistent throughout all departments in relation to the use of early warning scores, clinical observations and general monitoring of patients, and that where required, categories and frequency of monitoring is stipulated to ensure clarity.
Ensure that all staff use the same guidance relating to the frequency of observations
Ensure that sanitising gel is available in all dispensers
Review the suitability of the room used to store major incident equipment in relation to taking blood samples from patients
The trust should review the entrance and exit door to the paediatric emergency care centre with a view to ensuring the risk of children or young people exiting the department is as low as practicable.
Consider amending the checklists used on resuscitation trolleys to ensure any action to replace missing items can be documented to avoid potential confusion.
Consider introducing checklists to record that defibrillators have been checked rather than relying on printed strips stored in no particular order.
Obtain assurance and ensure that staff involved in assessing patients are aware of, or appropriately prompted to consider female genital mutilation
Ensure that guidance about conditions requiring senior medical review covers occasions when consultants are not on site and available only on an on call basis.
Ensure that the care pathway for caring for patients with a blood borne virus is up to date and that the latest version is displayed on the relevant noticeboard in the emergency care centre.
Only store equipment in appropriate packaging and remove equipment that is not stored in this way.

Professor Ted Baker

Chief Inspector of Hospitals

The Royal Albert Edward Infirmary is one of three locations providing care as part of Wrightington, Wigan and Leigh NHS Foundation Trust. It provides a full range of hospital services including emergency care, critical care, a comprehensive range of elective and non-elective general medicine (including elderly care) and surgery, a neonatal unit, children and young people’s services, maternity services and a range of outpatient and diagnostic imaging services.

Wrightington, Wigan and Leigh NHS Foundation Trust provides services for around 320,000 people in and around Wigan and Leigh with 696 beds. In total, the Royal Albert Edward Infirmary had 497 beds.

We carried out an announced inspection of the Royal Albert Edward Infirmary on 8–11 December 2015 as part of our comprehensive inspection of Wrightington, Wigan and Leigh NHS Foundation Trust.

Overall, we rated the Royal Albert Edward Infirmary as ‘Requires Improvement’. We found that services were provided by dedicated, caring staff and patients were treated with dignity and respect. However, improvements were needed to ensure that services were safe, effective, well led and responsive to people’s needs.

Our key findings were as follows:

Cleanliness and infection control

The trust had infection prevention and control policies in place which were accessible to staff.
We observed good practices in relation to hand hygiene and ‘bare below the elbow’ guidance and the appropriate use of personal protective equipment, such as gloves and aprons, while delivering care.
‘I am clean’ stickers were used to inform staff at a glance that equipment or furniture had been cleaned and was ready for use.
Overall, patients received care in a clean, hygienic and suitably maintained environment. Staff were aware of and applied infection prevention and control guidelines.

Nurse staffing

Care and treatment were delivered by committed and caring staff who worked hard to provide patients with good services.
Nurse staffing within the paediatric services was inadequate. Nurse staffing levels on rainbow ward did not reflect Royal College of Nursing (RCN) standards and on the neonatal unit did not always meet standards of staffing recommended by the British Association of Perinatal Medicine (BAPM). Also staffing rotas on Rainbow ward did not identify an appropriately trained member of staff for the High Dependency Unit (HDU) for each shift.
There were no paediatric trained nursing staff available in the department between 1.30am and 7:30am. Across the department only 18% of staff were trained in paediatric life support (PLS) and 13% in advanced paediatric life support (APLS) which meant that it could not be guaranteed that there would be a sufficient number of staff trained to resuscitate a child when the CED was closed.
On the medical wards we found there were occasions where nurse staffing levels were not overall sufficient to meet the needs of patients. Staff vacancies had been identified on the departmental risk register.
Current long-term sickness and interim staffing requirements within maternity, during recruitment processes, were being covered by bank staff. The trust target for bank nurses was less than 5%, however 14% were employed in November 2015 and 8.9% in December 2015.

Leadership and Management

The senior team, in the majority of core services, were visible and accessible and well known to the staff.
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.
Clinical cabinet meetings took place monthly and were well attended by a managers and clinicians.
Within children and young peoples services there was a corporate and a divisional risk register in place. However managers were not fully aware of all the risks in their department. Risks regarding nurse staffing levels had been recognised by managers in September 2015; however this was not recorded on the risk register. It was recognised again on a leadership ‘walk around’ on 1 December 2015 but no immediate action was taken.
Lack of coherence between the executive team, service managers and staff meant identified risks were not clearly escalated, documented or robust actions taken to mitigate them within children and young people’s services. There was also a lack of proactive action in the case of nurse staffing on Rainbow ward. The lack of protected management time for the ward manager limited their ability to address managerial duties including addressing the staffing concerns.

Access and Flow

Between April 2015 and September 2015, the trust exceeded the 90% standard for the proportion of patients waiting 18 weeks or less from referral to treatment. The latest figures for October 2015 showed the trust’s performance was at 92%, with the exception of general and oral surgery. WWL is in the top 10% nationally for RTT performance as at October 2015, ranking 5th out of 139 Acute Trusts.
General surgery and trauma/orthopaedic wards had medical outliers (medical patients that were not nursed on a medical ward due to bed shortages) each month between January 2015 and August 2015. The number of patient outliers for June 2015 was 141. Staff reported daily review of these patients by medical staff.
Between March 2015 and the time of inspection, the departments performance in meeting the Department of Health target for 95% of patients to be seen, treated, discharged or admitted within 4 hours was mixed. The service met the target in six of the nine months. However, performance was consistently better than the national average in that time.
National targets to achieve 92% for referral to treatment for patients on incomplete pathways between April 2015 and October 2015 were achieved overall within the paediatric specialities. Individually two specialities missed the target on one occasion in this period but this accounted for a total of two children only.
Children referred to child and adolescent mental health services (CAMHS) were usually seen within 24 hours however staff reported long delays to access specialist inpatient beds. Between 17 August 2014 and 16 August 2015 the trust had 178 admissions receiving care from the CAMHS team.
Within outpatients, the 18-week referral to treatment performance between January 2015 and October 2015 showed the trust had exceeded the trust’s 95% target and was better than the England average and standard with an overall average of 98%.

We saw several areas of outstanding practice including:

The end of life service had a visible person-centred culture. are was provided by compassionate, caring staff who were sensitive to the needs of seriously ill patients. People were respected and valued as individuals, and staff throughout the service demonstrated a commitment to recognising the needs of the patients at end of life, and of their families. There were systems in place to support this, including the use of the swan logo. The use of the logo was seen to be identified universally and promoted high quality care to patients at the end of life and their families.
The emergency department used an electronic dashboard (A&E APP) that constantly monitored flow through the department. It used predictive information based upon seasonal variances and data from previous years to generate likely numbers of attendees to the department. The system also used live data of ambulances on route to the department. Where demand was strong at particular times of the day the department was able to flex staff from other areas to ensure response rates were maintained. Meetings were held several times per day to discuss flow throughout the hospital to avoid delays in patients moving through the Hospital system.
The trust recognised that an important element of achieving high quality care was to ensure that the staff had the capacity and capability to deliver improvement. The trust had set up a ‘Quality Champion’ programme to support the delivery of service improvement and recognise the achievements of the staff. All Quality Champions who had completed the training programme and commenced an improvement project were awarded a bronze badge. Silver and gold badges were awarded to those Champions who sustained their improvements and disseminated them to other organisations. The department had a number of staff of various grades who were quality champions, and had identified staff who were about to start the programme.
Within radiology there was effecting in-sourcing of staff to cover shortfalls.
Staff were supported to undertake a counselling qualification in order to improve the staff support network.

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

Importantly, the trust must:

In Emergency Department:

Ensure that there are sufficient numbers of staff who are trained to resuscitate children at all times.

In Medicine:

Deploy sufficient staff with the appropriate skills on wards.
Ensure that all staff receive appraisals and complete mandatory training to enable them to carry out the duties they are employed to perform.
Ensure that records are kept secure at all times so that they are only accessed by authorised people.

In Children and Young People:

Ensure staffing levels are maintained in accordance with National professional standards.
Ensure that there is one nurse on duty on Rainbow ward trained in Advanced Paediatric Life Support each shift.
Ensure that staff are trained and competent to deliver the care required by patients with a tracheostomy.
Ensure that risk rating and escalation is robust to ensure mitigating actions are taken in a timely way.
Ensure the ward manager has sufficient time to perform the managerial tasks associated with the role.
Ensure the senior leaders of the service are cited on the risks and actions being taken.

In addition the trust should:

In Emergency Department:

Improve incident reporting by ensuring all staff are aware of the types of incidents they should report.
Improve the reviewing of risk assessments to manage and mitigate them in a continuous and timely way.
Improve documentation in patient records to ensure it is accurate and fully completed.
Take action to improve performance in the monitoring of vital signs for children.
Take action to improve the provision of leaflets in different languages to reflect the needs of the local population.
Improve the screening for infectious diseases, such as Ebola, across the department.
Review the compliance with policies and procedures relating to the time patients should spend in the clinical decision unit (CDU).
Review compliance with the cleaning regime in the children’s emergency department (PECC).

In Medicine:

Improve the timeliness of discharge when patients are fit to do so.
Reduce the moves between wards that patients are experiencing and the number of patients receiving care on a ward not specific to their needs.
Consider implementing formal procedures for the supervision of staff to enable them to carry out the duties they are employed to perform.
Review the gaining of consent for the use of bedrails and the application of the Mental Capacity Act (2005) principals where appropriate. Supported by procedures and relevant mental capacity act training.
Review the prescribing of oxygen for patients when required.
Maintain patients’ privacy and dignity at all times in the discharge lounge.

In Surgery:

Maintain that trolleys containing patient’s notes are kept locked.
Maintain that records are fully completed with name and designation always clearly recorded and printed.
Display dated green ‘I am clean’ stickers on all equipment.

In Maternity:

Review and maintain that emergency equipment and medicines are checked in line with trust policies and procedures and that a record is held.
Review and maintain that equipment is checked and records are kept to ensure equipment is maintained and fit for purpose.
Review accessibility procedures into the maternity unit.
Review procedures related to temporary staff and ensure that there are robust monitoring arrangements in place.
Review and maintain that guidelines are up to date and include evidence of the use of latest recognised publications.
Review communication methods used to deliver key messages to midwifery staff.
Review the on-going problems with the drainage problem on the maternity unit to seek resolution.
Review and maintain that there are robust systems in place to ensure the security of both the postnatal ward and delivery suite.

In Children and Young People:

Consider the provision of accredited Newborn Life Support training for junior Doctors working on Rainbow ward and the neonatal unit.
Take steps to ensure that resuscitation equipment is available and fit for use.
Record the maximum and minimum fridge temperatures for each medication fridge.
Maintain equipment within the required timeframes.
Review the checking of controlled medicines is in line with trust policy.
Develop a current Female Genital Mutilation policy which includes the mandatory reporting requirements and a domestic abuse policy and training that includes modern slavery, human trafficking and domestic violence prevention orders.
Identify staff learning needs through the trusts appraisal process.
Consider employing a Registered Mental Health Nurse to care for children requiring Child and Adolescent Mental Health Services.
Ensure shower facilities for parents staying with their children are in good working order.

In End of Life:

The service should improve their compliance with the regional DNACPR standards particularly with regards to the use of MCA and best interest decisions.
The service should consider improving access to medical devices out of hours. At the time of our inspection syringe drivers which may be required at the weekend were kept in a loan store in the basement.
The service should improve the review and updating of the risk register in a timely manner, with target dates for actions, to ensure all risks are being managed effectively and are not left on the register without being addressed for an extended time.

In Outpatient:

Consider improving outpatient facilities such having drinking water available and children’s facilities in the outpatient waiting area.
Consider the implementation of the use of the Safety Checklist for Interventional Radiology.
Review the outpatient area in proximity to the reception desk to explore options for improving privacy for patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We inspected the hospital in November 2012 and again in April 2013. At both of these inspections we found that the hospital was not meeting the standards required for the management of medicines. We issued a Warning Notice after our inspection April 2013 and asked the hospital to make improvements. We issue Warning Notices to a registered person [in NHS Trusts this person is the Chief Executive Officer(CEO)] where the quality of the care they are responsible for falls below what is legally required.

After our inspection in April 2013, the provider (the hospital senior managers) wrote to us and told us about the changes that had made and those that they were planning to make. When we visited in July 2013 we found that that many improvements had been made. Patients told that they had no concerns about their medicines. One patient told us 'You can see the nurses checking your medicines before they give them to you. This makes me feel safe.' We found that the hospital was now meeting the standards for the management of medicines.

We looked at the systems in place for checking that medicines were managed safely within the hospital. This is sometimes referred to as a quality assurance system. We found that significant improvements had been made and that the hospital was now meeting this standard too.

This was a follow up inspection to the one that we carried in November 2012. At that inspection we found that there were concerns about the timeliness with which patients received fluids, the level of privacy and dignity and arrangements in place regarding the management of medicines for patients administering their own medication whilst in hospital. We were also concerned as there were not always plans in place to achieve full compliance with guidelines issued by the National Institute for Health and Clinical Excellence (NICE).

At this inspection we visited five wards and did not find any concerns about patients' care. We spoke with nine patients who told us that they were well looked after. Patients' comments included 'Everything is fine. They have kept me informed about what is happening.'; 'I had a long wait in A&E but staff were very busy. My experience has been OK' and 'There are lovely staff. They have been very good to me.'

Most patients said that there were no issues with their medicines. However when we checked patients' records we found that patients were not always receiving the medicines that they should. There were systems in place to check that patients had been given the correct medicines at the correct time but the problems identified had not been followed up with actions.

We visited the hospital because we had concerns about some serious incidents that had happened within the operating theatres at Royal Albert Edward Infirmary (Wigan Infirmary) and also at Wrightington Hospital. These incidents occurred because internationally recommended checklists were not being completely followed on some occasions. We found that systems had improved within the operating theatres where the serious incidents had taken place. However, some theatre staff told us that they did not always get the required level of support from some of the surgeons.

Some patients told us they were very happy with the care that they received and we heard comments such as 'The doctors explain everything, nothing is too much trouble." On one ward of the five we visited we heard mixed feedback from patients about the care they received. Two patients told us that they had not received pain relief. We were also concerned about the timeliness with which patients received fluids, the level of privacy and dignity and arrangements in place regarding the management of medicines.

We spoke with 15 staff who all told us that they received sufficient training for their roles and that they were supported in their jobs.

There were systems in place to monitor the quality of care being delivered. However, it is a concern that there were not always plans in place to achieve full compliance with guidelines issued by the National Institute for Health and Clinical Excellence.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

Royal Albert Edward Infirmary

All Inspections

During an assessment of Medical care (Including older people's care)

During an assessment of Urgent and emergency services

During an assessment of the hospital overall

During an assessment of Urgent and emergency services

During an assessment of the hospital overall

16 May 2023

During an inspection looking at part of the service

22 October to 28 November 2019

During a routine inspection

6 November 2017

During a routine inspection

17 March 2017

During an inspection looking at part of the service

Professor Ted Baker

8-11 December 2015

During a routine inspection

In End of Life:

18 July 2013

During an inspection looking at part of the service

11 April 2013

During a routine inspection

28 November 2012

During an inspection in response to concerns

22 September 2010

During an inspection looking at part of the service