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Inspection carried out on 22 October to 28 November 2019

During a routine 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 had training in key skills, understood how to protect patients from abuse, and managed safety well. The hospital controlled infection risk well. Orthopaedic surgical infection site rates for the hospital were one of the lowest within the NHS. 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 services 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

  • In surgery, patient records were not always secured securely and could be accessed by unauthorised persons in pre-operative assessment and ward areas.
  • In surgery, the design, use and maintenance of facilities, premises and equipment did not always reduce the risks to patients to keep them safe. The older theatre area was in poor condition and was affected by leaks and flooding at times of heavy rainfall. There were outstanding repairs at the time of our inspection such as the main theatre access door magnetic lock and theatre two door was broken.
  • In surgery, the service did not always record environmental risks it had identified and the actions to mitigate the risks in a timely manner.

Inspection carried out on 8 - 11 December 2015

During a routine inspection

Wrightington Hospital specialises in hip replacement surgery, upper and lower limb surgery and hip revision surgery. The services offered are in the orthopaedic centre, day case and private patient unit and include rheumatology services. There are 12,000 elective surgical procedures are carried out per year from 10 theatres, with after care on one of three inpatient wards. Wrightington Hospital admissions are 65% day case surgery and 35% elective surgery.

The outpatients department provides a range of clinics in areas such as; rheumatology, occupational health, physiotherapy, podiatry, respiratory medicine, trauma and orthopaedics, surgery, pain management, urology, gynaecology and orthopaedic care. The centre also accepts orthopaedic referrals from out of area.

There is also a radiology diagnostic imaging service which provides a comprehensive range of services including x-ray and bone densitometry.

We inspected the hospital between the 8 and 11 December 2015 as part of the comprehensive inspection of Wrightington, Wigan and Leigh NHS Foundation Trust.

Overall we found the hospital provided good services across all five domains of safety, effectiveness, caring, responsiveness and of being well led.

Our key findings were as follows:

  • Incidents were reported, investigated appropriately and lessons learnt shared with staff. There was a low incident of pressure ulcers and infections. Risk assessments were completed and staff implemented measures to reduce risks.

  • Staffing levels were sufficient and a safer nursing care staffing tool was utilised to ensure staffing levels were adequate. Medical staff rotas were in place and locum agency staff filled any gaps in cover. Rheumatology medical staffing however was a risk and the trust had taken steps to ensure the safety of patients.

  • Records were usually available, of good quality and stored securely overnight.

  • The infrastructure was old but some financial investment had taken place to refurbish areas such as re-flooring the outpatient department. Areas were visibly clean and tidy with the exception of two small areas in out patients. Equipment was well maintained and cleaning logs were completed. Medicines, including controlled drugs were managed safely and stored securely.

  • Staff followed national best practice guidelines, trust policies and procedures. Referral and discharges generally worked well and staff shared relevant information. Services worked in coordination and appropriately referred to specialist services when required.

  • Staff treated patients with respect and dignity, offered support and included them in care planning. Patients received a caring service and staff discussed treatment plans with patients to ensure a person-centred approach. We saw staff deal with patients in a kind and polite manner and they understood the principles of consent and best interest decision making.

  • The trust 18 week referral to treatment times were similar to or above the national average of 90% for Orthopaedic services.

  • Services were not operating seven days a week at the time of our inspection but evening and Saturday morning clinics occasionally took place.

  • Risk registers were in place and discussed at team meetings. Staff were aware of the trust’s values and vison and felt well-supported by managers and colleagues.

  • Staff morale was good and they felt well supported. Staff were enthusiastic and proud of the services they provided. However, only 50% of radiology staff at the hospital were up to date with appraisals which did not meet the trust target of 90%.

However, there were areas of practice where the trust could make improvements.

The trust should:

  • Review the cleanliness of plaster rooms and toilet areas with a view to improving standards.

  • Improve appraisal rates in staff groups which are currently below target.

  • Review the storage of disused equipment in x-ray room two.

  • Review the safe storage of patient notes trolleys and that these are kept locked

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 30 September 2013

During a routine inspection

We inspected this hospital as we had received concerns from a member of the public that patients having planned hip and knee surgery were not being treated in line with nationally recognised guidelines. During the inspection we spent time on wards 5, 6, 7, the day surgery unit, the pre-operation unit and the John Charnley Wing.

The patients who we spoke with were positive about the care and treatment they received. We heard comments such as �I would be happy to come back here if I need surgery on my other knee�; �The staff explain everything to you so you know what is happening next� and �I think that I have had good treatment here. All of the staff that I have met since my very first appointment here have been great.�

We found that recognised guidelines from the National Institute for Health and Care Excellence Clinical (NICE guidelines) were being followed for the care of people receiving hip surgery, knee surgery and rheumatology care.

We looked at the way that medicines were managed within the hospital. We found that patients were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.

The hospital followed NHS guidelines for dealing with and managing complaints. We found that the Trust�s policy for managing complaints was followed by staff.

Inspection carried out on 28 November 2012

During an inspection in response to concerns

We visited the hospital because we had concerns about some serious incidents that had happened within the operating theatres at Wrightington Hospital and also at the Royal Albert Edward Infirmary (also known as Wigan Infirmary). These incidents occurred because internationally recommended checklists were not being completely followed on some occasions. This report describes what we found at Wrightington Hospital. Please look at the report for Royal Albert Edward Infirmary to see what we found at that hospital.

Patients told us that their procedure had been explained and they felt that they were able to make an informed decision and give their full consent to the procedure being carried out. The records that we looked at showed that the patient's consent had been recorded. As a part of this inspection, one of our inspectors visited the operating theatre and we found that the recommended checks to ensure patients' safety were taking place. There was evidence to show that action had been taken and systems had improved since the serious incidents had occurred.

Inspection carried out on 19 July 2012

During a themed inspection looking at Dignity and Nutrition

Patients told us what it was like to be a patient in Wrightington Hospital. We spoke with 11 patients who described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector

joined by another CQC inspector, a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service

The patients had a lot of praise for the staff at Wrightington Hospital. We were told �There are lovely, caring nurses who work very hard� and "It doesn't matter where you go in the hospital - all the staff are fantastic." The patients who we spoke with told us that they were treated with dignity and respect.

Most patients told us that the food was "All right." One person told us that the food was "Fine." Another patient told us "The food is not what I would have at home but it is OK." On the day we visited some patients told us that the soup that was served for lunch was "really good." We did not speak with anyone who was dissatisfied with the food.

Inspection carried out on 22 September 2010

During an inspection looking at part of the service

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