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Inspection Summary


Overall summary & rating

Good

Updated 16 May 2019

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

  • Staff were well supported to improve quality and continuously develop. Staff were encouraged to contribute and work collaboratively to provide innovative ways to deliver more joined up care.
  • Consent practices were strong, and patient focussed including the accommodation of individual needs. People who use services were involved in the development of tools and support to aid informed consent.
  • Staff morale was high. Teams supported each other well and we saw examples of good teamwork. We saw staff from different professions working well together and staff told us they were proud of their work.
  • Infection control measures were effective. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Patient records across the trust were of a good standard, up to date, legible and accessible.
  • Feedback for the service was good and there were very few complaints. The culture was very person-centred and promoted kindness and dignity. People’s needs, and preferences were respected. The emotional needs of patients were in the forefront of the minds of staff and they worked with patients to develop better ways to encompass these.
  • There were escalation policies, guidance and care pathways for deteriorating patients. Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients confirmed that staff treated them well and with kindness, providing emotional support to minimise their distress.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Staff used the World Health Organisation (WHO) surgical safety checklist, ‘Five Steps to Safer Surgery’. National and local safety standards for invasive procedures incorporated the contents of the WHO surgical safety checklist.
  • Managers checked to make sure staff followed guidance, monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

However:

  • Staff were not up to date with mandatory training and other important training such as safeguarding vulnerable adults and children. Safeguarding processes were not robust. Additionally, staff had not undergone regular appraisals and did not feel competent to manage some of the patients who attended the department. As a result, we had concerns about the safety of the department.
  • The department did not have a suitable safe place for patients living with a mental health condition.
  • Some patients experienced delays in receiving some test results and often experienced delays being transported to other care settings; transport delays were outside of the influence of the trust. This was a potential risk to patients.
  • The UTC did not have embedded governance systems in place and had only recently introduced clinical audit as a way of assuring quality. Patient outcomes had not been monitored and managed in a robust way.
  • The UTC had undergone a series of changes. As a result, governance and leadership processes were not fully embedded in the department. Therefore, at the time of the inspection, despite there being plans in place for the department, we were not assured the department was able to demonstrate that it was well led.
  • Not all staff were not up to date with mandatory training and other important training such as safeguarding vulnerable adults and children. Safeguarding processes were not always robust in UTC. Additionally, staff had not undergone regular appraisals and did not feel competent to manage some of the patients who attended the department. As a result, we had concerns about the safety of the department.

Inspection areas

Safe

Good

Updated 16 May 2019

Effective

Good

Updated 16 May 2019

Caring

Good

Updated 16 May 2019

Responsive

Requires improvement

Updated 16 May 2019

Well-led

Good

Updated 16 May 2019

Checks on specific services

Maternity and gynaecology

Good

Updated 9 February 2017

At our previous, in July 2015, we rated maternity and gynaecology services as 'good'. During this inspection, we again rated maternity and gynaecology services as 'good' because:

  • There was a robust incident reporting procedure. Staff knew how and what to report as incidents. There was evidence that learning from incidents was shared with staff.
  • The clinical area was visibly clean, and staff followed trust infection control procedures.
  • Adult and neonatal resuscitation equipment was checked daily so that staff could be assured it was in good working order. There were systems in place to ensure stock items were available and within expiry dates.
  • Medicines and intravenous fluids were stored appropriately.
  • Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice, and legislation.
  • The service had an infant feeding policy and was developing an infant feeding strategy.
  • The caseload ratio of Supervisors of Midwives (SoMs) to midwives was 1:15, which was in line with the national recommendation for caseloads. Supervisors had met all of the requirements of the local supervising authority audit.

  • Helme Chase Maternity Unit was available 24 hours a day, seven days a week, for women choosing to give birth there.
  • 100% of staff had received an appraisal.
  • SoMs provided a ‘birth afterthoughts’ service, which provided women with an opportunity to discuss issues surrounding their care during pregnancy and birth.
  • The trust was performing as expected in the CQC maternity survey.
  • WGH scored better than the England average for privacy, dignity, and wellbeing in the PLACE survey in 2015.
  • Women who had been assessed as low risk could choose home birth, birth in the midwifery-led unit at Helme Chase, or birth in one of the two consultant-led obstetric units at the trust.
  • The service employed a range of specialist midwives for patients with complex care needs, or for those in vulnerable circumstances.
  • The service had a robust system for monitoring, processing, and learning from complaints, which ensured that responses were sent in a timely manner, themes and trends were identified, and learning was disseminated to staff.

  • Consultant-led antenatal clinics were held within the unit three times a week, which meant that all women using the service could choose where to receive antenatal care.

However:

  • Although there was a plan, which set out the principles and governance arrangements for a strategic partnership with Central Manchester University Hospitals NHS Foundation Trust and Lancashire Teaching Hospitals NHS Foundation Trust, further work was required to effectively capture and monitor outcomes.

Outpatients and diagnostic imaging

Good

Updated 9 February 2017

We rated outpatients and diagnostic imaging services as 'good' because:

  • During our last inspection we had identified concerns about the timely availability of case notes and test results in the outpatients department. At this inspection staff and managers confirmed that the trust had reduced the use of paper records and implemented an electronic records system for most outpatient areas. This was still being rolled out across all departments, but we found that there had been significant improvements in the availability of case notes. Staff were positive about the improvements in efficiency and effectiveness for outpatient services, such as the availability of test results and timely access to information.

  • We found that there had been some improvements in diagnostic imaging staffing numbers since the previous inspection. When we inspected this time the department continued to work with vacancies, but a new rota system enabled it to make improvements.

  • During our last inspection we had noted that there was no information available in the department for patients who had a learning disability, nor any written information in formats suitable for patients who had a visual impairment. At this inspection we saw hat there was a range of information available in different formats, and staff had involved the public and groups including vulnerable people in producing information for use by patients.
  • We noted that space was still limited in some areas and the service provision was physically constrained by the existing environment. However, the overall environment had improved, with changes in flooring materials. We found that overall access to appointments had improved, but performance was variable.
  • Outpatient and diagnostic services were delivered by caring, committed and compassionate staff.
  • Patients were overwhelmingly positive about the way staff looked after them. Care was planned and delivered in a way that took account of patients’ needs and wishes. Patients attending the outpatient and diagnostic imaging departments received effective care and treatment. Care and treatment was evidence-based and followed national guidance.
  • Staff were competent and supported to provide a good quality service to patients. Competency assessments were in place for staff working in the radiology department, along with preceptorships for all new staff to the department.
  • We found that access to new appointments throughout the department had improved.
  • Overall, staff felt engaged with the trust and felt that there had been some improvements in service delivery since our previous inspection. There were systems in place for reporting and managing risks. Staff were encouraged to participate in changes within the department, and there was departmental monitoring at management and board level in relation to patient safety. The service held monthly core clinical governance and assurance meetings, with standard agenda items, such as incident reporting, complaints, training, and lessons learned.

However:

  • There remained a shortage of some staff groups, including occupational therapists, radiographers, and radiologists. Some staff raised concerns about the sustainability of the team under prolonged staffing pressures.
  • Some referral to treatment targets were missed, and follow-up appointments continued to suffer backlogs and delays.

Surgery

Good

Updated 16 May 2019

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

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Nurse staffing was managed using daily monitoring, acuity tools and professional judgement. The service provided mandatory training in key skills to all staff and monitored compliance.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • There were escalation policies, guidance and care pathways for deteriorating patients. Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients confirmed that staff treated them well and with kindness, providing emotional support to minimise their distress.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Staff used the World Health Organisation (WHO) surgical safety checklist, ‘Five Steps to Safer Surgery’. National and local safety standards for invasive procedures incorporated the contents of the WHO surgical safety checklist.
  • Managers checked to make sure staff followed guidance, monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. They planned and provided services in a way that met the needs of local people, taking account of patients’ individual needs. The service had been reconfigured to increase availability of surgical beds and access to rehabilitation.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

However:

  • Not all staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Not all staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They did not always follow trust policy and procedures when a patient could not give consent.
  • Staff training compliance for Safeguarding Adults and Children, levels 1, 2 and 3, which included Mental Capacity Act and Deprivation of Liberty Safeguards training, failed to meet the trust target.
  • The number of staff within surgery who had received an appraisal was below trust compliance targets.
  • All specialties except ear, nose and throat (ENT) were below the England average for referral to treatment times (RTTs) within 18 weeks for admitted pathways.

Medical care (including older people’s care)

Good

Updated 16 May 2019

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

  • There was a holistic approach to planning and delivering care and treatment. Innovative approaches were being used to maximise resources and deliver up to date evidence-based techniques. Care was of a good quality.
  • Staff were well supported to improve quality and continuously develop. Staff were encouraged to contribute and work collaboratively to provide innovative ways to deliver more joined up care.
  • Consent practices were strong, and patient focussed including the accommodation of individual needs. People who use services were involved in the development of tools and support to aid informed consent.
  • Staff morale was high. Teams supported each other well and we saw examples of good teamwork. We saw staff from different professions working well together and staff told us they were proud of their work.
  • Feedback for the service was good and there were very few complaints. The culture was very person-centred and promoted kindness and dignity. People’s needs, and preferences were respected. The emotional needs of patients were in the forefront of the minds of staff and they worked with patients to develop better ways to encompass these.
  • There were good mechanisms in place to report, feedback and learn from incidents and staff were aware of the importance of doing so.
  • Infection control measures were effective. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Patient records across the trust were of a good standard, up to date, legible and accessible.
  • The service participated in local and national audit. Results were good, and the service set high standards to improve still further.
  • Staff demonstrated good knowledge and understanding of their responsibilities under the Mental Capacity Act 2005. Staff were 100% complaint with the relevant training.
  • The service was responsive to individual patients’ needs. Learning disability and mental health nurses worked on wards to provide bespoke care and wider ad-hoc learning opportunities for other ward staff. People with a learning disability or dementia had their preferences recorded and respected.
  • The care group leadership team had good oversight and knowledge of their strengths and weaknesses and leaders at ward level were visible and approachable. Managers had the right skills and abilities to run their service.
  • Provision of IT and other equipment was good in the care group, and staff told us they had the right tools to do their jobs.

Urgent and emergency services

Requires improvement

Updated 16 May 2019

We rated this department as requires improvement because:

  • Staff were not up to date with mandatory training and other important training such as safeguarding vulnerable adults and children. Safeguarding processes were not robust. Additionally, staff had not undergone regular appraisals and did not feel competent to manage some of the patients who attended the department. As a result, we had concerns about the safety of the department.
  • The department did not have embedded governance systems in place and had only recently introduced clinical audit as a way of assuring quality. Patient outcomes had not been monitored and managed in a robust way.
  • The department did not have a suitable safe place for patients living with a mental health condition.
  • Some Patients experienced delays in receiving some test results and often experienced delays being transported to other care settings; transport delays were outside the influence of the trust. This was a potential risk to patients.
  • The department had undergone a series of changes. As a result, governance and leadership processes were not fully embedded in the department. Therefore, at the time of the inspection, despite there being plans in place for the department, we were not assured the department was able to demonstrate that it was well led.

However:

  • Staff delivered treatment that was caring and compassionate and people were treated with respect and their dignity protected.