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North Manchester General Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 February 2020

Our rating of services stayed the same. We rated it them as requires improvement.

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

Inspection areas

Safe

Requires improvement

Updated 7 February 2020

Effective

Good

Updated 7 February 2020

Caring

Good

Updated 7 February 2020

Responsive

Requires improvement

Updated 7 February 2020

Well-led

Good

Updated 7 February 2020

Checks on specific services

Medical care (including older people’s care)

Good

Updated 7 February 2020

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

  • The environment in areas such as the ambulatory care unit was found to be satisfactory.
  • Nurses achieved 90.1% compliance for the mandatory training compliance and 93.7% compliance for their mandatory safeguarding training, both of which are above the trusts 90% target.
  • The service used bank staff as and when needed to ensure that patient care was not adversely affected.
  • Staff reported incidents and learning from incidents was shared with all staff in the medicine department.
  • There was a good staff culture within the unit.
  • Bed capacity was managed via the local and senior teams.
  • Staff told us that the department was well led and that leaders at all levels were visible and approachable.

However:

  • Patient records were not consistently completed in order to monitor the care provided. The records did not consistently contain completed forms used; for example, in discussing do not attempt cardiopulmonary resuscitation.
  • The service did not store medicines well. We found several repeated instances where fridge and room temperatures were noted that had breached excessive temperatures. Staff in the clinical areas were reporting these breaches as they had been instructed to do and we were told that the estates department attended each time.
  • We found medicines that had passed their expiry date.
  • Medical staff only achieved 70.5% in their mandatory safeguarding training compliance and 62.9% mandatory training compliance, neither of which did not meet the trusts targets of 90%

Services for children & young people

Requires improvement

Updated 1 March 2018

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

  • Nurse staffing numbers in post were less than children’s services had planned for and staffing pressures were a concern. The service had to fill gaps with agency or bank staff and staff were transferred from the wards to cover gaps. Sickness levels for nursing were worse than the trust target. However we did not see any adverse impact on patient care and treatment.
  • Mandatory training levels were variable for certain training modules particularly for medical staff. There were plans to improve these levels.
  • Staff did not always keep appropriate records of patients’ care and treatment. Audits showed the quality of record keeping was variable. The small sample of records we looked at were however, were clear and available to staff providing care.
  • At the last inspection the use of the Manchester Children’s Early Warning scores had been identified as an area for improvement. During this inspection we found that an audit process was in place however the scores showed that more work was needed to improve compliance against standards.
  • A number of clinical guidelines had not been reviewed in line with trust timescales.
  • The service had not achieved all areas of compliance with Facing the Future: Standards for Acute General Paediatric Services.

  • The trust target for appraisal was 90%. Staff in most services, particularly neonatal services, were lower than required.
  • At times the working environment became over crowded with patients. Staff felt that waiting areas, wards and clinical spaces were sometimes cramped.

However

  • The service had made improvements since our last inspection in 2016.The changes had occurred despite a management restructure and a move to a new care organisation for its staff.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Improvements had been made in the auditing of infection prevention and control.
  • The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time.
  • The service had recruited to medical posts. The increased medical staffing numbers had made a positive impact on patient care and the ability of wards and units to carry out their roles. There was a reduction in shifts covered by agency medical staff.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. In some cases staff took the initiative to go beyond what was expected of them in terms of ensuring management of risk.

  • The service 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. Data showed that the service had England average outcomes in most of the national audits it participated in.
  • Staff were competent for their roles.

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress.
  • The service planned and provided services in a way that met the needs of local people. The service reviewed data regarding its local population and took this into account when developing services.

  • The service had recognised the needs of its population particularly regarding cultural diversity. It had set up a number of groups and projects to improve the service provided by them to individuals from those communities.

  • The leadership, governance and culture had improved since our last inspection. The service had restructured its leadership model. We found systems were in place to identify risk and challenges in the service. We found meetings were in place where information was shared and disseminated.

  • Senior managers and staff were aware of the findings of the previous CQC inspection in 2016 and many of the issues in that inspection such as medical staffing cover had been prioritised. The staff and managers showed a determination to reshape the service and improve its outcomes.

Critical care

Good

Updated 12 August 2016

We have judged  the critical care services provided were good because.

  • There were systems in place for reporting and learning from incidents.There were sufficient numbers of suitably skilled nursing and medical staff to care for the patient Care and treatment was planned and delivered in accordance with evidence based guidance.Critical care services were delivered by caring, compassionate and committed staff.We saw patients, their relatives and friends being treated with dignity and respect.There was a positive culture with staff and the public being engaged in the development of the service.

However

  • It was rare for there to be a supernumerary clinical co-ordinator on duty as set out in the national service specification for intensive care (D16).There was a problem with delayed and out of hours discharges.Governance processes were present but yet to be embedded.

End of life care

Outstanding

Updated 7 February 2020

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

  • Patients and families were truly respected and valued as individuals and empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. Staff consistently went the extra mile to ensure that patients received individualised care that took account of their needs and preferences in the last days and hours of their lives and that their relatives were supported practically and emotionally.
  • Services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility and choice. Staff actively engaged with local patient groups and communities to tailor services to meet their needs. Decisions which affected the service were made with patients and their families at the centre.
  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. 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 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Services were delivered flexibly and were accessible to people when they needed it. There was a bereavement nurse working within the local coroner’s office to provide bereavement advice and support to people who would otherwise have to actively seek this out themselves.
  • Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed. 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.

Maternity and gynaecology

Good

Updated 1 March 2018

We previously inspected maternity jointly with gynaecology, so we cannot compare our new ratings directly with previous ratings.

Maternity services had improved since the last inspection in several areas. We rated maternity services as good, however further work was still needed in some areas:

  • Maternity Early Warning Scores assessments were not always completed within the prescribed timescale to detect deterioration in a woman’s condition. This included when assessments indicated there was a risk to the woman.
  • Staff did not consistently follow the trust schedule for checking all equipment was present and in working order. This included resuscitation equipment for women and babies.
  • Appropriate records of patient’s care and treatment were not kept in a way in which they could be shared with other health professionals.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness except in one area of maternity services. There was no guideline for the admission of women into the maternity triage area despite this being an action required following a serious incident.
  • There was no formal system of support for midwives regarding safeguarding practice. There was no clear record to show women had been asked the required questions to identify safeguarding concerns at every interaction.

However:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. There had been significant improvements in the midwifery staffing numbers since the last inspection.
  • The service managed patient safety incidents well. Since the last inspection a new system for the management of incidents had been introduced. The investigations were completed within the trust’s timescales and learning was shared with changes made to prevent recurrence.
  • The service provided mandatory and obstetric specific training in key skills to all staff and most staff had completed it. Practice education midwives had been introduced. The mandatory training compliance had improved and was meeting the trust’s target.
  • Women could access the service when they needed it. Systems were in place to reduce delays in the discharge of women from the post-natal ward. This included specific staff to co-ordinate the required checks prior to discharge.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. There had been changes in the leadership of the maternity services at the trust since the last inspection.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff reported an improvement in the culture since the last inspection.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • The service had suitable premises and equipment.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

Outpatients and diagnostic imaging

Good

Updated 12 August 2016

We judged  the service as Good because

   

·        

Mandatory training levels were good and the environment was visibly clean and tidy. Equipment was checked regularly and there was evidence to support this. Staff knew how to report incidents and the learning from these incidents was followed up through regular staff meetings.

·         

 

·        

Staff were using national guidelines which were being reviewed for compliance by the trust. There were good opportunities for staff development and evidence of effective multi-disciplinary team working. Leadership was good at an operational level  in both OPD and radiology and information was shared at all levels in the division; however some allied health professionals were unhappy with the lack of leadership for their professions in the trust.

 

·        

Pathology services were efficient with patient blood test results being available during clinics. The service  was provided a 24 hour, seven day per week service.

 

However

·

The did not attend for appointment (DNA) rates in OPD were higher than the England average and the trust did not have anything in place to address this. DNA rates were also high in the radiology department.

·

There were issues around the storage of medicines in OPD clinics but the trust were working to change this with pharmacy colleagues.

Surgery

Good

Updated 7 February 2020

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

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staff kept detailed records of patients’ care and treatment. Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • The service had enough medical, nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
  • Cancer waiting times were improving across the service.
  • Staff treated patients with compassion and kindness, supported their emotional needs, and included them in decisions about their care and treatment.
  • Leaders had the skills and abilities to run the service. They had a vision of what they wanted to achieve and a strategy to do so, and they operated effective governance structures.

However,

  • The trust did not have a policy to manage post-operative nausea and sickness.
  • From February 2018 to January 2019, all patients had a higher than expected risk of emergency readmission for elective admissions when compared to the England average.
  • Five out of seven specialties were below the England average for referral to treatment times. The trust was engaged in activities to improve, but this had not yet had full impact on the service.

Urgent and emergency services

Good

Updated 7 February 2020

Our rating of this service stayed the same. We rated 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.
  • 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.

However;

  • The number of staff who completed mandatory training did not meet trust targets.
  • The number of staff who completed safeguarding training did not meet trust targets.
  • The service performed worse than the national average for unplanned patient re-attendance within seven days.
  • The number of medical staff who completed appraisals did not meet trust targets.
  • Whilst people could access the service when they needed it, waiting times from arrival to treatment were consistently worse than national expectations and there was a worsening trend in performance.
  • The proportion of patients that received treatment within one hour and the proportion of patients that left the department without being seen were also worse than the national average.
  • Whilst the service treated concerns and complaints seriously and investigated them, complaint responses were not always within trust targets.
Other CQC inspections of services

Community & mental health inspection reports for North Manchester General Hospital can be found at The Pennine Acute Hospitals NHS Trust.