You are here

Provider: Manchester University NHS Foundation Trust Good

On 23 April 2019, we published a report on how well Manchester University NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  

Read more about use of resources ratings

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 19 March 2019

We have not rated this service before. We rated it as good because:

Inspection areas

Safe

Good

Updated 19 March 2019

We have not previously rated these services since the new provider was formed in October 2017. We rated it as good because:

  • We rated safe as good at Royal Manchester Children’s Hospital, Royal Manchester Eye Hospital, Saint Mary’s Hospital, Trafford General Hospital, Wythenshawe Hospital, Altrincham Hospital, Withington Community Hospital, and across the mental health and community services. We rated the University Dental Hospital of Manchester as outstanding for safe.
  • Most staff were confident to report incidents and learning from incidents was disseminated to staff across the trust. There was a positive culture around incident reporting in most areas.
  • Effective systems were in place to safeguard patients.
  • Medicines were mostly stored well and administered appropriately.
  • The environment was mostly clean and tidy and infection rates were low.
  • Although there were challenges to staffing levels, there were effective systems and processes were in place to manage these.
  • There were effective systems in place to manage patients at risk of deterioration.

However

  • The five steps to safer surgery were not fully adhered to at Manchester Royal Infirmary and Trafford General Hospital.
  • There were areas of concern regarding staffing in the emergency departments at Manchester Royal Infirmary and Wythenshawe Hospital.
  • Levels of compliance with mandatory training were low in some areas.
  • We found that records were not always available particularly within surgical services at Manchester Royal Infirmary and the outpatients department. Records were not always fully completed in the urgent and emergency care services or outpatients.
  • The urgent and emergency care service and surgical services at Manchester Royal Infirmary did not always ensure its premises were suitable or that equipment was looked after. Equipment was not always serviced and maintained in a timely way in all parts of the trust.
  • At Manchester Royal Infirmary, we found several areas of the emergency department, including some equipment to be visibly dirty and inconsistent infection control practices in theatres.

Effective

Good

Updated 19 March 2019

We have not previously rated these services since the new provider was formed in October 2017. We rated it as good because:

  • We rated Royal Manchester Children’s Hospital, Saint Mary’s Hospital, Altrincham Hospital, Trafford General Hospital, Wythenshawe Hospital, Withington Community Hospital and the community services as good for effective. We rated Manchester Royal Eye Hospital, the University Dental Hospital and community child and adolescent mental health services as outstanding for effective.
  • The trust provided care and treatment based on national guidance and evidence of its effectiveness.
  • There was a strong learning culture and opportunities for staff to develop. New roles were being developed to support service development and to address gaps in staffing and recruitment.
  • The trust measured patient outcomes and benchmarked themselves against other organisations.
  • Staff gave patients enough food and drink to meet their needs, although there were inconsistencies in the timeliness of nutrition and hydration assessments in surgery at Manchester Royal Infirmary.
  • Multi-disciplinary team working was evident in most areas across the trust to support patient care and improve patient outcomes.

However

  • We rated effective as require improvement at Manchester Royal Infirmary. Outcomes for people who used the service were below expectations when compared to other services in some areas including surgery and the emergency department.
  • Not all staff had received an annual appraisal.

Caring

Outstanding

Updated 19 March 2019

We have not previously rated these services since the new provider was formed in October 2017. We rated it as outstanding because:

  • We rated caring as outstanding at Royal Manchester Children’s Hospital, Manchester Royal Eye Hospital Saint Mary’s Hospital, Wythenshawe Hospital and community child and adolescent mental health services.
  • We rated caring as good at Manchester Royal Infirmary, The University Dental Hospital, Altrincham Hospital, Trafford General Hospital, Withington Community Hospital and the community services.
  • We saw numerous examples that staff provided outstanding care to patients and their relatives and carers. Feedback from patients and those close to them was continually positive across many areas of the trust.
  • We observed patients were treated with privacy and dignity at all times.
  • There was support for patients and their relatives and carers in the trust and the trust worked with external partners to support patients in their communities.

Responsive

Good

Updated 19 March 2019

We have not previously rated these services since the new provider was formed in October 2017. We rated it as good because:

  • We rated responsive as good at Royal Manchester Children’s Hospital, Saint Mary’s Hospital, Altrincham Hospital, Trafford General Hospital, Withington Community Hospital and the community health services. We rated responsive as outstanding at Manchester Royal Eye Hospital and community child and adolescent mental health services.
  • The trust planned and provided services in a way that met the needs of most people.
  • There was mostly a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met these needs, which was accessible and promoted equality.

However

  • We rated responsive as requires improvement at Manchester Royal Infirmary, The University Dental Hospital and Wythenshawe Hospital.
  • Patients could not always access treatment when they needed do. For example, the emergency departments were not meeting the national four-hour standards for admitting, transferring or discharging patients at Manchester Royal Infirmary and Wythenshawe Hospital.
  • The time taken to respond to patient complaints was not always in line with trust policy.

Well-led

Good

Updated 19 March 2019

We have not previously rated these services since the new provider was formed in October 2017. We rated it as good because:

  • We rated well-led as good at Royal Manchester Children’s Hospital, Saint Mary’s Hospital, Altrincham Hospital, Trafford General Hospital, Withington Community Hospital, the community health services and Wythenshawe Hospital. We rated well-led as outstanding at Manchester Royal Eye Hospital, The University Dental Hospital and community child and adolescent mental health services.
  • Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care in most areas.
  • The trust had a vision for what it wanted to achieve and services had workable plans to turn it into action.
  • Learning, continuous improvement and innovation was embedded across most services. There was substantial research activity at the trust.
  • Risk was well managed and there were governance arrangements in place to improve patient safety and the quality of services.
  • There was a positive culture across most parts of the trust and most staff were positive about the merger.

However

  • We had concerns about the leadership and culture within surgery at Manchester Royal Infirmary.

Assessment of the use of resources

Use of resources summary

Good

Updated 19 March 2019

Checks on specific services

Child and adolescent mental health wards

Good

Updated 19 March 2019

We had previously not inspected this service for this provider. We rated it as good because:

  • The service was well staffed. Staff managed risk effectively. Staff completed patient risk assessments on admission and updated these regularly. The environment was subject to regular checks. A ligature risk assessment was in place. Actions to mitigate or remove risk were in place. Staff knew how to identify potential safeguarding concerns, and the action to take in response.
  • A multidisciplinary team of staff provided care to patients. Staff completed and updated assessments of patients, and developed care plans from these. Care plans were detailed and holistic. Staff and patients completed a range of rating scales and outcome measures that were used to inform treatment. There was excellent physical health care. Patients’ physical health care was routinely assessed, monitored and treated when required. There was excellent physical health care. Patients’ physical health care was routinely assessed, monitored and treated when required.
  • Staff treated patients with compassion and kindness. Patients and carers were involved in decisions about their care and treatment. Patients and carers were able to give feedback on the service they had received. Patients and carers we spoke with were positive about the service.
  • The service had an admission criteria and a referral pathway. Referrals were managed in a timely manner. Discharge planning began from the point of admission. Staff supported patients with activities outside the service, such as work, education and family relationships.
  • Managers promoted a positive culture that supported and valued staff. Staff we spoke with were positive about their jobs, the service and the care they provided. Staff were able to give feedback on the service and were involved in service development. There were effective systems and processes in place to drive quality improvement and safety. The service supported innovation and research.

Community end of life care

Good

Updated 19 March 2019

We had not previously inspected this service. We rated it as good because:

  • End of life care services were planned, organised and delivered well.
  • The service had a clear vision and strategy which had been developed with the involvement of staff and external partners.
  • Services were safe and well managed.
  • Care was delivered by competent practitioners who considered the needs of all patients and families in their care.
  • Staff provided a range of treatment and care for patients based on national guidance and best practice.
  • Staff were caring and demonstrated compassion and kindness to patients and their families.
  • The approach to end of life care was multi-disciplinary with all partners working together to support patients at the end of their lives.
  • There was 24-hour cover for end of life services. Patients were triaged according to need.
  • Care given was holistic, feedback from patients and their relatives described exemplary treatment and care.
  • Training was available for staff to support their communication skills in dealing with patients at the end of their lives.
  • Patients records were electronic in most areas and for those areas that were still using paper records had plans in place to become paperless.
  • Safeguarding processes were in place and the trust were working closely with a neighbouring mental health unit.
  • There were governance processes in place and risk was managed appropriately.
  • Staffing levels were reviewed daily in all three localities, however the service in the Central region had only one band 6 nurse who was on secondment and an interim band 8 nurse. There was a business plan in place for an investment from a National cancer charity which would enable the service to recruit more staff.

Community dental services

Good

Updated 19 March 2019

This service has not been inspected before. We rated it as good because:

  • Staff were qualified and competent to carry out their roles. They were encouraged to complete mandatory training, and this was actively monitored. There were systems in place to ensure patients were protected from abuse or neglect. Premises and equipment were clean and hygienic and used dental instruments were sterilised according to nationally recognised guidance. The service had a good track record of safety and there were systems and processes in place to reduce the risks associated with the carrying out of the regulated activities.
  • Staff provided treatment, advice and care in line with nationally recognised guidance. The service used skill mix effectively through the use of dental therapists and dental nurses with extended duties. They monitored patient outcomes to ensure they were following nationally recognised guidance. Staff worked with other healthcare professionals to ensure patients received the best possible treatment. Staff were aware of the importance of obtaining and recording consent and were aware of their responsibilities under the Mental Capacity Act 2005 and the principals of Gillick competence.
  • Staff cared for patients with compassion and kindness. We observed positive interactions between staff and patients throughout the patient journey. Patients told us that staff were professional, friendly and supportive.
  • The service took into account patients’ individual needs. Most clinics were fully accessible for wheelchair users or those with limited mobility. They had access to a wheelchair tipper, bariatric couch and a hoist. Translation services were available for patients who did not have English as a first language. The appointment system met patients need and there were arrangements for patients requiring emergency treatment both in and outside normal working hours.
  • There was a clearly defined management structure. Managers had the right skills to support high quality sustainable care. There were systems in place to develop management to ensure management remains strong. Systems and processes were in place to manage and mitigate risks to the service. Staff engaged with patients, other healthcare professionals and external stakeholders in order to continually improve the service.

However:

  • The process for ensuring all medical emergency equipment was available and in date was not effective.

Community health inpatient services

Good

Updated 19 March 2019

We have not previously rated this service. We rated it as good because:

  • Staff had the appropriate skills and experience to provide effective care and treatment. Staff could access mandatory training and the department had good compliance rates.
  • Staff understood their roles and responsibilities to protect patients from abuse. Staff had access to safeguarding training, policies and procedures and compliance rates for safeguarding training were good.
  • The trust had measures in place to manage infection risk. Premises were visibly clean, tidy and well maintained with good access to cleaning materials.
  • The service managed risk well and completed risk assessments for each patient.
  • The trust arranged for good G.P. and pharmacy cover across the three locations.
  • The trust knew how to monitor safety and the service used the information to make improvements. The trust was open and honest about safety information.
  • Patients received food and drink according to their individual requirements and likes and dislikes. Staff monitored fluid and food intake and assisted patients to eat and drink where required.
  • Patients were asked about their pain levels and staff aimed to keep patients comfortable.
  • The trust was very good at multidisciplinary working with different types of staff working together to achieve aims and objectives and meetings the needs of patients.
  • Staff knew what to do if patients were not able to consent to their care and treatment and the trust ensured good access to training, policies and procedures around mental capacity.
  • Patients and their relatives and carers told us that staff were caring and took account of their emotional needs. Staff included patients and their carers in care and treatment planning.
  • The trust placed importance on planning and providing services to meet the needs of the local people. The trust had measures in place to record experiences and feedback to develop the service.
  • The service took account of patients’ individual needs and focussed on ensuring the care and treatment supported patients to be as independent as possible.
  • People could access the service when they needed it with therapy available across seven days.
  • The service had a good record for dealing with queries and concerns. The service treated concerns seriously, investigated concerns and learned lessons from the results. The trust shared the results with staff.
  • The vision of the trust for inpatients care was clear and staff at all levels knew what the vision was and were engaged. The trust looked at different ways to engage both patients and staff and understood the importance of doing so to improve and develop the service.
  • The trust learned from things that went wrong, and were open and honest when they did.
  • The trust maintained a positive culture. All staff we saw spoke highly of working for the trust and were happy in their work.

Community health services for adults

Good

Updated 19 March 2019

We had not inspected this service previously. 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.
  • The service managed patient safety incidents well and staff recognised and reported incidents appropriately.
  • All services we visited held a daily safety huddle where caseloads, patients at risk, incidents and staffing were monitored.
  • The service was developing fully integrated clinical pathways in line with national guidance.
  • The service participated in research projects with local universities to improve evidence based practice and patient outcomes.
  • The service made sure staff were competent for their roles and supported staff to undertake training and modules at degree level with the local universities.
  • Staff from different professions and services worked together as a team to benefit patients.
  • The service was working well towards fully integrating teams and staff acknowledged the evident benefits to patient care.
  • Staff cared for patients with compassion, dignity and respect. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Services were developed and reviewed to ensure they were responsive to the needs of the community.
  • The service had a range of fully integrated health and social care teams delivering services across the community.
  • The service had a range of nursing and therapy teams providing specialist clinics for patients in vulnerable and complex circumstances.
  • The service had a clear vision for community services. Staff actively supported and promoted the vision.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service demonstrated a good culture of identifying and reporting risks.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

Specialist community mental health services for children and young people

Outstanding

Updated 19 March 2019

We had not previously inspected this service under this provider. We rated the service as outstanding because: