Walsall Healthcare NHS Trust provides local general hospital and community services to around 260,000 people in Walsall and the surrounding areas. The trust is the only provider of NHS acute care in Walsall, providing inpatients and outpatients at the Manor Hospital as well as a wide range of services in the community.
Walsall Healthcare NHS Trust is working in collaboration with the Royal Wolverhampton NHS Trust under the leadership of a joint chair and chief executive.
Between 20 September 2022 and 10 November 2022, we carried out an unannounced inspection of three of the acute services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We also inspected the well-led key question for the trust overall.
We inspected Children and Young Persons services using our focused inspection methodology. We also inspected Medical and Surgical services. We inspected these services, at Manor Hospital, as our intelligence suggested there may have been a deterioration in the safety and quality of care provided. In addition, in Medical services, we needed to follow up a section 29a warning notice, issued to the trust in March 2021, as we found significant improvement was required to the nurse staffing of the service, the governance of the service and how they provided patients with a safe discharge.
We did not inspect any other services at Walsall Healthcare NHS Trust because our monitoring process had not highlighted any concerns. We will re-inspect these services as appropriate.
Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level. Our findings are in the section headed ‘is this organisation well-led’. We inspected the well-led key question between 9 and 10 November 2022. A financial governance review was also carried out at the same time as the well-led inspection, this was undertaken by NHS England. There was not a separate ‘Use of Resources’ assessment in advance of this inspection.
Following our core service inspection, we served a Warning Notice under Section 29A of the Health and Social Care Act 2008. This warning notice served to notify the trust that the Care Quality Commission had formed the view that the quality of health care provided by Walsall Healthcare NHS Trust in relation to the management of medicines, including prescribing, administration, recording and storage, in Medical services required significant improvement.
Our rating of services stayed the same. We rated them as requires improvement because:
- We rated safe, effective, responsive and well-led as requires improvement and caring as outstanding.
- We rated two of the trust’s acute services as good and one as requires improvement.
- In rating the trust, we took into account the current ratings of the five acute services and four community services not inspected this time.
- Safe processes and systems were not always in place to manage the prescribing, administration and storage of patients’ medicines and medicine related documents. Services did not always control infection risk well. Care records were not always complete. In the Surgery service staff did not always assess risks to patients in relation to venous thromboembolism (VTE).
- In the Medical Care service, arrangements to ensure assessment of patient’s mental capacity or deprivation of liberty were not robust.
- Services for children and young people did not always take account of patients’ individual needs.
- Service leaders did not always run services well and information systems were not always reliable.
- We found improvements during our inspection of how well led the organisation was.
- Services mostly 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. Staff mostly assessed risks to patients and acted on them. Services managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
- Staff provided kind 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 and had access to good information. Key services were available seven days a week.
- Across all services 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.
- Although people could not always access the service when they needed it, the trust was working hard to ensure waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
- Services planned care to meet the needs of local people and made it easy for people to give feedback.
- Leaders 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.
How we carried out the inspection
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.