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Provider: Bolton NHS Foundation Trust Good

On 11 April 2019, we published a report on how well Bolton NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 11 April 2019

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

  • We rated safe, effective, caring and responsive as good.
  • We rated all of the trust’s eight acute services as good. In rating the trust, we took into account the current ratings of the five acute, Bolton One and community services not inspected this time.
  • We rated well-led for the trust as outstanding.
  • The trust had taken the appropriate actions relating to the requirements of the previous inspection.
  • The trust was inspected for its use of resources and rated good which gives a combined rating of good.

At the Royal Bolton Hospital;

  • We inspected urgent and emergency care services during this inspection to check if improvement had been made since our last inspection in 2016. The ratings for safe, effective and responsive improved from requires improvement to good. This improved the overall rating for this service to good.
  • We inspected medical care (including older people’s care) and found that there had been improvement since our last inspection in 2016. The rating for safe improved from requires improvement to good and caring improved to outstanding.
  • We inspected maternity services and rated the service as good across all domains.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RMC/reports.

Inspection areas

Safe

Good

Updated 11 April 2019

Our rating of safe improved. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • All core services we inspected were rated as good for safe.
  • The rating for safe in the urgent and emergency care services at Royal Bolton Hospital improved from requires improvement to good. They had addressed all the concerns raised from the previous inspection. Environmentally the service was much improved and there were sufficient staff.
  • The rating for safe in the medicine services at Royal Bolton Hospital improved from requires improvement to good. They had addressed the concerns raised from the previous inspection particularly in the areas of patient moves at night and timely discharges which had improved.
  • The overall rating for safe at Royal Bolton Hospital improved from requires improvement to good.

Effective

Good

Updated 11 April 2019

Our rating of effective stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The rating for the effective domain in the urgent and emergency care service improved from requires improvement to good. National audit results were acted upon and training compliance had improved, and uptake of appraisal rates met the trust target.
  • The other two core services were rated as good in effective which was unchanged from the previous inspection.

Caring

Good

Updated 11 April 2019

Our rating of caring stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • All core services we inspected were rated as good for the caring domain.
  • Caring in the medical care service were rated as outstanding.
  • There were examples of outstanding practice, patients were at the heart of decision making and family and carers were fully involved.
  • Trust wide there was a culture of improving patient experience.

Responsive

Good

Updated 11 April 2019

Our rating of responsive stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The rating for the responsive domain in the urgent and emergency care service improved from requires improvement to good. Facilities and the premises had been refurbished to better meet people’s needs, with more spacious facilities to allow for streamlined services and a more positive environment generally. There was an improving picture on waiting times and flow was being managed proactively.
  • The other two core services we inspected were rated as good for the responsive domain.

Well-led

Outstanding

Updated 11 April 2019

Our rating of well-led stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • All three core services we inspected maintained their well-led rating of good.
  • The services had leaders at all levels with the right skills and abilities.
  • Staff were positive about the leadership of the services.
  • Leaders promoted a positive culture that supported and valued staff and created a sense of common purpose based on shared values.
  • The services were committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.
  • The services had effective systems for identifying risks, planning to eliminate or reduce them, and coping with the expected and unexpected.
  • There was widespread engagement with people who used the services and their families.
Assessment of the use of resources

Use of resources summary

Good

Updated 11 April 2019

Combined rating
Checks on specific services

Community health inpatient services

Good

Updated 10 August 2016

Overall rating for this core service

Community inpatient services were rated as good overall. This was because;

  • The service used the NHS safety thermometer to monitor its performance in relation to safety. Action plans were in place to improve harm free care.

  • Incidents were reported and learning was shared. There was a good reporting culture. Incidents were investigated in a timely way.

  • The environment was visibly clean and tidy. We saw staff using personal protective equipment such as aprons and gloves and observed them washing their hands appropriately. Hand hygiene compliance audits were high. Medicines were stored correctly and securely.

  • A new nurse call buzzer was in place to improve patient safety.

  • Overall mandatory training rates met the trust target. Adult safeguarding level two had been completed by 96% of staff. Staff we spoke with understood their responsibilities in relation to safeguarding adults.

  • There were systems in place to ensure that patients were assessed and risks were monitored and minimised. There were clear admission criteria to ensure patients could be safely cared for outside of an acute hospital environment.

  • A daily safety huddle involving key members of the multidisciplinary team was in place to highlight particular patient safety concerns.

  • Nursing staffing fill rates were generally good. Nursing staff were supported by staff from the local authority.

However,

  • Risk assessments were not always completed in a timely way, for example the risk of developing a pressure ulcer.

  • There was not sufficient structure to intentional rounding documentation to ensure this essential patient safety task was completed in an effective way.

  • The environment required the planned upgrades to ensure patients could be cared for in a safe way.

We rated effective as good because;

  • Audits of care were completed and showed that 100% of patients had an individualised care plan.

  • Care and treatment followed evidence based practice and national guidance. A consultant provided a ward round twice weekly.

  • Pain was monitored and pain relief given in a timely way.

  • There was access to additional training to improve staff knowledge in areas such as falls and dementia care.

  • Multi-disciplinary working was well-established. The service worked well with colleagues from the local authority.

However;

  • Appraisal rates did not meet the trust target.

We rated caring as good because;

  • Friends and family test scores showed a high percentage of patients would recommend the service.

  • Patients and those close to them were involved in their care and treatment. A care co-ordinator acted as a point of contact.

However;

  • Scores for privacy and dignity on the patient led assessment of the care environment (PLACE) were much lower than the England average although details from the trusts own survey showed that patients felt they were treated with dignity and respect.

We rated responsive as good because:

  • Services were planned around the needs of local people. There was additional capacity at times of high demand for intermediate care beds.

  • Individual needs were understood and considered when delivering care and treatment. There was additional facilities and support for patients living with dementia.

  • The service monitored admissions and discharges. This information was shared with staff at the hospital to improve access and flow.

  • There were low numbers of complaints about Darley Court. Lessons were learnt from complaints and shared within the division and the wider trust.

However,

  • The environment required improvements to better meet the needs of patients living with dementia.

We rated well-led as good because:

  • Governance and risk management systems were in place that supported the delivery of care. Risks were managed and regularly reviewed to minimise the impact to the service.

  • Leaders used comprehensive performance dashboards to monitor how the service was doing. The service had good systems in place to review data about patient referrals and outcomes.

  • Leaders were supportive and enthusiastic about the service they provided. They valued every member of the team.

  • The culture was open and honest. Staff engagement was good.

  • The service was working closely with local partners to improve, develop and ensure a sustainable service for the future.

However,

  • Issues with IT meant that leaders could not always look at data relating solely to Darley Court.

  • There had been no recent patient experience survey.

Community health services for adults

Good

Updated 10 August 2016

Overall we rated adult community services as good because:

  • All community staff were aware of the trust’s incident reporting processes and there were mechanisms in place to learn from incidents.

  • We found compassionate and respectful care was present in all interactions we observed.

  • Patients accessing the service received effective care and treatment that followed national clinical guidelines including those from the National Institute for Health and Care Excellence (NICE). The service planned its services to meet the individual needs of the local population it served.

  • Patients had access to the right care at the time and where targets in respect of this were not met, the service was working to improve and evidence of this improvement was well documented.

  • There were robust governance frameworks and managers were clear about their roles and responsibilities.

  • Risks were appropriately identified, monitored and there was evidence of action taken, where appropriate.

However,

  • There were some instances where records were not fully completed in accordance with best practice.

  • Staff did not always have timely access to computers.

Community health services for children, young people and families

Good

Updated 10 August 2016

We rated the community children and young people services at the Bolton NHS foundation trust as ‘Good’.

This was because: -

  • The level of incidents reported showed low risk of harm and safe systems for care and treatment of patients. Staff understood how to report incidents.

  • There were enough suitably skilled, competent staff with the right mix of skills to meet patients’ needs.Patients were treated in clean and suitably maintained premises. Patient records were complete and accurate.

  • The care and treatment was based on national clinical guidelines and staff used care pathways effectively. Audit records showed most patients experienced positive outcomes following their care and treatment and appropriate actions were taken to improve compliance with best practice standards

  • Services were planned and delivered to meet the needs of local people. There were systems in place to support vulnerable patients. Most patients received care and treatment in a timely manner.

  • Patients and their relatives spoke positively about the care and treatment they received. They were treated with dignity and compassion. They were kept involved in their care and they were supported with their emotional needs.

  • The service delivery was based on the trust values and core objectives and staff had a clear understanding of what these involved. There was clearly visible leadership in place through local team leaders and staff were positive about the culture and support available.

However;

  • Only 70% of staff in the Children's Community Nursing service had received their level three safeguarding children training.

  • Some staff experienced difficulties in accessing trust-wide IT systems due to connectivity issues.

  • There was a gap in compliance for nocturnal enuresis (bed-wetting) in children and young people because of an issue with alarms.