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Provider: Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 26 February 2020

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

  • We rated safe, effective, caring, responsive and well-led as good. We rated all three of the core services we inspected as good. In rating the trust, we took into account the current ratings of the five core services not inspected this time.
  • Our ratings for Royal Albert Edward Infirmary, Leigh Infirmary and Wrightington Hospital were good, which was the same as the ratings at the last inspection.
  • Our ratings for surgery at all three sites and critical care at Royal Albert Edward Infirmary were good which was the same as the last inspection. Although, our rating for safe in surgery at Royal Albert Edward Infirmary and Wrightington Hospital has gone from good to requires improvement.
  • Our rating for maternity at Royal Albert Edward Infirmary was good which was an improvement from the last inspection when we rated it as requires improvement.
  • We rated well-led for the trust overall as good, which was the same as the last inspection.
  • We have not yet inspected and rated community services or urgent and emergency services at Leigh Infirmary which the trust has provided since 1 April 2019. We have not inspected and rated Wilmslow Health Centre.
Inspection areas

Safe

Good

Updated 26 February 2020

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

  • The trust provided mandatory training in key skills to all staff and monitored completion of the training.
  • Staff understood how to protect patients from abuse and the trust worked well with other agencies to do so.
  • The trust controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The trust had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, although in areas there was high use of bank and agency staff.
  • The trust used systems and processes to safely prescribe, administer store and record medicines
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, and easily available to all staff providing care.
  • The trust managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider trust.
  • The trust used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.

However,

  • In surgery, at Royal Albert Infirmary and Wrightington Hospital, the use and maintenance of facilities and premises did not always keep people safe.
  • In surgery, at all three hospitals, patient records were not always stored securely.

Effective

Good

Updated 26 February 2020

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

  • The trust provided care and treatment based on national guidance and evidence-based practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The trust made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.

Caring

Good

Updated 26 February 2020

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

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 26 February 2020

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

  • The trust planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The trust was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • People could generally access the trust when they needed it and received the right care promptly. The trust admitted, treated and discharged patients in line with national standards.
  • It was easy for people to give feedback and raise concerns about care received. The trust treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The trust included patients in the investigation of their complaint.

However,

  • Although the trust was meeting national access standards, in some specialties the referral to treatment time was below the national average.
  • In critical care there were sometimes delays to patients being discharged.

Well-led

Good

Updated 26 February 2020

Our rating of well-led stayed the same. We rated it as good because:

  • Leaders had the skills and abilities to run the services. They understood and managed the priorities and issues the trust faced. They supported staff to develop their skills and take on more senior roles.
  • The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The trust had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the trust and with partner organisations.
  • Leaders and teams used systems to manage performance effectively. In most areas they identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • The trust collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

However,

  • Senior leaders were not always visible to for patients and staff.
  • Not all surgical services had a clear vision and strategy as plans were dependent on progress in regional developments within the wider health economy.
  • In surgery, risks we identified during our inspection had not been identified and mitigated through the risk management processes.
Assessment of the use of resources

Use of resources summary

Good

Updated 26 February 2020

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

We rated the trust’s use of resources as good. Since the previous Use of Resources assessment in November 2017, the trust has been able to demonstrate an improvement across a range of metrics together with an increase in collaborative working both across the local health economy and wider systems, and in particular a greater use of technology to drive efficiencies and provide high quality care.

The trust reported a surplus in 2018-19 and at the time of the assessment were on track to achieve a surplus in 2019-20. Despite some challenges across the workforce, leading to a high and increased overall pay cost, the trust demonstrated they are using innovative alternative workforce models and expanding already successful recruitment programmes to tackle the highlighted issues.

Please see the separate use of resources report for details of the assessment. The report is published on our website at www.cqc.org.uk/provider/RRF/Reports.

Combined rating

Combined rating summary

Good

Updated 26 February 2020

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

  • We rated safe, effective, caring, responsive and well led as good.
  • We rated all three of the core services we inspected as good.
  • We took into account the current ratings of the five core services not inspected at this time.
  • Our ratings for Royal Albert Edward Infirmary, Leigh Infirmary and Wrightington Hospital were good, which was the same as the ratings at the last inspection.
  • The trust was rated good for use of resources.