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Provider: The Pennine Acute Hospitals NHS Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 7 February 2020

Overall the services we inspected have improved.

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

We rated effective, caring and well-led as good, and safe and responsive as requires improvement. We rated 15 trust services, three as outstanding, 11 as good and one as requires improvement. In rating the trust, we took into account the current ratings of the 15 services not inspected this time.

There was clear evidence, that improvements had been made against the key lines of enquiry in each of the five key questions. There were quality improvement systems in place, such as the nursing assessment and accreditation system that were maturing throughout the trust and had a positive impact on the delivery of care to patients. Our judgement has reflected these findings in the overall ratings.

We found a number of examples of outstanding practice during the inspection. For more information, see the outstanding practice section in this report.

Inspection areas

Safe

Requires improvement

Updated 7 February 2020

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

  • Not all staff had completed safeguarding training.
  • In medicine at North Manchester General Hospital some equipment had not been serviced in line with trust targets.
  • Staffing in critical care at Fairfield Hospital did not meet national standards. There were gaps in medical cover for theatre lists at Rochdale Infirmary.
  • Medicines were not always stored in line with guidelines.
  • There was variability in record keeping regarding the assessment of capacity, best interests and do not attempt cardio-pulmonary resuscitation.

However

  • Staff understood how to protect patients from abuse and the service 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. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

  • 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.
  • Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • Staff kept detailed records of patients’ care and treatment. Most records were clear, up-to-date, stored securely 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 service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The trust used systems and processes to safely prescribe, administer and record medicines.

Effective

Good

Updated 7 February 2020

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

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • 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 service made sure staff were competent for their roles. Managers provided support and development to staff.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

However

  • Staff did not always know how to support patients who lacked capacity to make their own decisions.
  • Appraisal rates did not always meet trust targets particularly for nursing and allied health professional staff.

Caring

Good

Updated 7 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, took account of their individual needs, and helped them understand their conditions. There were examples of excellent caring interactions in end of life care services.
  • 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

Requires improvement

Updated 7 February 2020

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

  • Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.

However

  • 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.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

Well-led

Good

Updated 7 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 service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. 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. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • The service collected data and analysed it. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • 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. Leaders encouraged innovation and participation in research.

However

  • Some staff were not aware of the Freedom to Speak up arrangements in the trust.
  • Staff could not always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements because the IT systems did not always provide reliable data.
Assessment of the use of resources

Use of resources summary

Requires improvement

Updated 7 February 2020

We rated the use of resources as requires improvement:

We award the Use of Resources rating based on an assessment carried out by NHS Improvement. 

Combined rating

Combined rating summary

Good

Updated 7 February 2020

We have not previously undertaken a use of resources inspection. We rated the combined quality and resources as good because:

Our combined rating for Quality and Use of Resources summarises the performance of the trust taking into account the quality of services and the trust’s productivity and sustainability. This rating combines our five trust-level quality ratings of safe, effective, caring, responsive and well-led with the Use of Resources rating. 

Checks on specific services

Community end of life care

Good

Updated 12 August 2016

Overall rating for this core service: Good

We rated community end of life care services at The Pennine Acute Hospitals NHS Trust as good because:

  • Staff delivered end of life care in the community setting that was caring, compassionate and supportive of patients and their families.
  • The service had a comprehensive framework and strategy for end of life care.
  • The advanced care plan document developed to replace the Liverpool Care Pathway in July 2014 was comprehensive and person-centred.
  • The trust had appointed a board member with a specific lead role for end of life care and staff were aware of whom this executive lead was.
  • Safety was a high priority and there was measurement and monitoring of safety and performance within the service.
  • Risks were appropriately managed and identified.
  • We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness guidance and priorities of the dying person, particularly personalised care.
  • There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
  • The training for staff involved with the delivery of end of life care was appropriate and provided on a regular basis.
  • The end of life care team worked effectively and engaged with other professionals to ensure patients received the required level of care and support.
  • Staff appraisals were completed and staff had sufficient clinical supervision.
  • Staff spoke positively about the support they were given by seniors and management.
  • A consultant with a responsibility for end of life and was co-located with the end of life care team provided good clinical leadership and support to the palliative care team.
  • Staff worked with local hospices, hospitals, GPs and specialists to seek advice when needed.
  • When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.
  • Staff were observed providing care to patients with kindness, compassion and dignity.

Community health inpatient services

Good

Updated 7 February 2020

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

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect children, young people and families from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew when and how to apply it.
  • Staff knew how to keep patients safe and knew how to respond if a patient became unwell. Staff used risk assessments to put patients on correct pathways of care.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.  
  • The service had enough staff with the right qualifications, skills, training and experience to keep people and adults safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • The service 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 service.  
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • Staff knew how to keep patients safe and knew how to respond if a patient became unwell. Staff used risk assessments to put patients on correct pathways of care.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service 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.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced and sought support to enhance leadership. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Staff felt respected, supported and valued; however, the service was going through structural change which impacted on some staff members. Despite these changes, staff were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

However

  • Whilst we positively checked resuscitation trolleys on our inspection, a previous internal audit of the units resuscitation trolleys showed two units failed to comply because the trolleys had not been checked correctly on one day of the month.
  • Although the trust told us that ward and ward moves at night were rare we received no data confirming this as requested in the inspection process.

Community health services for children, young people and families

Good

Updated 12 August 2016

Overall rating for this core service Good O

We rated the community children and young people services at the Pennine Acute Hospitals NHS 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 suitable 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.

  • Care and treatment was based on national clinical guidelines and staff used care pathways effectively. The services participated in clinical audits to look for improvements to the service. 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. Some staff experienced difficulties in accessing trust-wide IT systems. This was being addressed by providing staff with additional computers enabled with access to trust-wide systems.

  • 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. However, a significant number of patients did not attend (DNA) their scheduled appointments in the community orthoptics and audiology services. Staff followed up patients that did not attend by sending letters to them and to other health professionals involved in their care, such as their general practitioners (GP’s).

  • 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.

Community health services for adults

Good

Updated 12 August 2016

Overall rating for this core service Good

We Community services for adults at The Pennine Acute Hospitals NHS Trust as good because:

  • Staff delivered care that was caring, compassionate and supportive of patients and their families.
  • The service worked effectively and engaged with other professionals to ensure patients received the required level of care and support.
  • Staff appraisals were completed and staff had sufficient clinical supervision.
  • Staff spoke positively about the support they were given by seniors and management.
  • Staff worked effectively with hospitals, GPs and specialists to seek advice when needed.
  • When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.
  • Staff were observed providing care to patients with kindness, compassion and dignity
  • Safety was a high priority and there was measurement and monitoring of safety and performance within the service.
  • Risks were appropriately managed and identified.
  • We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness guidance.
  • There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
  • Patients could access the care and treatment they required in a timely way.
  • There were strong areas of innovation and the service had won a number of awards for innovative practice.

However:

  • Data from the NHS Friends and Family Test showed that the percentage of patients who would recommend the service to their friends and family was below the England average for the 2015/2016 period at 85%.