Royal Oldham Hospital

Northern Care Alliance NHS Foundation Trust was formed on 1 October 2021 when Salford Royal Hospital NHS Foundation Trust legally acquired Pennine Acute Hospitals NHS Foundation Trust.

The trust has four hospitals – Salford Royal Hospital, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary which provide a full range of acute services, including acute medicine, urgent and emergency care, acute frailty units, rehabilitation services, dental services and surgical services, to a population of approximately 1 million people. The trusts had been working in partnership from 2016 until the acquisition. This included a shared executive leadership team.

When a trust acquires another trust in order to improve the quality and safety of care we do not aggregate ratings from the previously separate trust at trust level for up to two years. The ratings for the trust in this report are therefore based only on the ratings for Salford Royal Hospital and our rating of leadership at the trust level.

Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, our usual inspection work has been curtailed by the COVID-19 pandemic.

At Northern Care Alliance we inspected only those services where we were aware of current risks. We did not rate the hospital overall.

In our ratings tables starting on page 30 we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect this time.

Royal Oldham Medical Care

Medical care services at Royal Oldham Hospital are provided by The Northern Care Alliance NHS Foundation Trust. The Trust changed its name on 1 October 2021 when Salford Royal NHS Foundation Trust legally acquired Pennine Acute Hospitals NHS Trust.

We visited Royal Oldham Hospital as part of our unannounced inspection from 8 August to 10 August 2022. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

Medical care services are part of the division of specialist medicine at Royal Oldham Hospital.

During our inspection we visited and inspected the acute medical unit, respiratory (F7), cardiology (F8) including the coronary care unit, the general medical unit including the discharge lounge, gastroenterology (G2), three general medical wards (F9, F10 and T4) and endoscopy (G3), which is part of the surgery division.

We observed care and treatment of patients and looked at seven care records. We spoke with eight patients and two relatives, as well as staff members across the department. This included senior nurses, staff nurses, ward managers, consultants, healthcare assistants and the senior leadership team for the division.

We previously inspected the medical division when it was part of a different organisation so we cannot compare our new ratings directly with previous ratings. We rated it as requires improvement because:

• The service provided mandatory training but not all staff completed it on time. Nursing staff on some of the wards had low compliance rates for adult basic life support (resuscitation) level two training and did not always complete safeguarding training as required. The service did not always control infection risk well and did not always use equipment and control measures to protect patients, themselves and others from infection. Equipment on the wards was not always checked appropriately and could potentially cause harm to patients requiring assistance. Medicines were not always stored correctly. The service did not always have enough medical or nursing staff to keep patients safe.
• The service did not always provide treatment based on national guidance and evidence-based practice. There was limited access to some support services at weekends including speech and language therapy and dieticians.
• People could not always access the service when they needed it and receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
• Leaders ran services well using reliable information systems and supported staff to develop their skills, but senior leaders were not often visible to staff. The service did not have a specific vision and strategy for what it wanted to achieve. The service did not always identify and escalate relevant risks and issues or actions to reduce their impact.

However:

• Staff completed risk assessments for patients and quickly acted upon patients at risk of deterioration. Records were clear, up to date, stored securely and available to staff when required. Staff were knowledgeable about incidents and reported them well. Managers investigated incidents and shared lessons to the team.
• Staff gave patients enough to eat and drink and gave patients 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, supported them to make decisions about their care, and had access to good information.
• 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. Staff understood patients’ personal, cultural and religious needs.
• The service planned care to meet the needs of local people. Staff made reasonable adjustments to help patients access services. Patients found it easy to give feedback and raise concerns about their care. The service managed complaints well and shared lessons learned with all staff.
• Staff mostly felt respected, supported and valued. The service was focused on the needs of patients receiving care. Leaders operated effective governance processes. Staff were clear about their roles and accountabilities.

Royal Oldham Urgent and Emergency Care

We carried out an unannounced comprehensive inspection of Royal Oldham Hospital urgent and emergency care service between the dates of 08 and 10 August 2022.

The urgent and emergency care services had been inspected previously before the acquisition. However, the service had not been rated under the new Northern Care Alliance NHS Foundation Trust. We rated it as ​requires improvement​ because:

• The service did not have enough staff to care for patients and keep them safe. Staff did not always have training in key skills and did not always manage safety well. Not all staff completed training on how to recognise and report abuse.
• The service did not consistently control infection risk well. Staff did not consistently assess risks to patients, nor act on them.
• The design, maintenance and use of facilities, premises and equipment did not always keep people safe.
• The service did not always use systems and processes to safely record, prescribe, and administer medicines.
• Not all policies and procedures were ratified and in date. The service did not always provide care and treatment based on national guidance and evidence-based practice.
• People could not access the service when they needed it and had to wait too long for treatment.
• Leaders did not consistently run services well and did not always use reliable information systems. Staff did not always understand the service’s vision and values, and how to apply them in their work. Staff did not always feel respected, supported, and valued.
• Managers did not always make sure staff were competent for their roles. Overall compliance with annual appraisals was 85% for nursing staff and 0% for medical staffing.
• Staff did not always feel respected, supported, and valued.

However:

• Staff 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• 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.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Staff were committed to improving services we did see evidence of ongoing quality improvement work or innovation.

Royal Oldham Maternity

Maternity and midwifery services for the Northern Care Alliance were mainly at the Royal Oldham Hospital. There were antenatal services and community midwives based at Rochdale Infirmary.

The women's and children’s building opened in 2012. The service had about 5,000 births per year. Most maternity services were situated on the first floor with the exception of the postnatal ward on the second floor. Services included an antenatal clinic including sonography. There was a fetal medicine unit and antenatal day assessment unit (ANDU) with triage. The antenatal ward, of 22 beds, had a dedicated induction bay. The postnatal ward had 29 beds that were a combination of bays and side rooms. The labour ward had 11 private rooms, two of which were classed as high dependency and one was a bereavement suite. There were five beds in the birth centre including access to pools.

The obstetric theatres and level three neonatal unit, with 38 beds, were situated close to the labour ward.

There were community midwives available for home births as well as antenatal and postnatal care.

Specialist midwives supported across both locations. These included safeguarding, perinatal mental health, enhanced needs teams, continuity teams, governance, bereavement and smoking cessation.

We rated it as ​requires improvement​ because:

• The service had not ensured that staff had all required training in key skills including resuscitation, safeguarding and Practical Obstetric Multi-Professional Training (PROMPT).
• There was equipment, in all areas, that was past scheduled maintenance check dates. There was not always enough registered midwives or care staff to care for women and babies. There were some concerns about medicines management including oversight of medicines past their expiry dates. Care was recorded either electronically or on paper and not always clear to review the complete care record.
• The service was not accredited with the UNICEF baby friendly initiative. Compliance with staff appraisal completion was below the trust target. The service was an outlier for stillbirths and preterm babies.
• Staff we spoke with did not know the vision and strategy for the service. For community staff, there were no formal lone working arrangements.

However:

• Staff understood how to protect women from abuse, and managed safety well. The service controlled infection risk well. Midwives assessed risks to women and acted on them. The service managed safety incidents well.
• Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated women 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 women, families and carers.
• The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Recent changes in senior leadership provided assurance of agreed plans to improve services including updated information systems and to support staff to develop their skills. Some staff had felt respected, supported and valued. Staff were focused on the needs of women receiving care and were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.

Royal Oldham Surgery

Royal Oldham Hospital is situated in Oldham and is one of the four acute hospitals that form part of Northern Care Alliance NHS Foundation Trust which looks after a population of approximately 820,000 people. The trust was created on 01 October 2021 following a process of acquisition, in which Salford Royal NHS Foundation Trust acquired Pennine Acute NHS Foundation Trust. Royal Oldham Hospital was part of the Pennine Acute NHS Foundation Trust.

The division of surgery provides a range of general and specialist surgical services, including trauma and orthopaedic, vascular and colorectal surgery.

We observed care and treatment of patients and looked at care records. We spoke to patients, as well as staff members across the department. This included senior nurses, staff nurses, ward managers, consultants, healthcare assistants and the senior leadership team for the division.

We previously inspected the surgical division as part of a different organisation so we cannot compare our new ratings directly with previous ratings. We rated it as ​requires improvement​ because:

• Records were clear, up to date, stored securely and available to staff when required. Staff were knowledgeable about incidents and reported them well. Managers investigated incidents and shared lessons to the team.
• Staff provided good care and treatment based on national guidance and evidence-based practice. Staff gave patients enough to eat and drink and gave patients 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• 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. Staff understood patients’ personal, cultural and religious needs.
• The service planned care to meet the needs of local people. Staff made reasonable adjustments to help patients access services. Patients found it easy to give feedback and raise concerns about their care. The service managed complaints well and shared lessons learned with all staff.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. The service had a vision and strategy for what it wanted to achieve. Staff understood the service’s vision and values, and how to apply them in their work. Staff mostly felt respected, supported and valued. The service was focused on the needs of patients receiving care. Leaders operated effective governance processes. 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.

However:

• The service provided mandatory training but not all staff completed it on time. Medical staff did not always complete life support training in a timely manner.
• The service did not always have enough medical or nursing staff to keep patients safe.
• Staff did not always complete and review risk assessments for patients.
• The service did not always use systems and processes to safely store medicines.