Archived: The Royal Oldham Hospital

Updated 10 February 2021

The Royal Oldham Hospital serves a population of approximately 230,000 people in the Oldham area. There are approximately 445 inpatient beds on the site. The hospital is part of the Pennine Acute Hospitals NHS Trust.

We carried out a focused inspection of The Royal Oldham Hospital’s urgent and emergency care service on 30 November 2020 as part of our winter pressures programme. This was the only service we inspected during this inspection.

We took into account nationally available performance data and concerns we had received about the safety and quality of the services. We inspected against the safe, responsive and well-led key questions; we inspected key lines of enquiry relevant to the winter pressures programme.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. Before the inspection, we reviewed information that we had requested from the trust about the intelligence we had received.

Following our inspection, we wrote to the trust under section 31 of the Health and Social Care Act 2008. This was because we were concerned about the potential significant risk of harm to patients. The trust took immediate action to address our concerns and developed an action plan to make and embed improvements to the service.

Our rating of the urgent and emergency care service went down. We rated it as requires improvement. The overall rating for the hospital stayed the same.

See the urgent and emergency care section for what we found.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection

Updated 7 February 2020

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

• Staff understood how to protect patients 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 how to apply it. The service 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. Staff risk assessed patients, identified and quickly acted upon patients at risk of deterioration.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way and patients received enough food and drink to meet their needs and improve their health.
• The service 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 and there was good multidisciplinary working. Staff gave patients practical support and advice to lead healthier lives.
• Staff respected patients’ privacy and dignity and provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
• The service 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. People could access the service when they needed it and received the right care promptly and staff made reasonable adjustments to help patients access services.
• Leaders had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. Leaders and teams used systems to manage performance effectively and leaders operated effective governance processes.

Updated 1 March 2018

Our rating of this service improved. We rated it as requires improvement because:

• The service did not consistently have enough staff with the right qualifications, skills, training and experience to mitigate risks to patients and to provide the right care and treatment. Staff were moved from other areas to cover gaps and staffing on the High Dependency Unit did not always meet planned staffing levels.
• The service did not have robust systems and processes in place to learn from incidents and effectively share learning and improve practices.
• The service did not always prescribe, record and give medicines well, which had resulted in 14 incidents over a six month period.
• A number of clinical guidelines were not reviewed in line with timescales.
• Systems for identifying risks, planning to eliminate or reduce them had not yet been embedded.

However:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Staff cared for patients with compassion; staff treated children with kindness and reassurance.
• Managers and clinical leaders had started to engage well with patients, staff, and the public and local organisations and had introduced systems and processes to improve the service.

Updated 7 February 2020

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

• The service 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. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good 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, 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. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and 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.

Updated 7 February 2020

Our rating of this service improved. We rated it as outstanding because:

• Patients and families were truly respected and valued as individuals and empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. Staff consistently went the extra mile to ensure that patients received individualised care that took account of their needs and preferences in the last days and hours of their lives and that their relatives were supported practically and emotionally.
• Services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility and choice. Staff actively engaged with local patient groups and communities to tailor services to meet their needs. Decisions which affected the service were made with patients and their families at the centre.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Services were delivered flexibly and were accessible to people when they needed it. There was a bereavement nurse working within the local coroner’s office to provide bereavement advice and support to people who would otherwise have to actively seek this out themselves.
• Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed. 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.

Updated 1 March 2018

We previously inspected maternity jointly with gynaecology, so we cannot compare our new ratings directly with previous ratings.

Maternity services had improved since the last inspection in several areas. We rated maternity as good overall although work was still required in some areas.

• Staff did not complete Maternity Early Warning Scores assessments within the prescribed timescale to detect deterioration in a woman’s condition. This included when assessments indicated there was a risk to the woman.
• The World Health Organisations’ surgical safety checklist was not always fully completed and the procedure in theatre we observed did not follow the guidance.
• Staff did not consistently follow the trust schedule for checking all equipment was present and in working order. This included resuscitation equipment for women and babies.
• Following community midwife visits, including booking, there were delays in recording patient information onto a computer system, which could be accessed by other health professionals.
• Staff did not always provide pain relief to women when they needed it on the post-natal ward.
• Complaints were not being managed within the timescales set out in the trust’s policy.

However:

• The service provided mandatory and obstetric specific training in key skills to all staff and most staff had completed it.
• The service now had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The service managed patient safety incidents well. This had improved since the last inspection.
• Women reported good support with feeding their baby in the way they chose. Trained staff offered this support on a one to one basis when required.
• Staff worked together as a team to benefit patients.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. The leadership of the maternity services had changed and improved since the last inspection.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. This was a positive change since the last inspection.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• The service had suitable premises and equipment.
• The service monitored the effectiveness of care and treatment and used the findings to improve them.

Updated 12 August 2016

We rated outpatients and diagnostic imaging services Good overall because:

• Staff were confident about raising incidents and encouraged to do so.
• Principles of duty of candour when things went wrong were followed patients received an apology, full explanation and were supported going forward.
• The departments inspected were visibly clean and we observed staff following good practice guidance in relation to the control and prevention of infection.
• Equipment was clean and in good work order. Medicines were stored and checked appropriately.
• There were appropriate protocols for safeguarding vulnerable adults and children and staff were aware of their roles and responsibilities in regard to safeguarding.
• Staff in outpatients and diagnostic services demonstrated good team working (including multidisciplinary working) and were competent and well trained.
• Staffing levels were appropriate to meet patient needs
• Outpatient and diagnostic services were delivered by caring, committed and compassionate staff who treated people with dignity and respect.
• .The number of patients waiting longer than 18 weeks from referral to treatment (RTT) was consistently better than the England average. The cancer waiting times for the trust were consistently better than the England average.

However,

• The trust reported in their missed cancer diagnoses action plan that they had produced a leaflet and banners to support and empower patients, to ask about the tests they have undergone and that these had been distributed in all sites in outpatients and radiology. During the inspection, we were unable to find the leaflets in clinics and staff had not heard about them.
• The paper notes we reviewed contained limited information, were out of sequence and in some cases were illegible also not all notes had been scanned and paper notes were still in use for some patients..
• At November 2015 there was a staffing shortfall of 5.4wte Band 5 radiographers and 1wte Band 8a Manager. The department was actively recruiting 6 student radiographers
• We found there was no set of local rules and  risk assessments to hand in a number of  departments. They had not been printed off and signed by staff so there was no indication that they were aware of, and had an understanding, of the rules.

• Lucy Pugh Outpatients Department was located at the bottom of a very steep slope and was not safely accessible externally to those who were not steady on their feet or in the event of inclement weather. To enter the department internally via lift access involved a long walk through the hospital.

Updated 7 February 2020

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

• At our previous inspection in 2017 we rated the service as requires improvement, we rated safe and effective as requires improvement and responsive, caring and well-led as good. At this inspection we rated safe, effective, caring and well-led as good and responsive as requires improvement
• At the last inspection we told the service it must improve compliance with completion of the World Health Organisation surgical safety checklist and ensure theatre staff were trained in appropriate levels of resuscitation training. During this inspection we saw the service had made improvements in both these areas and though not all required staff had received paediatric life support training the service had acted to mitigate the risk and ensure all staff received training by December 2019.
• We also saw the service had improved staff reporting of incidents, the monitoring of surgical site infections and provision of patient information. The service had improved the maintenance of the environment and equipment in theatres. Managers had acted to ensure staff received training in sepsis and staffing levels were maintained in line with national guidelines.
• The service 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. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good 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, 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. Cancer waiting times were improving across the service.
• Leaders ran services well using reliable information systems and 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.

However,

• We found low levels of compliance with paediatric intermediate life support training for theatre staff. However, the service had a plan to address this and acted to ensure there was also one appropriately trained member of staff available in theatre when children were operated on.
• The service did not have a system to track and monitor staff compliance with deprivation of liberty safeguards legislation. We found at our last inspection that assessments of mental capacity were not always completed appropriately and at this inspection we found staff had not consistently assessed patients’ capacity before applying for deprivation of liberty safeguards.
• Staffing issues in theatres led to cancelled operations and low theatre utilisation rates. Between April 2018 and March 2019, the service cancelled 91 operations where the patient was not treated within 28 days. Referral to treatment performance was consistently below the England average in some specialities.

Updated 10 February 2021