Fairfield General 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.

Medical Care

We rated it as requires improvement because:

• The service provided mandatory training in key skills but not all staff completed it, this was particularly evident for resuscitation training. The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Staff did not always identify patients at risk of deterioration. The service did not always have enough nursing and medical staff to keep patients safe from avoidable harm and to provide the right care and treatment.
• There was limited evidence that the medical division monitored the effectiveness of care and treatment and used the findings to make improvements and achieved good outcomes for patients. There were gaps in management and support arrangements for staff, such as staff appraisals.
• People could not always access the service when they needed it or received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards. Complaints were not always responded to within the timescales specified in the trust complaints policy.
• The service did not have a fully developed or implemented vision and strategy at the time of our inspection.

However:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff used equipment and control measures to protect patients, themselves and others from infection. Records were clear, up-to-date, stored securely and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. Staff recognised and reported incidents and near misses.
• The service 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. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. 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.
• 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.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had the skills and abilities to run the service. They were visible and approachable in the service for patients and staff. Staff mostly felt respected, supported and valued. The service promoted equality and diversity in daily work and provided opportunities for career development. Leaders operated effective governance processes throughout the service. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.

Urgent and emergency services

• The service did not always have enough nursing staff and support staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• The children’s emergency department did not have paediatric consultant or doctor cover in line with national guidance.
• Staff were experienced and qualified but did not always have right skills and knowledge to meet the needs of patients. This was because not all staff completed the required mandatory and job-related training.
• 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 use equipment and control measures to protect patients, themselves, and others from infection.
• Staff did not always monitor the effectiveness of care and treatment. Findings were not used to make improvements and achieve good outcomes for patients.
• The design, maintenance and use of facilities, premises and equipment did not always keep people safe.
• Staff did not consistently support patients to make informed decisions about their care and treatment.
• People could not access the service when they needed it and had to wait too long for treatment.
• Staff did not always give pain relief in a timely manner.

However:

• The service managed medicines well. Medicines including controlled drugs were safely stored with the trust’s monthly audits showing good compliance.
• Managers monitored the effectiveness of the service and encouraged staff to complete mandatory training.
• 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.
• 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. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.