Royal Oldham Hospital

Updated 22 December 2022

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 22 December 2022

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 22 December 2022

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 22 December 2022

Updated 22 December 2022