Royal Albert Edward Infirmary

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Leaders had the appropriate skills and experience to carry out their roles but did not always have resources and space to manage the priorities and issues the service faced. There were clear reporting structures and staff understood their roles and responsibilities. Staff told us leaders were approachable, visible, and provided them with good support. Leaders were able to demonstrate the improvement actions they had undertaken or planned to address key risks. However, the actions taken to address key issues or reduce their impact had not yet resulted in effective and timely improvements in the management of risks, issues and performance across the services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Nursing and medical staff across the urgent and emergency services understood the key risks to the department. They were aware of the challenges faced by the emergency department and were able to explain the improvement actions being undertaken to improve capacity and patient flow in the department. Staff told us the departmental leads and senior managers were approachable, visible and provided them with good support. Staff understood the reporting structures and leaders understood their key roles and responsibilities. The senior leaders fully understood the key risks and challenges faced by the department. They were able to explain the improvement measures that had been undertaken and were able to describe their planned improvement plans to improve capacity and flow issues within the department. The senior leaders were able to demonstrate how they worked as part of a multidisciplinary team within the service and how they worked with external stakeholders, such as the local and regional commissioners, Greater Manchester integrated care partnership and local NHS ambulance and mental health trusts. Stakeholders such as NHS England and local NHS ambulance and mental health trusts told us they worked collaboratively with the urgent and emergency services. They told us they worked well together and there was regular engagement to review performance and identify improvements to services.

Leaders had the appropriate range of skills, knowledge, and experience to carry out their roles. There was a triumvirate leadership structure at departmental and divisional level with medical, nursing and operational leads in place. There were clear reporting structures and key roles were supported by deputies or associate roles to support succession planning. Leaders held routine monthly governance meetings to discuss governance, risk and performance. Risk registers were reviewed during these meetings. The governance and reporting processes enabled leaders to understand the key risks and challenges to the service and to identify improvement actions to address key risks, such as capacity and flow issues. Daily safety huddles and bed management meetings enabled sharing of information and escalation of patient risks and capacity and resource issues. Leaders understood but did not always have resources and space to manage the priorities and issues the service faced. Capacity constraints within the services and across other parts of the hospital impacted on patient flow in the emergency department. Leaders engaged and worked in collaboration with external partners to monitor performance, identify key risks and to develop improvement plans to address key risks, such as patient flow and capacity constraints within the service and across the hospital. This included measures to improve admission avoidance and patient discharge processes. Task and finish groups and working groups were in place to monitor and implement improvements. Leaders were able to demonstrate the improvement actions they had undertaken or planned to address key risks, such as capacity and flow issues. However, the actions taken to address key issues or reduce their impact had not yet resulted in effective and timely improvements in the management of risks, issues and performance across the service.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Governance, management and sustainability during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.