Archived: Fairfield General Hospital

Updated 7 February 2020

Fairfield General Hospital is situated in Bury and is one of the four acute hospitals that form part of Pennine Acute Hospital Trust, which looks after a population of approximately 820,000 people. There are approximately 236 inpatient beds on the site.

The hospital hosts an Accident and Emergency department.

Medical care services at the hospital provide care and treatment for a wide range of medical conditions, including general medicine, cardiology, respiratory and gastroenterology. The surgical services carry out a range of surgical procedures such as elective day case surgery including Gynaecology and ENT. Alongside Orthopaedic and ENT elective and non-elective surgery, the hospital is one of three primary stroke units in Greater Manchester.

The critical care unit is a closed, consultant-led unit with the ability to change between level three intensive care beds and level two high dependency beds as required. The critical care unit is located on Ward 10. The hospital also has four commissioned level two beds that are on Ward 2. The unit had 415 admissions between April 2018 to March 2019.

End of life care encompasses all care given to patients who are approaching the end of their life and following death. The end of life care service supports patients with life-limiting illnesses and is based on a multi-disciplinary model of care. Fairfield General Hospital provides a bereavement office and the service works alongside the mortuary services, helping to facilitate efficient death certification and HM Coroners cases. The trust had 2,558 deaths from February 2018 to January 2019.

We inspected critical care and end of life care services only during this visit.

Updated 7 February 2020

Our rating of services improved. We rated it them as outstanding.

A summary of our findings about this location appears in the overall summary of the provider report.

Updated 1 March 2018

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

• There were systems and processes in place to reduce the risk of harm to patients. The service had introduced a nursing and accreditation system to assess and work towards improving the quality and safety of care.
• Both medical and nurse staffing had improved and the acute medical unit was fully staffed with nurses. On other wards we saw that shifts were covered by overtime and agency staff and there were new starters with starting dates.
• Infection control processes were in place and there had been a successful approach to reducing the incidence of hospital acquired infections.
• There was effective multi-disciplinary team working in place across the service between all staff including nurses and allied health professionals and consultants from different specialties.
• Staff were observed to be caring and had gone the extra mile for patients and their relatives. On a number of wards we saw that staff worked closely with patients and their relatives to improve outcomes for patients. There was involvement of families during the patient’s journey through the service.
• There were activity co-ordinators on the ward for patients with dementia. There was a programme of activities and some of these involved families. Staff said that there was a positive impact on those who participated in the activities.
• Governance structures were in place and we saw that there was good communication up and down the organisation. Staff meetings were used to discuss complaints and incidents and also the introduction of any new guidance.
• The senior management team were very visible in the organisation and staff knew who they were. Staff were aware of the vision and strategy for the organisation and there had been staff participation and engagement in the development of the strategy.
• The service had appointed a mortality lead and systems and processes had been improved since the appointment. The service standardised mortality rate had consistently reduced and was now within normal range.
• There was a rapid access transient ischaemic attack (also known as mini stroke) clinic on the stroke unit.

However:

• Patient records were both paper and electronic and some paper records were not always in the correct order. The medical staff preferred to use the paper records as did the allied health professionals.
• Services were not always a seven day service. In cardiology this was because consultants were on other rotas across the health economy and in the stroke service there were not enough speech and language therapists to provide a full seven day service.
• Allied health professional did not feel that they were represented at a strategic level in the organisation.
• Staff did not always close the doors to side rooms when patients were barrier nursed.

Updated 7 February 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service did not make sure medical staff completed mandatory training. The design of the unit did not meet national guidance. The service did not have enough allied health professionals with the right qualifications, skills, training and experience to provide the right care and treatment. The service did not manage patient safety incidents well. Staff frequently recognised and reported incidents and near misses.
• Doctors, nurses and other healthcare professionals worked together to benefit patients but there was limited participation in multidisciplinary working.
• Leaders did not always use systems to manage performance and risk.
• The service did not have a vision for what it wanted to achieve, and the governance arrangements were not robust. Processes were not in place to manage performance and risk. The service was not focused on the needs of the patient.

However:

• People could access the service when they needed it and received the right care promptly. Staff were caring and compassionate and relatives were involved in decision making processes.
• There were enough nursing staff to safely care for patients on the unit and mandatory training levels had been achieved. Safeguarding processes were in place and staff knew how to recognise and report abuse.

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.
• Managers and staff continually engaged with religious communities to tailor services to meet their needs. Staff had worked together to carry out people’s religious and spiritual wishes after they had died such as preserving the integrity of the body and facilitating vigils or religious ceremonies.
• 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.

However

• The service did not have its own palliative care consultant, although staff had access to specialist palliative care advice and support 24 hours a day, seven days a week.
• We did find one policy that was out of date, although this had been reviewed and was awaiting final sign off.
• Not all IT services allowed easy access to data.

Updated 12 August 2016

We judged outpatients and diagnostic imaging services as Good overall this was because

• • • • • • • Staff were confident about raising incidents and told us that they were encouraged to do so.
          • Staffing levels were appropriate to meet patient needs although increased demand on the Radiology services meant some reporting on diagnostic imaging is outsourced overnight to ensure that turnaround times for reports are within national guidelines.
        • There were appropriate protocols for safeguarding vulnerable adults and children and staff were aware of their roles and responsibilities in regard to safeguarding.
      • The departments inspected were visibly clean and staff followed good practice guidance in relation to the control and prevention of infection.
  • We observed that the equipment used in the care and treatment of patient’s was clean and in good work order.
• An electronic patient record system allowed the filtering out of relevant information and facilitated information being available to different teams very quickly.
• Outpatient and diagnostic services were delivered by caring, committed and compassionate staff who treated people with dignity and respect
• Departmental managers were knowledgeable and supportive and had vision improve their services.
• Staff in outpatients and diagnostic services, demonstrated good team working (including multidisciplinary working) and were competent and well trained.

However

• Not all notes had been scanned and paper notes were still in use for some patients.

Updated 1 March 2018

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

• The service had a good record of reporting patient safety incidents.
• The trust’s ‘open and honest’ boards displayed information about staff and safety issues for patients and visitors.
• All areas we visited were visibly clean and free from clutter.
• Medicines were managed well and patient records were securely stored and completed appropriately.
• Staff understood how to manage any safeguarding concerns and this was part of mandatory training requirements that were monitored by managers weekly.
• The trust had recruited both nursing and medical staff and staffing was identified on department risk registers. Staffing was monitored daily and any shortfalls were supplemented with bank and agency staff to ensure sufficient numbers of suitably qualified staff.
• There was a site-specific major incident plan and staff were familiar with this.
• Ward managers were supportive of staff and proud of services provided.
• The trust values were displayed in public areas and there was a strategy in place that included action plans to improve services. There was a positive culture where managers valued staff.
• Risk registers were in place across the surgical departments with control measures in place. The trust collected data to monitor and drive improvement.

However

• National guidance recommends that staff in theatre receive training in advanced life support training. However; training provided was for basic life support only.
• The theatre environment was not fit for purpose and it was not clear when proposed refurbishment would take place.
• Patient information boards displayed patient details visible to others.
• Senior managers acknowledged that waiting times for certain specialities was a challenge with operations being cancelled for non-clinical reasons.
• We found that the service did not investigate complaints in a timely manner, although managers recognised this.
• The surgical safety checklist compliance figures had been supplied but we observed some gaps in the process.

Updated 1 March 2018

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

• The service was delivered by staff that were competent, trained and supported by their managers, and in sufficient numbers, to provide safe and effective care.
• A learning culture encouraged staff to recognise and report patient safety incidents and safeguarding concerns. Complaints and concerns were managed appropriately.
• The service used local and national audits to identify areas of weakness, to develop improvement plans, and to increase the effectiveness and responsiveness of the department.
• Staff focused on what matters to their patients, their emotional needs, and included patients in their care and were compassionate in their delivery of care.
• Performance was benchmarked across the trust and against national targets. Performance across a range of measures had significantly improved and was in line with or better than the expected improvement trajectory.
• The service worked with the local commissioners and other agencies to plan, deliver and further develop the urgent and emergency services offered to meet the needs of the local community.
• Leaders across the directorate, division, and hospital had a strategy for the service, were visible, and supported their staff. Leaders understood the risks and challenges to the service.

However:

• The environment, documentation used, and quality of assessment records within the paediatric area meant there was an over-reliance on professional curiosity to identify potential signs of safeguarding concerns.
• There was a poor responsiveness of the information technology in the department which had the potential to affect the timeliness and safety of care and treatment.