The Care Quality Commission (CQC) has published a report following an inspection at Bolton NHS Foundation Trust in May and June.
CQC looked at how well-led the trust is, due to concerns regarding the leadership and management at the trust. Children’s and young people’s services was also inspected as part of its continual checks on the safety and quality of healthcare services.
Following this inspection, the trust’s overall rating for well-led has dropped from outstanding to requires improvement. The other areas weren’t inspected, therefore, the trust’s ratings for safe, effective, caring and responsive remain as good. The overall rating for the trust remains as good.
The children’s and young people’s services were again rated as good overall. Effective, caring, responsive and well-led were also again rated as good. The service has improved from requires improvement to good for being safe.
Karen Knapton, CQC deputy director of operations in the north, said:
“When we inspected the trust, we found there was a strong commitment to wellbeing from senior leaders, however, there was a breakdown of trust and relationships between some of the board and the Council of Governors which affected how well the trust was run.
“The culture was very mixed within the trust. We found that staff didn’t always feel respected, supported, or valued by senior leaders, however they remained focused on the needs of people receiving care. Some staff expressed concerns about a closed culture where they couldn’t raise concerns without fear and didn’t always feel listened to and feedback wasn’t consistent, whilst others described it as a fair workplace.
“However, when we inspected the children’s and young people’s services at The Royal Bolton Hospital, it was reassuring to find that leaders of these services were approachable and accessible to both the people using them and staff.
“During the inspection, we spoke to people using the service about their care. They felt staff treated them with compassion and kindness, respected their privacy and dignity and helped them understand their conditions.
“We saw that leaders and staff in this area worked hard to ensure people were receiving safe care.
“We will continue to monitor and assess the trust, to make sure that trust leaders make improvements going forward.”
During the trust well-led inspection, inspectors found:
- A lack of face-to-face meetings of senior leaders and governors during the pandemic had had a significant and lasting negative impact on relationships and promoted a culture of mistrust in some areas
- Staff did not always feel respected, supported, or valued by senior leaders but they remained focused on the needs of people receiving care
- Some staff expressed reservations about raising concerns without a fear of retribution, did not always feel listened to and feedback was not consistent. This included concerns about the effectiveness of the Freedom to Speak Up function within the trust
- Elective recovery had shown signs of improvement however, in some pathways it continued to be more difficult to address. In particular, the breast cancer, urology and colonoscopy pathways.
However,
- Leaders mostly had the skills and abilities to run the trust. They understood the priorities and issues the trust faced
- Leaders and staff actively and openly engaged with people, staff, the public and local organisations
- They worked with partner organisations to help improve services for patients.
During the inspection for children’s and young people’s services at Bolton Hospital; inspectors found:
- The service had enough staff to care for children and young people and keep them safe
- Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well
- Managers monitored the effectiveness of the service and made sure staff were competent
- Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information
- The service planned care to meet the needs of local people, took account of children and young people’s 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
- The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.
However:
- Mental health risk assessments including environmental assessments were not always thoroughly completed.