The Care Quality Commission (CQC) has published a report following an inspection at Northern Care Alliance NHS Foundation Trust in August and September.
Northern Care Alliance NHS Foundation Trust was formed on 1 October 2021 when Salford Royal NHS Foundation Trust legally acquired Pennine Acute Hospitals NHS Foundation Trust.
CQC carried out this unannounced inspection as part of its continual checks on the safety and quality of healthcare services, and as the trust is a new provider running services formerly run by different trusts. This inspection only included services where CQC were aware of risks.
Inspectors looked at how well-led the trust is overall, as well as some services in the four hospitals – Salford Royal Hospital, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary – which provide a range of acute services, including acute medicine, urgent and emergency care, acute frailty units, rehabilitation services, dental services and surgical services.
This was the first inspection since the formation of the Northern Care Alliance NHS Foundation Trust.
The trust has been rated requires improvement overall, and for being safe, effective, responsive and well-led. It has been rated good for being caring.
Karen Knapton, CQC head of hospital inspection, said:
“When we visited Northern Care Alliance, we found staff working incredibly hard under pressure to deliver the best possible care to patients.
“During our inspection, we found there had been positive changes in the leadership team since the acquisition, and new leaders, led by the chief executive, had already identified issues and started to make improvements. Their initial focus was on maternity services, patient safety, waiting times and addressing health inequalities. These improvements weren’t fully embedded at the time of our inspection.
“It was clear that leaders didn’t always actively and openly engage with patients and staff to plan and manage services, although plans were in place to improve this. However, it was reassuring that the trust engaged well with external stakeholders and local partners to help improve services for patients.
“Additionally, the trust reported and investigated complaints and incidents. However, these weren’t always completed in a timely manner, and learning wasn’t always shared with relevant departments across the trust.
“Our inspectors found staff didn’t always feel respected, supported and valued. However, they remained focused on the needs of patients receiving care.
“Leaders have started to make changes to improve patient care and know what further improvements are needed. We will return to check on progress to ensure these are embedded and sustained across the trust.”
Inspectors found:
- The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and most staff understood and knew how to apply them and monitor progress
- All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research. Improvement projects were at various stages of development and completion across the trust
- The service had a culture where patients and their families could raise concerns without fear.
However:
- Leaders had the skills, abilities and experience to run the service. Most leaders understood the priorities and issues the trust faced. However, some expressed different levels of understanding of the drivers for change and the priorities expressed by their executive colleagues
- Some staff expressed reservations about raising concerns, and others did not always feel listened to
- Leaders did not operate consistent, effective governance processes throughout the service. There were differences in policies and clinical practice which did not reflect best-practice guidelines. However, most leaders were clear about the need to review these functions to ensure they were fit for purpose
- The service collected data and analysed it. However, not all staff were assured the data was always accurate. Staff could not always find the data they needed, in accessible formats to understand performance, make decisions and improvements.
