Archived: The Pennine Acute Hospitals NHS Trust

Updated 7 February 2020

The Pennine Acute Hospitals NHS Trust serves the communities of North Manchester, Bury, Rochdale and Oldham, along with the surrounding towns and villages. The area is in the Northeast sector of Greater Manchester and has a population of over 800,000.

The trust provides a range of elective, emergency, district general services, some specialist services and operates from four sites: North Manchester General Hospital, The Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary.

The trust provides services in the following specialties: urgent and emergency care, medicine, surgery, women and children, diagnostics, specialist services and community services. The major services are on two sites at North Manchester General Hospital and The Royal Oldham Hospital, each serving a population of approximately 400,000. The trust’s main commissioners are NHS Bury, NHS Heywood, Middleton and Rochdale, NHS Oldham and NHS Manchester.

During 2016 /2017 Pennine worked under the leadership of Salford Royal NHS Foundation Trust. This arrangement was made formal from the 1 April 2017, when the Northern Care Alliance NHS Group (NCA) was launched bringing together over 17,000 staff and over 2000 beds. Whilst Pennine and Salford remain statutory bodies the respective trust boards have delegated the exercise of their functions to a Group Committees in Common managing both trusts.

Four Care Organisations have been established in the Alliance: Oldham, Bury & Rochdale and North Manchester alongside Salford. The care organisations are responsible for the day to day running of each hospital.

At the last inspection in November 2017 the trust was rated overall as ‘requires improvement’. This showed improvement from the 2016 inspection which rated the trust as ‘inadequate’.

Updated 7 February 2020

Overall the services we inspected have improved.

Our rating of the trust improved. We rated it as good because:

We rated effective, caring and well-led as good, and safe and responsive as requires improvement. We rated 15 trust services, three as outstanding, 11 as good and one as requires improvement. In rating the trust, we took into account the current ratings of the 15 services not inspected this time.

There was clear evidence, that improvements had been made against the key lines of enquiry in each of the five key questions. There were quality improvement systems in place, such as the nursing assessment and accreditation system that were maturing throughout the trust and had a positive impact on the delivery of care to patients. Our judgement has reflected these findings in the overall ratings.

We found a number of examples of outstanding practice during the inspection. For more information, see the outstanding practice section in this report.

Updated 7 February 2020

Updated 7 February 2020

Updated 12 August 2016

Overall rating for this core service Good

We Community services for adults at The Pennine Acute Hospitals NHS Trust as good because:

• Staff delivered care that was caring, compassionate and supportive of patients and their families.
• The service worked effectively and engaged with other professionals to ensure patients received the required level of care and support.
• Staff appraisals were completed and staff had sufficient clinical supervision.
• Staff spoke positively about the support they were given by seniors and management.
• Staff worked effectively with hospitals, GPs and specialists to seek advice when needed.
• When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.
• Staff were observed providing care to patients with kindness, compassion and dignity
• Safety was a high priority and there was measurement and monitoring of safety and performance within the service.
• Risks were appropriately managed and identified.
• We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness guidance.
• There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
• Patients could access the care and treatment they required in a timely way.
• There were strong areas of innovation and the service had won a number of awards for innovative practice.

However:

• Data from the NHS Friends and Family Test showed that the percentage of patients who would recommend the service to their friends and family was below the England average for the 2015/2016 period at 85%.

Updated 12 August 2016

Overall rating for this core service Good O

We rated the community children and young people services at the Pennine Acute Hospitals NHS trust as ‘Good’.

This was because: -

• The level of incidents reported showed low risk of harm and safe systems for care and treatment of patients. Staff understood how to report incidents.

• There were enough suitable skilled, competent staff with the right mix of skills to meet patients’ needs. Patients were treated in clean and suitably maintained premises. Patient records were complete and accurate.

• Care and treatment was based on national clinical guidelines and staff used care pathways effectively. The services participated in clinical audits to look for improvements to the service. Audit records showed most patients experienced positive outcomes following their care and treatment and appropriate actions were taken to improve compliance with best practice standards. Some staff experienced difficulties in accessing trust-wide IT systems. This was being addressed by providing staff with additional computers enabled with access to trust-wide systems.

• Services were planned and delivered to meet the needs of local people. There were systems in place to support vulnerable patients. Most patients received care and treatment in a timely manner. However, a significant number of patients did not attend (DNA) their scheduled appointments in the community orthoptics and audiology services. Staff followed up patients that did not attend by sending letters to them and to other health professionals involved in their care, such as their general practitioners (GP’s).

• Patients and their relatives spoke positively about the care and treatment they received. They were treated with dignity and compassion. They were kept involved in their care and they were supported with their emotional needs.

• The service delivery was based on the trust values and core objectives and staff had a clear understanding of what these involved. There was clearly visible leadership in place through local team leaders and staff were positive about the culture and support available.

Updated 7 February 2020

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

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• Staff understood how to protect children, young people and families from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew when and how to apply it.
• Staff knew how to keep patients safe and knew how to respond if a patient became unwell. Staff used risk assessments to put patients on correct pathways of care.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.  
• The service had enough staff with the right qualifications, skills, training and experience to keep people and adults safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.  
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
• Staff knew how to keep patients safe and knew how to respond if a patient became unwell. Staff used risk assessments to put patients on correct pathways of care.
• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced and sought support to enhance leadership. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
• Staff felt respected, supported and valued; however, the service was going through structural change which impacted on some staff members. Despite these changes, staff were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

However

• Whilst we positively checked resuscitation trolleys on our inspection, a previous internal audit of the units resuscitation trolleys showed two units failed to comply because the trolleys had not been checked correctly on one day of the month.
• Although the trust told us that ward and ward moves at night were rare we received no data confirming this as requested in the inspection process.

Updated 12 August 2016

Overall rating for this core service: Good

We rated community end of life care services at The Pennine Acute Hospitals NHS Trust as good because:

• Staff delivered end of life care in the community setting that was caring, compassionate and supportive of patients and their families.
• The service had a comprehensive framework and strategy for end of life care.
• The advanced care plan document developed to replace the Liverpool Care Pathway in July 2014 was comprehensive and person-centred.
• The trust had appointed a board member with a specific lead role for end of life care and staff were aware of whom this executive lead was.
• Safety was a high priority and there was measurement and monitoring of safety and performance within the service.
• Risks were appropriately managed and identified.
• We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute of Clinical Effectiveness guidance and priorities of the dying person, particularly personalised care.
• There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.
• The training for staff involved with the delivery of end of life care was appropriate and provided on a regular basis.
• The end of life care team worked effectively and engaged with other professionals to ensure patients received the required level of care and support.
• Staff appraisals were completed and staff had sufficient clinical supervision.
• Staff spoke positively about the support they were given by seniors and management.
• A consultant with a responsibility for end of life and was co-located with the end of life care team provided good clinical leadership and support to the palliative care team.
• Staff worked with local hospices, hospitals, GPs and specialists to seek advice when needed.
• When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.
• Staff were observed providing care to patients with kindness, compassion and dignity.