Northern Care Alliance NHS Foundation Trust ‘requires improvement’ after first CQC rating

The Northern Care Alliance NHS Foundation Trust (NCA) has been rated as “requiring improvement” following its first inspection by the Care Quality Commission (CQC).

An unannounced inspection took place in August and September 2022 when inspectors looked at how well-led the trust is overall, as well as some services in its four hospitals – Salford Royal Hospital, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary.

The official overall rating for the trust is ‘requires improvement’ for being safe, effective, responsive and well-led. It has been rated good for being caring.

The CQC said that staff work ‘incredibly hard under pressure’, but nurses often felt ‘unsafe’ on wards due to workforce shortages.

Emergency departments were deemed ‘overcrowded’ with patients cared for on corridors and not have enough suitably qualified staff to keep them safe.

Staff across all four hospitals in surgery, medical care and maternity services have not done mandatory training including in resuscitation and safeguarding.

Some staff said they did not always feel respected, supported or valued.

The rating comes a year after the new NHS trust was formed, following Salford Royal’s legal acquisition of the Pennine Acute Hospitals NHS Foundation Trust.

The two trusts were previously rated outstanding and good respectively.
 

Read more: New era for Rochdale Infirmary and local services as new NCA NHS Foundation Trust launchesPublished: 01 October 2021

Inspectors found that the NCA 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.

It was noted that 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, whilst the service had a culture where patients and their families could raise concerns without fear.

The inspectors observed that 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.

Inspectors added that some staff expressed reservations about raising concerns, and others did not always feel listened to, and 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.

According to inspectors, 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.

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.”

Dr Owen Williams, NCA Chief Executive, said: “The care and safety of patients and the wellbeing of our colleagues remain central to what we are about and we are determined to work together to get better results for the people we serve.

“We fully accept the CQC’s judgement and their recommended areas for improvement and as the CQC have acknowledged, some improvements are already being made but they do not go far enough at this moment in time.”

Dr Williams thanked colleagues working across the organisation for their ongoing care and commitment during a time of unprecedented demand and added: “I am pleased that the inspectors recognised what I have found out to be true in my first year as CEO, which is that many colleagues are totally caring and are working incredibly hard under a level of pressure the likes of which many of us have not experienced before.

“There is a lot of work to do but our patients can be assured that their safe care and treatment is of utmost importance to us and, on behalf of all my colleagues at the NCA, I would like to thank them for their understanding and support as we work very hard to turn this around.”

Reporting: Rochdale Online

Additional reporting: Joseph Timan, Local Democracy Reporting Service