Rochdale Infirmary

Northern Care Alliance NHS Foundation Trust was formed on 1 October 2021 when Salford Royal Hospital NHS Foundation Trust legally acquired Pennine Acute Hospitals NHS Foundation Trust.

The trust has four hospitals – Salford Royal Hospital, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary which provide a full range of acute services, including acute medicine, urgent and emergency care, acute frailty units, rehabilitation services, dental services and surgical services, to a population of approximately 1 million people. The trusts had been working in partnership from 2016 until the acquisition. This included a shared executive leadership team.

When a trust acquires another trust in order to improve the quality and safety of care we do not aggregate ratings from the previously separate trust at trust level for up to two years. The ratings for the trust in this report are therefore based only on the ratings for Salford Royal Hospital and our rating of leadership at the trust level.

Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, our usual inspection work has been curtailed by the COVID-19 pandemic.

At Northern Care Alliance we inspected only those services where we were aware of current risks. We did not rate the hospital overall.

In our ratings tables starting on page 30 we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect this time.

Maternity and midwifery services for the Northern Care Alliance were managed from the Royal Oldham Hospital. Rochdale Infirmary provided an additional base for patients to access antenatal services and support from community midwives. The community midwives provided support with home-births as well as antenatal and postnatal care.

Rochdale Infirmary did not offer any birthing services on-site. Specialist midwives provided advice and support across both locations. These included safeguarding, perinatal mental health, enhanced needs teams, continuity teams, governance, bereavement and smoking cessation.

We carried out this focussed inspection as part of our inspection of the Northern Care Alliance in accordance with the methodology for our national maternity programme. The programme requires us to report on whether maternity services are safe and well-led only.

• The service had not ensured that staff had all required training in key skills including resuscitation, safeguarding and Practical Obstetric Multi-Professional Training (PROMPT).
• There was equipment in all areas past scheduled maintenance check dates. There were not always enough registered midwives or care staff to care for women and babies. There was some concern about medicines management including medical gases. Care was recorded either electronically or on paper dependent on which part of the pathway was at.
• The service was not accredited with the UNICEF’s baby friendly initiative. Compliance with staff appraisal completion was below the trust target. The service was an outlier for stillbirths and preterm babies.
• Staff we spoke with did not know the vision and strategy for the service. For community staff, there were no formal lone working arrangements.

However:

• Staff understood how to protect women from abuse, and managed safety well. The service controlled infection risk well. Midwives assessed risks to women and acted on them. The service managed safety incidents well.
• Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
• The service planned care to meet the needs of local people, took account of women’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.
• Recent changes in leadership indicated plans to run services well using updated information systems and to support staff to develop their skills. The leadership team and division were the same across the two trust locations with detail included in the Royal Oldham Hospital report. Some staff had felt respected, supported and valued. They were focused on the needs of women receiving care. Staff were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.