Updated 22 December 2022
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 operates a range of acute, community health and social care services which are provided by the trust's four care organisations; Salford, Oldham, Rochdale and Bury.
The trust has over 20,000 staff and has four acute 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 within hospital settings and the community. 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 from date of acquisition. 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 the Northern Care Alliance, we inspected only those services where we were aware of current risks. We did not rate the hospitals 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.
This was our first inspection since the formation of the Northern Care Alliance NHS Foundation Trust.
We carried out this unannounced (staff did not know we were coming) inspection of Northern Care Alliance NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services and because it was a new provider which ran services formerly run by different trusts.
We visited Salford Royal Hospital, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary as part of our inspection between 8 and 11 August and on 12 September 2022. Our inspection was unannounced to enable us to observe routine activity.
In addition, we inspected the well-led key question for the trust overall. The Well Led inspection was announced and took place between 13 and 15 September 2022.
We did not inspect all the core services provided by the trust as this was a risk-based inspection. We continue to monitor all services as part of our ongoing engagement and will re-inspect them as appropriate.
This is our first rating of the Northern Care Alliance. We rated them as requires improvement because:
We rated safe, effective, responsive and well-led as requires improvement, and caring as good. In rating the trust, we took into account the current ratings of the Salford services not inspected this time.
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 articulated by their executive colleagues. Staff reported leaders were not always visible and approachable.
Staff did not always feel respected, supported and valued. However, they remained focused on the needs of patients receiving care. Some staff expressed reservations about raising concerns and others did not always feel listened to. The service had a culture where patients and their families could raise concerns without fear.
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. Most leaders were clear about the need to review these functions to ensure they were fit for purpose.
Leaders and teams did not consistently use systems to manage performance effectively. They identified and escalated relevant risks and issues but did not always take actions to reduce their impact. Staff did not always have the opportunity to contribute to decision-making and help avoid pressures compromising the quality of care.
The service collected data and analysed it. However, not all staff were assured that the data was always accurate. Staff could not always find the data they needed, in accessible formats to understand performance, make decisions and improvements. Data was not recorded or presented uniformly across the trust and some important data was not captured. Data or notifications were submitted to external organisations as required. The information systems were secure. However, they were not always reliable or integrated well. The trust had recently appointed an experienced executive with specific responsibility for improving the management of digital data.
Leaders did not always actively and openly engage with patients and staff to plan and manage services. However, they had plans in place to improve these. The trust engaged with external stakeholders and local partners to help improve services for patients.
However:
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 trust reported and investigated complaints and incidents. However, these were not always completed in a timely manner and learning was not always shared with relevant departments across the trust.
How we carried out the inspection
During our inspection we spoke with a variety of staff including consultants, doctors, therapists, nurses, healthcare support workers, pharmacists, patient experience staff, domestic staff, administrators and the trust’s board. During the inspection we also spoke with patients and relatives. We visited numerous clinical areas across the hospital sites. We reviewed patient records, national data and other information provided by the trust.
We held several staff focus groups with representatives from all over the trust to enable staff who were not on duty during the inspection to speak to inspectors. The focus groups included junior and senior staff from pharmacy, junior and senior nursing staff, junior doctors and consultants, allied health professionals, staff representing equality, diversity and inclusion. We also had focus groups for the non-executive directors and governors.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.