Source · CQC inspection

Royal Bolton Hospital

Type NHS Healthcare Organisation Region North West Last inspected 18 Oct 2023

Overall rating: Good View full CQC report

Domain ratings

Five CQC key questions

Safe

Requires Improvement

Effective

Good

Caring

Good

Responsive

Good

Well-led

Good

Earlier inspection findings

pre-2024 framework · 7 must-do 6 should-do

Must-do actions (7)

Legal requirements based on regulation breaches identified during inspection.

Must-do action 1 of 7

Must do

Well-led

The trust must ensure staff feel supported to speak up without fear of retribution by seeking and acting on feedback from relevant persons or other persons on the service provided in the carrying on of the regulated activity, for the purpose of continually evaluating and improving such services.

Regulation: Regulation 17(2)(e)

⚠ Staff expressed reservations about raising concerns without fear of retribution, did not always feel listened to, and feedback was not consistent. Concerns were raised about the effectiveness of the Freedom to Speak Up function, lack of confidentiality, impartiality, and consistency.

Must-do action 2 of 7

Must do

Well-led

The trust must ensure that the board and council of governors are working effectively together to create constructive relationships and governance arrangements at this level.

Regulation: Regulation 17(1)

⚠ There was a significant breakdown of trust and relationships between some elements of the board and the Council of Governors, with the potential to affect the effectiveness of how the board managed and governed. The Council of Governors did not always work effectively together or with the board, with friction …

Must-do action 3 of 7

Must do

Well-led

The trust must ensure it aligns relevant policies and procedures and that all policies are up to date.

Regulation: Regulation 17(1)

⚠ Policy governance needed to be strengthened. Six out of 20 reviewed policies were out of date, with five being at least three months overdue for review.

Must-do action 4 of 7

Must do

Well-led

The trust must ensure the disciplinary and grievance/resolution procedures fully meet the current required legislative standard and are fair to the person involved, follow correct procedure and are consistently operated effectively.

Regulation: Regulation 19(5)

⚠ Disciplinary and grievance/resolution processes did not always follow best practice and were not consistently applied. The policy was lengthy, confusing, and lacked adherence to ACAS Code of Practice elements (right to be accompanied, appeal criteria). The 'fast track' system was not consistently applied, and there was no robust oversight or …

Must-do action 5 of 7

Must do

Well-led

The trust must ensure that records relating to care and treatment of each person using the service are accessible to authorised people as necessary to deliver people’s care through improved IT connectivity.

Regulation: Regulation 17(2)(c)

⚠ Connectivity across the organisation was a significant challenge. The electronic patient record system was not yet active in all areas (community, maternity, outpatients). Staff reported inconsistent Wi-Fi connectivity impacting IT use, with one ward having a large area with no Wi-Fi.

Must-do action 6 of 7

Must do

Safe

Development and investment in workforce and systems must be prioritised to make sure clinical pharmacy services including medicines reconciliation rates are improved across the trust.

Regulation: Regulation 12(2)(b)(g)

⚠ Clinical pharmacy services were significantly reduced due to workload pressures, impacting medicines reconciliation rates and medicines safety. Audits showed trust targets of 95% of patients having medicines reconciled within 24 hours were not being met, with average rates of 37.5% on weekdays and 30.62% at weekends (55.44% and 30.26% for …

Must-do action 7 of 7

Must do

Well-led

The trust must continue with plans to strengthen the trust position on equality, diversity and inclusion are managed and monitored in a timely way and that all reasonable steps are taken to make reasonable adjustments to enable people to carry out their role in line with the requirements for employees under the Equality Act 2010.

Regulation: Regulation 19(1)(c)

⚠ WRES data showed staff from ethnic minority groups were underrepresented in clinical roles above band 6, with no BME staff at Bands 8d or VSM. There was a significant decrease in BME staff believing the Trust provides equal opportunities for career progression and an increase in BME staff experiencing discrimination. …

Should-do actions (6)

Recommended improvements to enhance service quality.

Should-do action 1 of 6

Should do

Well-led

The trust should ensure the review of the trust strategy is completed in a timely way, ensuring clear aims and objectives are supported by current and relevant enabling strategies to turn them into action.

Should-do action 2 of 6

Should do

Well-led

The trust should promote and communicate relevant strategies via different means to make them meaningful to all staff. Staff should be provided with the opportunity to comment and contribute where appropriate.

Should-do action 3 of 6

Should do

Well-led

The trust should continue to improve governance processes in particular the senior oversight of risk, policy governance and the management of risk.

Should-do action 4 of 6

Should do

Well-led

The trust should ensure that the networks for staff from ethnic minority groups; Disabled staff and LGBTQ+ staff, have suitable corporate support to improve their effectiveness and that the socio-economic, age and gender networks, currently in developmental stages, are supported to develop in a timely way.

Should-do action 5 of 6

Should do

Effective

The service should ensure that appraisals for medical staff are completed in a timely manner.

Should-do action 6 of 6

Should do

Safe

The trust should ensure that mental health risk assessments including environmental assessments are thoroughly completed.