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R0A Manchester University NHS Foundation Trust Manchester University NHS Foundation Trust Inspection report Trust Headquarters Cobbett House Manchester, Lancashire M13 9WL Date of inspection visit: 2nd October - 8th November Tel: 0300 330944 2018 www.mft.nhs.uk Date of publication: 19/03/2019 We plan our inspections based on everything we know about services. Each report explains the reason for the inspection. This report describes our judgement of the quality of care provided by this trust. We based it on a combination of what we found when we inspected and other information available to us. It included information given to us from people who use the service, the public and other organisations. This report is a summary of our inspection findings. You can find more detailed information about the service and what we found during our inspection in the related Evidence appendix. Ratings Overall rating for this trust Good ––– Are services safe? Good ––– Are services effective? Good ––– Are services caring? Outstanding Are services responsive? Good ––– Are services well-led? Good ––– Are resources used productively? Good ––– Combined quality and resource rating 1 Manchester University NHS Foundation Trust Inspection report 19/03/2019 Summary of findings We rated well-led (leadership) from our inspection of trust management, taking into account what we found about leadership in individual services. We rated other key questions by combining the service ratings and using our professional judgement. Background to the trust The Manchester University NHS Foundation Trust was established on 1 October 2017. The trust was formed following a merger of Central Manchester University Hospitals NHS Foundation Trust and the University Hospital of South Manchester NHS Foundation Trust and is one of the largest NHS trusts in the country. The trust includes nine hospital sites: Manchester Royal Eye Hospital, Manchester Royal Infirmary, Royal Manchester Children’s Hospital, Saint Mary’s Hospital, The University Dental Hospital, Altrincham Hospital, Trafford General Hospital, Wythenshawe Hospital and Withington Community Hospital. The trust has an inpatient child and adolescent mental health unit and a community child and adolescent mental health service. The trust also provides community health services; these are provided by the Manchester Local Care Organisation which is hosted by the trust. The trust has approximately 2,435 inpatient beds and 578 day-case beds. The majority of these beds are at the Oxford Road campus site with 1237 inpatient beds (which incorporates Manchester Royal Eye Hospital, Manchester Royal Infirmary, Royal Manchester Children’s Hospital, Saint Mary’s Hospital) and a further 1097 beds at Wythenshawe Hospital and Trafford Hospital. The trust delivers over 13,322 babies, perform over 189,000 operations and procedures and have around 405,000 attendances annually at the emergency departments. There are more than 1,725,000 attendances to outpatient clinics. The trust employs over 20,000 staff. The annual turnover is £1.6 billion. The trust is the main provider of hospital care to approximately 750,000 people in Manchester and Trafford. The trust provides a range of specialist services including breast care, vascular, cardiac, respiratory, urology cancer, children’s services, women’s services, ophthalmology and genomic medicine. It is a major provider of specialist services in England. The trust has an extensive research and innovation agenda. This was the first inspection of the newly formed trust. Overall summary We have not rated this trust before we rated it as Good ––– What this trust does Manchester University NHS Trust has nine hospital sites: Manchester Royal Eye Hospital, Manchester Royal Infirmary, Royal Manchester Children’s Hospital, Saint Mary’s Hospital, The University Dental Hospital, Altrincham Hospital, Trafford General Hospital, Wythenshawe Hospital and Withington Community Hospital. The trust also provides community services. The trust provides a range of primary, secondary and tertiary care services across Manchester and the wider region. 2 Manchester University NHS Foundation Trust Inspection report 19/03/2019 Summary of findings Key questions and ratings We inspect and regulate healthcare service providers in England. To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so, we rate the quality of services against each key question as outstanding, good, requires improvement or inadequate. Where necessary, we take action against service providers that break the regulations and help them to improve the quality of their services. What we inspected and why We undertook a comprehensive inspection at Manchester University NHS Trust. A comprehensive inspection is when we inspect all core services and all five key questions for each core service followed by an inspection of how well-led a provider is. We undertook a comprehensive inspection because this was a new trust which was established on 1 October 2017 following a merger of Central Manchester University Hospitals NHS Foundation Trust and the University Hospital of South Manchester NHS Foundation Trust. We inspected all 42 core services of the trust because this is a new organisation. What we found Overall trust We have not rated this service before. We rated it as good because: Are services safe? We have not previously rated these services since the new provider was formed in October 2017. We rated it as good because: • We rated safe as good at Royal Manchester Children’s Hospital, Royal Manchester Eye Hospital, Saint Mary’s Hospital, Trafford General Hospital, Wythenshawe Hospital, Altrincham Hospital, Withington Community Hospital, and across the mental health and community services. We rated the University Dental Hospital of Manchester as outstanding for safe. • Most staff were confident to report incidents and learning from incidents was disseminated to staff across the trust. There was a positive culture around incident reporting in most areas. • Effective systems were in place to safeguard patients. • Medicines were mostly stored well and administered appropriately. • The environment was mostly clean and tidy and infection rates were low. • Although there were challenges to staffing levels, there were effective systems and processes were in place to manage these. • There were effective systems in place to manage patients at risk of deterioration. However • The five steps to safer surgery were not fully adhered to at Manchester Royal Infirmary and Trafford General Hospital. 3 Manchester University NHS Foundation Trust Inspection report 19/03/2019 Summary of findings • There were areas of concern regarding staffing in the emergency departments at Manchester Royal Infirmary and Wythenshawe Hospital. • Levels of compliance with mandatory training were low in some areas. • We found that records were not always available particularly within surgical services at Manchester Royal Infirmary and the outpatients department. Records were not always fully completed in the urgent and emergency care services or outpatients. • The urgent and emergency care service and surgical services at Manchester Royal Infirmary did not always ensure its premises were suitable or that equipment was looked after. Equipment was not always serviced and maintained in a timely way in all parts of the trust. • At Manchester Royal Infirmary, we found several areas of the emergency department, including some equipment to be visibly dirty and inconsistent infection control practices in theatres. Are services effective? We have not previously rated these services since the new provider was formed in October 2017. We rated it as good because: • We rated Royal Manchester Children’s Hospital, Saint Mary’s Hospital, Altrincham Hospital, Trafford General Hospital, Wythenshawe Hospital, Withington Community Hospital and the community services as good for effective. We rated Manchester Royal Eye Hospital, the University Dental Hospital and community child and adolescent mental health services as outstanding for effective. • The trust provided care and treatment based on national guidance and evidence of its effectiveness. • There was a strong learning culture and opportunities for staff to develop. New roles were being developed to support service development and to address gaps in staffing and recruitment. • The trust measured patient outcomes and benchmarked themselves against other organisations. • Staff gave patients enough food and drink to meet their needs, although there were inconsistencies in the timeliness of nutrition and hydration assessments in surgery at Manchester Royal Infirmary. • Multi-disciplinary team working was evident in most areas across the trust to support patient care and improve patient outcomes. However • We rated effective as require improvement at Manchester Royal Infirmary. Outcomes for people who used the service were below expectations when compared to other services in some areas including surgery and the emergency department. • Not all staff had received an annual appraisal. Are services caring? We have not previously rated these services since the new provider was formed in October 2017. We rated it as outstanding because: • We rated caring as outstanding at Royal Manchester Children’s Hospital, Manchester Royal Eye Hospital Saint Mary’s Hospital, Wythenshawe Hospital and community child and adolescent mental health services. • We
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