Manor Hospital

Updated 15 September 2023

Walsall Healthcare NHS Trust provides local general hospital and community services to around 260,000 people in Walsall and the surrounding areas. The trust is the only provider of NHS acute care in Walsall, providing inpatients and outpatients at the Manor Hospital, as well as a wide range of services in the community. Manor Hospital has 554 acute beds (501 overnight beds and 53-day case beds) and provides a wide range of services including a 24-hour accident and emergency department and maternity services.

Walsall Healthcare NHS Trust is working in collaboration with another NHS trust with the leadership of a joint chair and chief executive.

On 20 June 2023, we carried out an unannounced focused inspection of the medicine core service (including older peoples care) provided by the trust. We needed to follow up a Section 29a Warning Notice, issued to the trust in October 2022, as we found significant improvement was required in the safe management of medicines. This included prescribing, administration, recording and storage, within medical services. We visited the following wards: the Acute Medical Unit, wards 1, 2,17 and 29.

We did not inspect any other services at Walsall Healthcare NHS Trust because our monitoring process had not highlighted any further concerns and the trust had not had sufficient time to address all the requirements made at our last inspection. We will re-inspect other services as appropriate.

We inspected but did not rate the safe domain, we did not inspect effective, caring, responsive and well led.

Our rating of Manor Hospital stayed the same. We rated them as requires improvement.

• Whilst the service had made some improvement in the safe management of medicines, further improvement was required.
• Staff did not always follow systems and processes to prescribe and administer medicines safely.
• Staff did not always complete medicines records accurately and keep them up to date.
• Staff did not always follow national practice to check patients had the correct medicines when they were admitted, or when they moved between services.

However

• Staff mostly stored and managed medicines safely.
• Staff learned from safety alerts and incidents to improve practice.

Updated 25 January 2023

Updated 25 January 2023

Updated 25 July 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• Mandatory training compliance levels for medical staff were below the trust’s target for seven of the 10 mandatory training modules.
• The cover provided by the critical care outreach team was insufficient to sufficiently
• mitigate risk.
• The service did not always monitor infection risk well.
• The service did not always provide care and treatment based on national guidance and evidence of its effectiveness. Follow up clinics were not conducted to support patients after discharge from the unit. We had raised this as a concern at our previous inspection.
• Staff did not always deliver patient care and treatment seven days a week in accordance with national guidance.
• All staff had access to trust policies and procedures but they were not always up-to-date. Several guidelines had not been updated to reflect the patient pathway since relocating to the new unit.
• People could not always access the service when they needed it. Patients were not always admitted, treated and discharged patients in line with good practice and guidance.
• Discharges from the critical care unit did not always take place at appropriate times or place.
• The critical care service did not always use a systematic approach to continually improve the quality of the service and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The trust did not always collect, analyse, manage and use information well to drive improvement in the service.

However;

• The service had suitable premises and equipment and looked after them well. The purpose-built unit met Health Building Note guidance for critical care units.
• The service provided mandatory training in key skills to all nursing staff. The compliance rates were above the trust target for seven of the training modules and just below the trust target for the remaining three modules.
• The service had enough nursing staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.
• Physiotherapy staffing was sufficient to provide respiratory management and rehabilitation components of care.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Nursing staff met the trust’s target for all safeguarding and PREVENT training modules.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service exceeded the recommended levels of staff that had achieved their post registration qualification in critical care.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Nursing and medical staff compliance with Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training was above the trust target.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people. The purpose-built facilities and premises were appropriate for the critical care services delivered.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. The service had a clinical lead for critical care.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff morale had improved since relocating to the new critical care unit.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
• The trust was committed to improving services by learning from when things went well and when they went wrong. The service promoted specialist critical care training, research and innovation.

Updated 20 December 2017

We rated this service as good because:

• Between April 2016 and March 2017, the trust reported no incidents that were classified as never events for end of life care.

• The trust reported no serious incidents (SIs) for end of life care that met the reporting criteria set by NHS England between April 2016 and March 2017.

• There had been no end of life care incident, which required duty of candour (DoC) investigation in the palliative, and end of life care service.

• The service monitored patient outcomes through national and local audits; these were fed back to the board and end of life dashboard along with the trust’s quality report.

• Multi-Disciplinary Team (MDT) working was effective within the end of life care service. The team worked as a one integrated team across the acute and community sites.

• DNACPR forms were filed out correctly in front of patient records so that staff could locate them quickly. Since the last inspection 2015, the trust has improved significantly around the DNACPR documentation.

• Staff cared for patients in a compassionate, dignified, and respectful manner.

• We saw in one of the viewing rooms at the mortuary that there were facilities for washing the body for religious and cultural reasons. We saw this as an understanding and respect for patients’ cultural and religious needs.

• The chaplain service offered spiritual support to patients 24-hours a day, seven days a week.

• Patient discharge, including moving patients between acute and community care settings, followed patient-centred care best practice.

• The SPCT worked closely with commissioners and other providers to ensure patients’ needs were met.

• The ensured patients who required end of life and palliative care were seen promptly and were identified in a timely way, that deceased bodies were cared for, and that religious and spiritual beliefs were respected and dignified.

• The professional lead chaired a multi-professional group. Membership included the acute and community , palliative care team, and representation from the clinical commissioning group (CCG) as well as the director of nursing.

• The service leaders had a clear direction of the service. Their aim was for an effective integrated service to ensure patients were provided with quality end of life care.

• Staff of all levels felt supported from the end of life and palliative care team.

• We saw the trust’s five-year strategy plan for 2017-2022 called, “Becoming your partners for first-class integrated care”.

However:

• We spoke with the hospital porters around incidents and learning from incidents, they told us they did not have access to a computer or IT access. The porters told us they received no feedback or actions in relation to incidents.

• Ward staff knowledge and awareness of when to use individualised care plans when caring for end of life patients varied from ward to ward.

• Porters we spoke with during our unannounced visit on 6 July 2017 informed us that they were never informed if a patient had an infection, especially when transporting patients from one department to another.

• The trust set out a target of 90% for completion of safeguarding training; as at 31 March 2017 nursing staff for end of life care services failed to meet training targets.

• There was a low completion rate for major incident training at Walsall Hospital. As at 31 March 2017, only 56 out of 188 eligible staff (30%) had completed this training.

• The trust had the amber care bundle on some wards as part of a phased roll out programme from the . This was being introduced in the last inspection in 2015 but this had still not been fully embedded throughout the wards.

• We saw nutritional assessments were being carried out, but was not always documented as part of the individualised care plan.

• Documented evidence of completed advance care plans (ACP) was only noted in 63 patients and these were predominantly within the community setting, only five patients in the acute setting had an ACP in place.

• Combined results across both sites (community and acute) demonstrated that the use of the individualised end of life care plan was 20% (45 patients in acute setting).

• Registered nurses on the wards had received training to enable them to safely administer medications through the T34s McKinley infusion pumps; however this was not consistent, some staff were not trained or did not know which syringe drivers were being used.

• Porters we spoke with said they had not received any specific end of life training; they told us that newly appointed staff learnt from and shadowed porters that were more senior.

• Ward staff told us that it was difficult at times to support relatives during an emotional time, as there were no specific rooms to speak with relatives in private.

• The trust did not have any dedicated beds for end of life care patients, they were cared for on general wards throughout the hospital.

• The route that people had to walk to the mortuary for the general office was long and poorly signposted.

Updated 1 October 2021

Updated 17 November 2020

The service has 62 maternity beds across two sites:  

The Manor Hospital has 49 maternity beds, these are located within two wards and a delivery suite.  

There is a consultant led delivery suite with nine rooms plus an enhanced maternity care room and an obstetric theatre, a fetal assessment unit, a triage area, induction of labour suite, outpatient antenatal clinic, antenatal/postnatal ward and a community-based midwifery service.  

Elective Caesarean sections are currently performed in the elective theatres in main theatres and a Delivery Suite Theatre was opened in January 2020. There is a four-bedded transitional care unit on one of the wards. 

The Freestanding Midwifery Led Unit (MLU) has three maternity beds. This was closed during our inspection so wasn’t visited however has since reopened. Some community outpatient clinics took place at the MLU.   

This inspection was a focussed inspection of maternity services on 8 and 9 September 2020. 

We spoke to 22 staff and reviewed four prescription charts and five patient records. 

We last inspected maternity services at Walsall Healthcare NHS Trust in 19 March 2019.  

We rated safe as requires improvement and effective, responsive, caring and well-led as good. The overall rating for the service was good.  

A range of data was requested from the service as part of this inspection.

Updated 20 December 2017

We rated this service as good because:

• Staff reported incidents in a timely manner and we found evidence of learning from incidents. We found the radiology department met the requirements of Ionising Radiation (Medical Exposure) Regulations 2000. We found good infection control and waste management systems in place. Staff had a robust system in place to manage medication and the distribution of prescriptions.

• We found evidence based policies and procedures across all departments. Staff worked in facilities that promoted the effective treatment of patients. We found good evidence of multidisciplinary working across outpatients and imaging service. All registered nurses and doctors asked understood the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2010. However, three unregistered staff did not understand the legislation.

• All staff provided compassionate, supportive, and understanding care to patients. Staff encouraged patients to ask questions and be involved in the decision made about their care. Patient feedback about the service was positive. However, the latest Friends and Family Test results showed a lower than national average positive response.

• The trust was not meeting the national standard for the 18-week referral pathway. The fracture clinic environment was not easily accessible for patients who required a wheel chair or crutches to mobilise. Staff within outpatients had not undertaken any dementia awareness training. However, outpatients and imaging had received a low number of complaints.

• Staff had a positive attitude and we found an ethos of team working across the departments. Staff felt included within the team and that they could and did make a difference. We found good engagement with the public in the form of health promotion. However, we found meetings often lacked structure and detail, and did not routinely discuss feedback from complaints and incidents.

Updated 25 January 2023

Updated 17 November 2020

Walsall Healthcare NHS Trust has a purpose built emergency department (ED) that is part of the Manor Hospital. As a result of the COVID-19 pandemic the department had been split into two separate assessment streams for patients, those with potential or confirmed COVID-19 and those without any COVID-19 concerns.

For the COVID-19 stream there was an ambulance triage room, a four bedded resus area which included a dedicated paediatric bed, eight cubicles for the treatment of patients.

For the non-COVID-19 stream there were two triage rooms, a resuscitation area with two beds, one which could be used for paediatrics, five high dependency beds and seven cubicles. There was also an ambulance triage area for up to six trolleys. In the paediatric department there was a triage room, one treatment room for suspected COVID-19/non-infectious children and a separate treatment and triage room for potential COVID-19/infectious patients. There is an urgent care centre that is located on the same site and that shares an entrance and reception area with the ED, this is managed by a different provider and was not inspected.

From July 2019 to July 2020, there were 82,372 attendances at the trust’s urgent and emergency care services. This included adults (65,862) and children (16,510 patients) attendances for both majors and minors treatment.

We visited the ED as part of our unannounced focussed inspection on 8 and 9 September 2020. We spoke with 15 members of staff across a range of roles and looked at 22 sets of patient records.

During the last inspection in March 2019 we rated urgent and emergency services as good overall with effective, caring, responsive and well led rated good and safe rated requires improvement. We told the trust they must improve mandatory and safeguarding training compliance for all urgent and emergency care staff. (Regulation 18). We also told the trust that they should improve waiting target compliance levels for triage and treatment in the urgent and emergency for all patients and they should consider replacing old or missing equipment in the urgent and emergency department.