A summary of our findings about this location appears in the overall summary

The medical care services at the Leigh Infirmary provide neurological rehabilitation care for those with an acquired brain injury or neurological illness and elective diagnostic procedures such as gastroscopy, colonoscopy and flexible sigmoidoscopy. Taylor ward has 20 beds including 3 side rooms. The endoscopy unit was opened in May 2013 with decontamination facilities on the same site. There are two surgical wards, wards two and three, providing day case and short stay services.

At the Hanover Diagnostic Centre, the hospital offers an extensive range of urology services. The urology department is located in the Richmond unit and offers a range of services for patients including rapid access clinics, prostate assessment, vasectomy, haematuria, one stop and out of hours evening clinics.

The main outpatient clinic areas are situated on the ground floor of the infirmary in six ‘areas’. These areas house a range of clinics covering colorectal, breast and orthopaedic surgery, diabetes, lipids, renal, urology, neurology, anti-coagulation, cardiology, chest, obstetrics and gynecology. The Hanover Diagnostic and Treatment Centre provide clinics for women’s health, urology and endoscopy patients.

Diagnostic imaging and haematology services are also provided at Leigh Infirmary including ultrasound, plain film x-ray, barium enemas, and barium swallows with video-fluoroscopy and video-urodynamics.

We inspected the hospital between the 8 and 11 December 2015 as part of the comprehensive inspection of Wrightington, Wigan and Leigh NHS Foundation Trust.

Overall we found the hospital provided good services across the four domains of effective, responsiveness, caring and of being well led. However they required improvement in safety in medicine and effectiveness in maternity and gynaecology.

Our key findings were as follows:

• Staffing levels were adequate to meet the needs of patients at the time of the inspection.

• Staff received training appropriate to their role however uptake of some training could be improved especially in Mental Capacity Act training.

• Care was provided in clean and tidy surroundings and infection control practice was good. However the environment on Taylor ward did not fully meet the needs of the patients and were not conducive with safe patient care and the storage of waste was not always safe.

• Food and drinks were available and suitable to meet the varied needs of patients.

• Discharges from Taylor ward were not always timely.

• Care was not always supported by robust policies, procedures and guidance and not always adhered to.

• The use of restraining lap belts on one ward had become custom and practice and individual risk assessments had not been completed.

We saw several areas of outstanding practice including:

• Urology staff offered ‘one-stop’ appointments for haematuria patients which enabled patients to undergo biopsies during initial appointments rather than having to re-attend on another day.
• A trust ‘pioneering staff engagement’ programme was in place across a multi-disciplinary team with a number of innovating programmes in progress. The service had received several awards over the past two years.

However, there were also areas of practice where the trust needs to make improvements.

Importantly, the trust must:

• Ensure safeguarding, mental capacity act (2005) and deprivation of liberty safeguards are in place and followed to ensure patients safety at all times. Processes must be clearly defined, understood and followed by staff.

• Improve mandatory training uptake particularly mental capacity act training.

• Ensure that there is adequate space on the wards for patients to receive safe and effective care.

• Ensure that there are adequate facilities to store clinical waste safely.

• Ensure care is delivered as per evidence based guidance.

In addition the trust should:

• Improve the timeliness of patient discharges from Taylor ward.
• Improve staff annual appraisal rates.
• Keep trolleys containing patients notes locked
• Improve the completeness of records particularly with name and designation always clearly recorded and printed and consent forms available to review.
• Review local rules held in the radiology department and ensure staff can locate them if required.
• Review dosage instructions for adrenaline administration to treat anaphylaxis and ensure they are satisfied instructions are easy to interpret in an emergency.
• Review the benefit of documenting processes for organising staffing for outpatient clinics.

Professor Sir Mike Richards

Chief Inspector of Hospitals