We inspected this hospital as we had received concerns from a member of the public that patients having planned hip and knee surgery were not being treated in line with nationally recognised guidelines. During the inspection we spent time on wards 5, 6, 7, the day surgery unit, the pre-operation unit and the John Charnley Wing.

The patients who we spoke with were positive about the care and treatment they received. We heard comments such as “I would be happy to come back here if I need surgery on my other knee”; “The staff explain everything to you so you know what is happening next” and “I think that I have had good treatment here. All of the staff that I have met since my very first appointment here have been great.”

We found that recognised guidelines from the National Institute for Health and Care Excellence Clinical (NICE guidelines) were being followed for the care of people receiving hip surgery, knee surgery and rheumatology care.

We looked at the way that medicines were managed within the hospital. We found that patients were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.

The hospital followed NHS guidelines for dealing with and managing complaints. We found that the Trust’s policy for managing complaints was followed by staff.

We visited the hospital because we had concerns about some serious incidents that had happened within the operating theatres at Wrightington Hospital and also at the Royal Albert Edward Infirmary (also known as Wigan Infirmary). These incidents occurred because internationally recommended checklists were not being completely followed on some occasions. This report describes what we found at Wrightington Hospital. Please look at the report for Royal Albert Edward Infirmary to see what we found at that hospital.

Patients told us that their procedure had been explained and they felt that they were able to make an informed decision and give their full consent to the procedure being carried out. The records that we looked at showed that the patient's consent had been recorded. As a part of this inspection, one of our inspectors visited the operating theatre and we found that the recommended checks to ensure patients' safety were taking place. There was evidence to show that action had been taken and systems had improved since the serious incidents had occurred.

Patients told us what it was like to be a patient in Wrightington Hospital. We spoke with 11 patients who described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector

joined by another CQC inspector, a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service

The patients had a lot of praise for the staff at Wrightington Hospital. We were told “There are lovely, caring nurses who work very hard” and "It doesn't matter where you go in the hospital - all the staff are fantastic." The patients who we spoke with told us that they were treated with dignity and respect.

Most patients told us that the food was "All right." One person told us that the food was "Fine." Another patient told us "The food is not what I would have at home but it is OK." On the day we visited some patients told us that the soup that was served for lunch was "really good." We did not speak with anyone who was dissatisfied with the food.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

Wrightington Hospital specialises in hip replacement surgery, upper and lower limb surgery and hip revision surgery. The services offered are in the orthopaedic centre, day case and private patient unit and include rheumatology services. There are 12,000 elective surgical procedures are carried out per year from 10 theatres, with after care on one of three inpatient wards. Wrightington Hospital admissions are 65% day case surgery and 35% elective surgery.

The outpatients department provides a range of clinics in areas such as; rheumatology, occupational health, physiotherapy, podiatry, respiratory medicine, trauma and orthopaedics, surgery, pain management, urology, gynaecology and orthopaedic care. The centre also accepts orthopaedic referrals from out of area.

There is also a radiology diagnostic imaging service which provides a comprehensive range of services including x-ray and bone densitometry.

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 all five domains of safety, effectiveness, caring, responsiveness and of being well led.

Our key findings were as follows:

• Incidents were reported, investigated appropriately and lessons learnt shared with staff. There was a low incident of pressure ulcers and infections. Risk assessments were completed and staff implemented measures to reduce risks.

• Staffing levels were sufficient and a safer nursing care staffing tool was utilised to ensure staffing levels were adequate. Medical staff rotas were in place and locum agency staff filled any gaps in cover. Rheumatology medical staffing however was a risk and the trust had taken steps to ensure the safety of patients.

• Records were usually available, of good quality and stored securely overnight.

• The infrastructure was old but some financial investment had taken place to refurbish areas such as re-flooring the outpatient department. Areas were visibly clean and tidy with the exception of two small areas in out patients. Equipment was well maintained and cleaning logs were completed. Medicines, including controlled drugs were managed safely and stored securely.

• Staff followed national best practice guidelines, trust policies and procedures. Referral and discharges generally worked well and staff shared relevant information. Services worked in coordination and appropriately referred to specialist services when required.

• Staff treated patients with respect and dignity, offered support and included them in care planning. Patients received a caring service and staff discussed treatment plans with patients to ensure a person-centred approach. We saw staff deal with patients in a kind and polite manner and they understood the principles of consent and best interest decision making.

• The trust 18 week referral to treatment times were similar to or above the national average of 90% for Orthopaedic services.

• Services were not operating seven days a week at the time of our inspection but evening and Saturday morning clinics occasionally took place.

• Risk registers were in place and discussed at team meetings. Staff were aware of the trust’s values and vison and felt well-supported by managers and colleagues.

• Staff morale was good and they felt well supported. Staff were enthusiastic and proud of the services they provided. However, only 50% of radiology staff at the hospital were up to date with appraisals which did not meet the trust target of 90%.

However, there were areas of practice where the trust could make improvements.

The trust should:

• Review the cleanliness of plaster rooms and toilet areas with a view to improving standards.

• Improve appraisal rates in staff groups which are currently below target.

• Review the storage of disused equipment in x-ray room two.

• Review the safe storage of patient notes trolleys and that these are kept locked

Professor Sir Mike Richards

Chief Inspector of Hospitals