The ratings for Bolton NHS Foundation Trust have changed following recent inspections undertaken by the Care Quality Commission.

The independent regulator, which monitors health and social care services in England, visited Royal Bolton Hospital’s services for children and young people in May 2023, and undertook the well-led inspection focusing on the leadership and management of the organisation in June this year.

The safety rating for children’s services was upgraded to ‘good’, while the rating for ‘well-led’ was downgraded to ‘requires improvement’ reflecting the challenges the Board has experienced in relation to governance, leadership and relationships between former Board members. The Trust’s overall ratings remain good in all other areas; safe, effective, caring and responsive.

The CQC noted the recent change of Chair and found:

• The Executive team were ‘cohesive’ and all of the leaders they spoke to had a ‘very strong patient centered focus’.
• Bolton staff had a ‘strong determination to provide quality care to patients’.
• There was a palpable sense of ‘strong family values across the trust from every level’, which supported the quality of care seen.

The well-led inspection was initiated following whistleblowing concerns about the leadership of the Board of Directors including the culture and ability for some staff to speak up without fear.

Fiona Noden, Chief Executive at Bolton NHS Foundation Trust said:

I am really sorry that some of our staff don’t feel able to speak up or have confidence in the processes we have to listen and act on feedback. We have welcomed the opportunity to work with the CQC to understand and reflect on the areas we can improve, and will do everything we can to learn from this report.

“We have already started to take action in this area including the expansion of our freedom to speak up champions network, arrangements are now in place for people who don’t feel able to speak up internally and a review of the effectiveness and confidentiality of the process is currently underway. Thank you to those staff who have had the courage to raise, and those who continue to raise, their concerns.

The CQC identified some areas for improvement for the Trust to address which included:

• Ensuring all staff feel supported to speak up.
• Continuing to improve governance processes.
• Consistently applying processes across our workforce.
• Ensuring that the board and council of governors are working effectively together.
• Making sure reasonable adjustments are made to enable people to carry out their roles.
• Consistently undertaking risk assessments across clinical areas.

A number of areas of good practice for services for children and young people include:

• Leaders and staff actively and openly engaged with patients, staff, the public and collaborated with partner organisations to help improve services.
• Children and young people were treated with compassion and kindness, and their individual needs were taken into account.
• All staff were committed to continually learning and improving services. They were developing an effective understanding of quality improvement methods and the skills to use them.
• Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• The services inspected had an open culture where patients, their families and staff could raise concerns without fear.
• People could access services for children and young people when they needed to and did not have to wait too long for treatment.

Niruban Ratnarajah, GP and Chair of Bolton NHS Foundation Trust said:

Our rating for well-led is a fair reflection of where we were at the time of inspection. We acknowledge the feedback we’ve had from the CQC. The report has validated our areas of focus and is already helping us to strengthen our organisation and be the best we possibly can for the people of Bolton. We’ve thoroughly reviewed the report and we have taken on board all of the recommendations and actions are either already in progress or in development.”

“We’re so proud of our services for children and young people; achieving a good rating across all areas and improving their rating for safety. We are focused on all our services to be able to continue to provide safe, high quality care for the people of Bolton.

The full inspection report from the CQC can be viewed here.