Northern Care Alliance handed fresh warning over patient safety and leadership

One of England’s largest NHS trusts has been handed a fresh regulatory warning after inspectors identified significant concerns about patient safety, risk management and leadership, as staff warn that pressure across its hospitals is continuing to worsen.

The Care Quality Commission issued Northern Care Alliance NHS Foundation Trust with a Section 29A warning notice on 13 August following concerns about the way the organisation manages risk, patient safety, complaints, freedom to speak up, workforce wellbeing and inclusion.

The formal action represents the latest intervention at the Greater Manchester trust, which provides services to more than one million people across Salford, Oldham, Bury and Rochdale and employs around 20,000 staff.

Section 29A notices can be issued when the CQC believes there are systemic problems within an NHS trust that could result in harm or place patients at risk of harm.

Northern Care Alliance’s acting chief executive Suzanne Robinson informed staff about the latest warning and said the trust fully accepted the notice.

The concerns come during an already difficult period for the organisation, which has faced a series of investigations and regulatory interventions involving the safety and quality of patient care.

Earlier this year, NHS England took separate enforcement action after identifying what it described as a fundamental failure in quality governance. The regulator said the trust had been unable to provide sufficient assurance that its structures would prevent further patients from potentially suffering harm.

Concerns have previously emerged within gynaecology services after hundreds of women’s cases were reviewed following administrative delays associated with one consultant. Some women, including cancer patients, experienced delays to diagnosis and treatment.

The trust is now also facing an independent external review of gynaecological surgery because of continuing safety concerns.

Separate concerns have surrounded spinal surgery, while surgical services at Salford Royal Hospital have previously been subject to regulatory action after inspectors identified problems including staffing shortages and patients experiencing delays in receiving pain relief.

The latest warning broadens the focus beyond individual departments. The CQC’s concerns encompass how risk and patient safety are managed across the organisation as well as complaints, staff wellbeing and whether employees feel able to speak openly when something is wrong.

Those workforce concerns are particularly significant because some staff continue to describe severe pressure within clinical services.

One member of staff told The Independent they would not want a family member operated on at the trust and claimed conditions within theatres were deteriorating. They described staff as exhausted and sometimes unable to take lunch or toilet breaks because there were not enough colleagues available to relieve them during operations.

The trust has disputed suggestions that inexperienced theatre staff are being expected to work without appropriate preparation. It said training, supervision and competency procedures are in place for theatre roles and that staff must complete the required assessments and sign-offs before working independently.

It has also encouraged employees with concerns to speak up or submit incident reports so issues can be investigated.

The regulatory intervention comes as Northern Care Alliance faces substantial financial pressure.

The trust is dealing with a £141 million deficit and has been set a year-end target of reducing this to £28.8 million, requiring significant savings across the organisation. Board papers indicate measures include reducing agency spending and introducing unpaid breaks.

At the same time, industrial relations have become increasingly difficult. Critical care staff have recently taken strike action, following earlier action involving surgical theatre workers. During recent walkouts, the trust declared a critical incident as pressure on services intensified.

Hundreds more workers represented by Unison are due to strike for two days this week in a separate dispute over overtime payments.

The combination of financial savings, industrial action, staffing pressures and regulatory intervention creates a particularly difficult challenge for trust leaders.

Reducing NHS expenditure does not automatically mean patient care will deteriorate, and trusts across the country are under pressure to improve productivity and control spending. However, where a regulator is simultaneously raising significant concerns about patient safety, workforce wellbeing and risk management, decisions about where and how savings are made inevitably require close scrutiny.

Northern Care Alliance said the problems identified by the CQC were consistent with issues it already knew about and was working to address.

The trust said the CQC’s assessment had also recognised progress in strengthening clinical leadership. Improvement programmes are being delivered across its services, and the organisation has restructured to place greater clinical leadership around improvement work while receiving oversight and support from both the CQC and NHS England.

It said it is publicly reporting its progress and recognised the efforts of its 20,000 employees to provide safe, high-quality care.

The CQC has not released the full findings behind its latest warning and said it could not comment in greater detail until its report is published.

That report will provide a clearer picture of the regulator’s concerns and the improvements it expects Northern Care Alliance to make.

But the latest intervention is significant because this is no longer a story about one struggling department or an isolated patient-safety incident.

Northern Care Alliance is now dealing with formal intervention from both the CQC and NHS England while simultaneously attempting to close a substantial financial gap and manage serious workforce pressures.

For patients and staff across its four hospitals, the crucial question will be whether the trust can make the improvements regulators are demanding while also delivering the savings its finances require.

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