Chief Inspector of Hospitals finds significant progress at Croydon Health Services NHS Trust, but further improvements still required

The Chief Inspector of Hospitals has rated Croydon Health Services NHS Trust as Requires Improvement overall following an inspection by the Care Quality Commission (CQC).

The CQC inspection team, which included specialist advisors and experts by experience, visited the trust over a period of several days during June 2015. Inspectors found that overall Croydon Health Services NHS Trust was providing services that were effective and caring, but Required Improvement in order to provide services that are safe, responsive and well-led.

Trust core services, including emergency services, critical care, maternity and gynaecology, and end of life care are provided at Croydon University Hospital, while outpatient, phlebotomy and imaging services are provided at Purley War Memorial Hospital. The trust also provides community health services for adults, children, young people and families.

Community health services for adults were found to be effective, caring and well-led, but required some improvement to ensure that all aspects of care were safe and that services were responsive to patient needs.

Community health services for children, young people and families were found to be safe, caring and responsive; however some improvements were required in order to ensure that services were effective and well-led.

Full reports on all core services have been published on this website.

Although patients said that they received compassionate care and were treated with dignity and respect, inspectors found that not all staff were reporting incidents and the trust was reporting fewer incidents than trusts of a similar size. Feedback and learning from incidents was also inconsistent.

Operations were sometimes cancelled and the day surgery department experienced difficulty in coping with the increased of level of activity. Patients were also often delayed when being discharged from the critical care department.

Staff working within the inpatient and community service teams were using different IT systems to record patient care. Although aspects of the systems were working, staff in some services were continuing to use paper records until problems had been resolved or the systems could be more effectively integrated.

Inspectors found that staff attendance at mandatory training including safeguarding vulnerable adults and children varied across services and needed to improve.

Vacancies across all staff groups, including nurses, doctors and allied health professionals remained. In order to maintain safe staffing levels, the trust regularly used locum and bank and agency staff, while the recruitment of new staff was on-going.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Since our last inspection, in September 2013, Croydon Health Services NHS Trust has made significant improvements across a number of services in relation to patients being able to access care and treatment in line with national standards.

“Good progress has been particularly made in developing both the inpatient and community health services to meet the specific needs of the local population, particularly for vulnerable people.

“Patients and families we spoke with told us they received compassionate care and were treated with dignity and respect.

“Despite this, the trust continues to face challenges in many other areas, including community services, surgery and critical care.

“Operations were sometimes cancelled, the day surgery department experienced difficulty in coping with the increased level of demand and patients were often delayed when being discharged from critical care.

“We were concerned that vacancies across all staff groups remained an ongoing issue, resulting in the regular use of locum and bank and agency staff to maintain safe staffing levels. However, we were encouraged to see that the trust is committed to ongoing recruitment of new staff.

“Although we found several examples of outstanding practice, we have told the trust about a number of areas that require improvement, which I expect the trust to address as a priority. We will continue to monitor the trust's performance and we will return in due course to check on their progress.”

Inspectors saw several areas of outstanding practice, including:

• The Specialist Palliative Care team had engaged with the public and staff to inform the development of the ‘care of the dying person care plan.’ This included new prescribing guidance for symptoms that occur at the end of life, as well as new medical guidance.
• The trust was involved in the LEGACY study for secondary breast cancer, in collaboration with the Royal Marsden and the Institute of Cancer Research.  The objectives of the LEGACY study are to provide researchers with the best opportunity to understand secondary breast cancer, how it works and how to stop it.
• The special care baby unit had level 2 UNICEF accredited baby-friendly status where breast feeding was actively encouraged and mothers were given every opportunity to breast feed their babies.
• The urogynaecology and pelvic floor reconstruction unit had an international profile in relation to research, providing courses to the obstetric community which had won numerous awards.
• The maternity service was currently developing and piloting a programme of antenatal courses designed to support women with limited English.
• The children's specialist nurse diabetic service supported children and young people along with their carers to manage their disease and were part of a 24-hour helpline enabling parents and young people to access the advice and care they needed at all times.

The trust has been told that it must make improvements including:

• Continue to improve and embed systems to monitor the quality and safety of care provided.
• Improve clinical governance and risk management in the surgical directorate at Croydon University Hospital.
• Implement prompt plans to refurbish theatres and to put in place an equipment replacement programme.
• Ensure that 90% of staff receive up-to-date safeguarding and mandatory training.

The Care Quality Commission has already presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team's findings.

The trust must submit a report to the Care Quality Commission which details the action that will be taken to improve services to meet required services.

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For further information please contact Yetunde Akintewe, CQC Regional Engagement Manager, on 07471 020 659. For media enquiries, journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. For general enquiries, please call 03000 61 61 61.