Archived: St Mark's Hospital

Updated 20 August 2014

We carried out this comprehensive inspection because North West London Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. We undertook an announced inspection at St Mark's Hospital between 20 and 23 May 2014. St Mark's Hospital specialises in gastro-intestinal services and sits within the main trust location at Northwick Park Hospital.

North West London Hospitals NHS Trust is located in the London Boroughs of Brent and Harrow, and cares for more than half a million people living across the two boroughs, as well as patients from all over the country and internationally. The North West London Hospitals NHS Trust manages three main sites registered with the Care Quality Commission: Northwick Park Hospital and St Mark’s Hospital in Harrow, and Central Middlesex Hospital in Park Royal. St Mark’s Hospital is an internationally-renowned centre for specialist care for bowel diseases. The trust has a sustainable clinical strategy with Ealing Hospital that improves patient pathways, underpinned by combined ICT and estate strategies, and a vision to establish Northwick Park Hospital as the major acute hospital of choice for outer North West London.

Overall, we found the services provided at St Mark's Hospital require improvement to ensure that they are safe, effective and well-led. All services at this hospital were rated as requiring improvement due to lack of staff and coherent processes.

Our key findings were as follows:

• There was inadequate staffing on Frederick Salmon Ward.
• Patients were transferred out of the high dependency unit (HDU) to wards in which staff did not feel confident to manage their conditions. 
• There was a lack of junior doctors, and this affected teaching and appraisal opportunities.
• There were delays in emergency surgery taking place.
• Outpatients clinics in the main outpatients department often ran late and appointments were cancelled, sometimes at very short notice.
• Clinics were often overbooked and the delays were not always clearly explained to the patients.
• Staffing was not always sufficiently organised to support and respond to patients waiting for treatment.

We saw areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Ensure that there are adequate numbers of medical and nursing staff on Frederick Salmon Ward to provide care for patients.

In addition the trust should:

• Review the discharge arrangements for patients transferring from HDU facilities, to ensure appropriately trained staff are available to provide safe care.
• Review the availability of elective surgery allocations.
• Review the booking of outpatients appointments to reduce the cancellations and waiting times experienced by patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 20 August 2014

Medical care on Frederick Salmon Ward requires improvements. While patients on Jonson Ward (Intestinal Failure Unit) received care that was safe, effective and responsive, there were concerns about inadequate staffing, management of deteriorating patients, workload pressures on staff, the teaching and appraisal of junior doctors and a lack of compassion to patient needs on Frederick Salmon Ward.

There were enough nursing staff on Jonson Ward (Intestinal Failure Unit) to protect people from avoidable harm, but not on Frederick Salmon Ward. Pain management, infection control and medicines management were largely good in both areas. Medical and nursing staff were described by patients as “polite, respectful, friendly and helpful”. Jonson Ward (Intestinal Failure Unit) was well-led and patients said that it had “good management”.

Senior nurses told us that they had good support from their line managers.

We observed a lack of integration between St Mark’s Hospital and Northwick Park Hospital, despite being part of the same trust and being physically located on the same site. This led one nurse to describe it as being “them and us”.

Updated 20 August 2014

Patients received compassionate care and were treated with dignity and respect by staff. The environment was clean, reasonably comfortable and well maintained. Staff were professional and polite, and promoted a caring ethos. Clinicians gave patients sufficient time in consultations, and patients said that they felt involved in their care.

The trust had taken action to improve the time from patient referral to treatment. Plans were in place to respond to the increased demand for the chemotherapy outpatients service.

The clinics in the main outpatients department often ran late and appointments were cancelled, sometimes at very short notice. Clinics were often overbooked and the delays were not always clearly explained to the patients. Staffing was not always sufficiently organised to support and respond to patients waiting for treatment.

Updated 20 August 2014

Patients on Frederick Salmon Ward (FSW) received care that was compassionate and responsive. While the day-to-day running of the department generally provided effective care, the department requires improvement nonetheless.

The low number of middle grade doctors and the low number of general surgical lists meant that there were delays in emergency surgery taking place and very limited elective general surgery took place. While these concerns had been raised and plans to improve the department had been drawn up, these changes had not occurred. It was not clear if there was a specific date for when these planned adjustments would be made.