England’s chief inspector of hospitals has found some improvements in patient services at Barking, Havering and Redbridge University Hospitals NHS Trust following its latest unannounced inspection.
The trust, which serves 800,000 people in north-east London and into Essex, has been rated Requires Improvement overall by the Care Quality Commission - no change from the previous rating in 2016. The trust is rated Good for caring.
The trust operates from two sites; Queen's Hospital and King George Hospital. The CQC inspection took place during high winter pressures across the country. This was a time of extreme pressure on all emergency departments.
CQC carried out inspections of emergency and urgent care, medical care (including older peoples care) and surgery at both Queen’s Hospital and King George Hospital; and maternity services at Queen’s Hospital between January and March 2018.
Inspectors did find some areas of outstanding practice. There were innovative approaches to improving staffing, through taking on care support workers and training them to develop as emergency care assistants, and recruiting five apprentices to become support workers. CQC found family friendly working patterns and the redesigning of medical posts to allow development of expertise outside of the emergency department.
Medical wards were working to identify new ways to manage the challenges of short staffing. This included introducing leadership opportunities and the introduction of nursing associate posts.
The trust had introduced nurse apprenticeships, this enabled health care assistants (HCAs) who lived locally and had worked for the trust for some time the opportunity to train as qualified nurses.
In surgery, inspectors found marked improvements in safety. The trust was now using the ‘five steps to safer surgery’ checks in the operating theatres, and a more integrated clinical process allowed the trust to manage risk more effectively. The rating has now moved up from Requires Improvement to Good.
However, there are areas where the trust must improve:
- It must ensure there are enough doctors on duty to meet the needs of the surgical wards at King George Hospital at weekends and evenings.
- It must ensure appropriate supervision of the adult day unit at King George Hospital at weekends.
- It must ensure that the board has the appropriate extent of skill, knowledge and experience to govern effectively.
- It must address the low levels of completion of mandatory training across services.
You can see the latest ratings grids on pages 12, 13, 14 and 15 of the inspection report. Read the report in full
CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Inadequate for using its resources productively.
The combined rating for the trust, taking into account CQC’s inspection for the quality of services and NHSI’s assessment of Use of Resources is Requires Improvement.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“While I recognise there has been improvement in the quality of care in some areas at Barking, Havering and Redbridge NHS Trust, there is still scope for improvement in many areas.
“I note that the trust has developed inventive ways to deal with staffing shortages - but it must do more to ensure that the overuse of temporary staff does not compromise standards of patient care.
“The overall rating remains Requires Improvement and I hope that by strengthening its leadership that in the future the trust will be able to improve further. We will continue to monitor their progress carefully.”
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While I recognise there has been improvement...there is still scope for improvement in many areas
Professor Ted Baker, Chief Inspector of Hospitals