Barts Health NHS Trust rated as Inadequate by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has rated the services provided by Barts Health NHS Trust as Inadequate following inspection of the trust’s three main hospitals in London.

The trust had already been placed in to Special Measures following the Care Quality Commission’s report on Whipps Cross University Hospital which was published in March.

Following that inspection, CQC decided to inspect both the Royal London Hospital and Newham University Hospital. Both have also been found to be Inadequate. Full reports including ratings of all core services have been published on the CQC website: www.cqc.org.uk/provider/R1H.

CQC has identified 65 areas where the trust must make improvements. The Chief Inspector of Hospitals, Professor Sir Mike Richards, has already passed on his concerns to the provider and commissioners, seeking action to improve the safety and quality of services. The Trust Development Authority is working with the trust to support improvement.

Sir Mike said:

“Barts Health NHS Trust is the largest NHS trust in England, serving a population of well over two million people, and home to some world-renowned specialities. So it is all the more disappointing to report the extent and level of our concerns in all three hospitals, particularly in safety and leadership.

“It is clear that the leadership issues we found at Whipps Cross were replicated at the other hospitals. It is three years since the merger which formed the trust – but there is still a lack of engagement with the staff, low morale, high levels of stress, even confusion among the workforce about who is in charge.

“Across the trust there is too little attention paid to safety, with failures in incident reporting and auditing, and in dealing with or learning from complaints. It is worrying that the trust’s directors didn’t seem to have confidence in their own data – a basic requirement in assessing their performance. It is all the more of a concern with waiting times which were so long, or that operations were being cancelled.

“While we have found many individual services require improvement, we also found examples of good services at both Royal London Hospital and Newham. We met a very committed workforce who felt undervalued by trust leadership, but valued by their patients and colleagues, and their local managers.

“Barts Health NHS Trust as a whole has not made the progress we would have hoped for in dealing with the findings of our previous inspection in 2013. If the trust is to turn round – then it must focus first on the culture and on the leadership issues so that it can effectively deal with all the individual concerns which we have identified on this inspection. We will continue to work with the NHS TDA to ensure that these improvements are made.”

The Royal London Hospital and Newham University Hospital were inspected in January over a period of three days.by two inspection teams which included doctors, nurses and other specialists, hospital managers, CQC inspectors and experts by experience (people with personal experience of using or caring for someone who uses the type of services being inspected). They also made unannounced visits as part of the inspection.

The inspectors concluded that the trust lacked strategy and vision. The Clinical Academic Group structure which is meant to provide leadership across all clinical staff was ineffective.

Patient safety was not given sufficient priority. Staff did not always recognise concerns and incidents. Some staff were discouraged from raising their concerns and there was a culture of blame. When concerns or incidents were raised, or things went wrong, the approach to reviewing and learning was slow. There had been nine Never events over a period of 14 months, but very few audits to ensure that surgical teams were using the World Health Organisation’s safety check lists.

Inspectors rated Newham University Hospital as Good for Urgent and Emergency Services. Patients felt well cared for and staff felt supported and there were excellent outcomes for people who had suffered a stroke. Royal London hospital was rated Good for Critical Care with patients positive about the treatment received during a period of period of high activity.

Staffing levels in some areas were significantly below recommended levels and did not provide consistently safe care. Bed occupancy was so high that patients were not always cared for on the appropriate wards, and the high occupancy was affecting the flow of patients through the hospitals. Some patients faced delays of more than 18 weeks from referral to treatment and some patients had their surgery cancelled on several occasions due to a lack of beds.

During the previous inspection, in November 2013, inspectors had identified a culture of bullying and harassment. Although the trust commissioned an independent review, CQC found that the response had not been timely enough; the inspection team still had concerns about whether enough was being done to foster an open and transparent culture.

CQC has also identified a number of areas of outstanding practice across the trust, including:

Pain relief for children following an operation had been audited to introduce different strengths of local anaesthetic in order to reduce the pain experienced after operation. This had been shared with other NHS organisations through a national paediatric conference. The Royal College of Physicians audit of stroke care rated Royal London Hospital as 97.5% for patient experience from diagnosis to rehabilitation - the highest result in London.

The Royal London Hospital is a pioneer in trauma care. Around 25% of the patients attending the trauma service in emergency had penetrative wounds, significantly higher than any other UK trauma centre. The survival rate at the hospital was approximately twice the national average. They had worked with the armed forces while on combat operations, to apply specific learning to the service.

The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

This week the Care Quality Commission presented its findings to two local quality summits, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summits is to develop a plan of action and recommendations based on the inspection team’s findings.

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