Care regulator finds South London Healthcare Trust failing to meet some essential standards at three hospitals

14 January 2011

The Care Quality Commission has told the South London Healthcare Trust that it must take action to address a series of concerns over quality and safety at its three hospitals in Sidcup, Woolwich and Farnborough in Kent.

Reports which are published today by CQC identify breaches in regulations covering staffing levels, safeguarding, standards of care, the management of medicines, record-keeping and systems to assess the standards of care.

South London Healthcare Trust has been given seven days to produce its plans to show how it intends to achieve compliance. By law, providers of health care services have a legal responsibility to make sure they are meeting the essential standards of quality and safety.

Inspectors will return to the trust unannounced to check whether the necessary improvements have been made and to decide whether to initiate formal enforcement action.

Today's reports follow unannounced visits by inspectors to three of the trust’s hospitals in September, speaking to patients, carers and staff, focussing on all 16 essential standards. Three reports are published today:

At the Queen Mary Hospital in Sidcup and Beckenham Beacon in Beckenham, the Queen Elizabeth Hospital in Woolwich, and the Princess Royal University Hospital in Farnborough, the trust has been told it must take action to address the following concerns:

Care and welfare of people who use services

• Inspectors reported that some staff did not know how to use the electronic incident reporting system, or had not been trained in its use. Some incidents had gone unreported.
• Patients said they had experienced long waits at Beckenham Beacon in radiology, phlebotomy, and outpatients as well as there being a long waiting list for physiotherapy appointments.

Safeguarding people who use services from abuse

• Some staff told inspectors that they had not had training in adult safeguarding or in conducting mental capacity assessments and some staff told inspectors that they were unclear on how to report concerns relating to vulnerable adults.
• The trust provided training figures demonstrating that by July 2010 only 21% of staff across all locations had up to date adult safeguarding training.
• Doors were left open in areas where particularly vulnerable patient groups were being cared for, which could result in patients or visitors accessing areas or equipment which might compromise patient safety.

Management of medicines

• There was a lack of information provided to patients while they were in hospital about newly prescribed medicines and about the process for self-administration of medicines by patients within the hospital.
• There was a concern that information about discharge medicines should be written in line with the trust's medicines and discharge policy and that prescriptions and medicines should be made available so that medicines can be administered in the discharge lounge when required.
• There were significant gaps, omissions and inconsistencies in the records of medicines, leading to the risk that patient medication may not be administered appropriately and correctly.

Requirements relating to workers

• Inspectors reported concerns about the high numbers of eligible staff for whom records of CRB checks were not available, or were undertaken over three years ago.
• The trust has demonstrated that managerial staff are supported in their career development, but has not demonstrated that all staff groups and levels take up opportunities for career progression or are supported in their development.

Staffing

• Inspectors were concerned that there were not enough members of clinical and supporting staff on duty, and that this may have an impact on patient safety, health and welfare.

Assessing and monitoring the quality of service provision

• Inspectors reported concerns in relation to incident reporting and the learning of lessons to implement safer care by monitoring such incidents.
• Many operational staff did not know how to use the electronic incident reporting system, and said that they had not yet been trained in its use.
• Incidents had not been reported on the electronic system or in a timely manner, in order to enable staff to learn any lessons.

Records

• Inspectors reported concerns about the trust’s systems to ensure that people’s personal records are accurate, fit for purpose, held securely and remain confidential.
• Records which were seen displayed inconsistencies, gaps and inaccuracies, although the trust has provided information which demonstrates that it has action plans in place to improve information and records management.

At the Queen Mary Hospital Sidcup and Beckenham Beacon in Beckenham the trust was also told it must also address concerns over one further standard:

Meeting Nutritional Needs

• While the trust has an action plan to ensure staff are trained and comply with hospital priorities around nutrition, the plan was not consistently adhered to across all inpatient areas.
• Inspectors noticed that some elderly and more vulnerable patients on a number of wards were not encouraged or assisted to eat their meals or that there was a delay in them receiving assistance to eat their meals.

Colin Hough, Regional Director of CQC for London said that his staff would continue to monitor the hospitals to ensure that the necessary improvements are made. CQC would consider taking enforcement action if the trust failed to make progress against the compliance actions listed in the reports.

"Overall patients we spoke to were happy with the care they received at all three hospitals. However, they also said they didn’t think there were always enough staff on duty and some people told us they felt they had been let down by the hospitals.

“We saw staff who were professional and caring towards their patients and were committed to providing care of the highest quality although some staff told us they did not think they had enough suitable equipment to do their jobs well. Staff also told us they were concerned about changes that maybe taking place in the trust and that this has had an effect on staff morale.

“The trust must ensure that all its services are meeting essential standards of quality and safety. These are the standards of care anyone should be able to expect in any hospital and we will hold the trust to account if it continues to fail to meet them.

“We will return to all three hospitals at some time in the near future to ensure that these changes have been made and that improvements are sustained.”

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors