Chief Inspector of Hospitals finds that Lewisham and Greenwich NHS Trust Requires Improvement

13 May 2014

England's Chief Inspector of Hospitals has published his first reports on the quality of the services provided by Lewisham and Greenwich NHS Trust at University Hospital Lewisham and Queen Elizabeth Hospital, Woolwich.

University Hospital Lewisham was rated as Requires Improvement overall. It was rated as Good for its intensive and critical care and children’s care, and Requires Improvement for all other services inspected.

Queen Elizabeth Hospital was also rated as Requires Improvement overall. It was rated as Inadequate for its accident and emergency (A&E) department, Good for its maternity and family planning services, and Requires Improvement for all other services inspected. You can read the full reports here.

Inspectors found that the A&E at Queen Elizabeth Hospital was not fit for purpose. Capacity in the department was limited and there was a heavy reliance on agency staff. This was leading to delays in further investigation taking place and specialist advice being sought following patient admission via A&E at Queen Elizabeth Hospital.

Both hospitals were using different models of acute medical pathway, and neither of these led to efficient patient movement between different services. In some wards, patients told inspectors that they felt there was a lack of staff as it could take up to 30 minutes for call bells to be answered. Although recruitment programmes were in place to try and fill vacancies, inspectors observed staff shortages in many areas.

Inspectors found that staff on both sites were committed to delivering good care, and a number of areas of good practice were identified. Representatives of the Patients Association, a national healthcare charity, joined the inspection team to look at how complaints were handled in the trust. They found some areas of good practice and that the trust had a clear focus on meeting the needs of patients, but that complaints handling needed to be streamlined.

CQC has told the trust that it must make improvements in a number of areas including:

• Ensuring that it has enough staff in all areas to allow them to work safely and effectively.
• Ensuring that appropriate hand hygiene procedures and ‘bare below the elbows’ practices are followed at all times by all staff groups.
• Improving the management and storage of clinical waste.
• Reviewing medical and upper gastro-intestinal pathways to ensure that they are effective.
• Reviewing capacity in radiology to ensure timely and responsive scans.
• Reviewing the capacity, constraints and escalation process for A&E.

Inspectors also found some areas of good practice across the trust, including:

• A volunteer programme on the dementia ward which provided patients with help in eating their meals.
• The process for managing and learning from complaints, and the programme to learn from incidents.
• A commitment to staff development and training
• The staff culture and staff engagement developed through the recent merger.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“While we would acknowledge that this is a relatively new trust, we identified issues in both hospitals which we require it to take action to improve.

“The biggest problem here is in the A&E at Queen Elizabeth Hospital, which we have rated as Inadequate. Waiting times there regularly exceed the four hour target, there isn’t enough space for the number of people using the service, and the patient pathway from A&E to the ward doesn’t work as well as it should.

“Most patients we spoke to across both sites praised the caring nature of the staff looking after them, and told us that they were treated with respect and dignity. We saw this for ourselves – although the trust still has some work to do for this feedback to be universally positive.

“We’ve rated this trust as Requires Improvement overall. The trust has told us it will take action – and we’ll return in due course to make sure that it has done so.”

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts made announced visits to sites run by the trust in February. They examined the care provided in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients. Inspectors also visited a selection of health centres, looking at both acute and community services.

Inspectors also visited the sites unannounced as part of the inspection, held focus groups with staff, and held a public listening event. The report which CQC publishes today is based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

CQC inspectors will return to both hospitals in due course to check that the required improvements have been made.

ENDS

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