Chief Inspector of Hospitals publishes his findings on Barts Health NHS Trust

14 January 2014

England's Chief Inspector of Hospitals has today published his first reports on the quality of care provided by Barts Health NHS Trust across three acute hospitals, three specialist hospitals and two birthing centres in central and east London.

CQC inspected the Royal London Hospital, Whipps Cross University Hospital, Newham University Hospital, the London Chest Hospital, St Bartholomew’s Hospital, Mile End Hospital, the Barkantine Birthing Centre and the Barking Birthing Centre in November.

As a result of the inspection, 15 compliance actions were issued to the trust (divided across all the hospital sites with the exception of Mile End Hospital). Three warning notices issued to Whipps Cross Hospital in June last year have been lifted following this inspection.

Overall, the team of inspectors, including doctors, nurses and specialists, found that generally services run by Barts Health NHS Trust were safe, but that staffing levels were variable across services and that equipment wasn’t always readily available. This placed patients at risk of harm.

Reports on the whole trust and on each of the eight locations have been published on this website.

Read the full reports on the Barts Health Trust page.

Across the trust, a significant number of staff told the inspection team that they felt disconnected from the trust’s executive team and felt undervalued and not supported. The culture was not sufficiently open and some staff felt inhibited in raising concerns. Morale was low across all staffing levels, and some staff told inspectors they felt bullied.

Learning from incidents took place on individual sites, but not always trust- wide. There were problems with patient flow through the hospitals, bed occupancy and discharge planning at both the Royal London Hospital and Whipps Cross University Hospital.

While the majority of patients said that staff were caring and compassionate, and the team saw people treated with dignity and respect, some people complained that they did not feel listened to. Inspectors were contacted by a number of people who were dissatisfied with the trust’s response to their complaints.

Actions that the trust must take to improve included:

• Ensuring sure that risks identified are acted upon.
• Ensuring that there are sufficient staff with the right skill mix on all wards to deliver safe and effective care.
• Ensuring that equipment is readily available when needed.
• Ensuring that all patients receive nutritious food in sufficient quantities.
• Engaging the Executive Board better with staff; listening to them, responding to their concerns and adopting a zero tolerance approach to bullying.

Areas of good practice identified included:

• The care, commitment and compassion of staff.
• Palliative care, which was compassionate and held in high regard by staff, patients and friends and family.
• Good practice in children’s services, particularly in relation to education and activities for children while in hospital.
• Patients who had had a heart attack received equal treatment, whether admitted during the day or at night.
• Good support for relatives when patients were in a life-threatening situation or when difficult decisions needed to be made about continuing care.

Barts Health NHS Trust was one of the first to be inspected under radical changes introduced by the Care Quality Commission which are designed to provide a much more detailed picture of care in hospitals than ever before. As part of the inspection, the team held focus groups with staff and four public listening events.

The inspection team included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts. They visited the trust to examine 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. 

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “We found that Barts Health NHS Trust was, in the main, providing services that were safe. My team identified a number of areas of good practice and the majority of patients we met were complimentary about the way they had been treated by staff.

“On a more negative note, we found that staff morale was low. Too many members of staff of all levels and across all sites came to us to express their concerns about being bullied, and many only agreed to speak to us in confidence. The trust needs to take action to make sure people feel confident to speak up.

“Locally, the leadership of services is good, but there is a disconnect between the board and the ward. While the leadership team is well-established and cohesive, we found that it needs to be far more visible across all parts of the trust.

“Barts Health Trust is a very large, complex organisation, which plays a vital part in the life of many Londoners. I would encourage local people to read the individual reports on their local hospital or service as these give a detailed view of the care we saw being delivered.”

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit was to develop a plan of action and recommendations based on the inspection team’s findings.

CQC will continue to monitor Barts Health NHS Trust and will return in due course to carry out further inspections of all trust services as part of its regulatory programme.

Ends

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143. For general enquiries, call 03000 61 61 61.

Notes to editors

The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike is implementing his new approach to hospital inspection with 18 NHS trusts which represent variation of care across England. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model.

Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?