The Care Quality Commission has rated an NHS trust, which provides services across the three London boroughs of Brent, Ealing and Harrow, as Requires Improvement overall.
London North West University Healthcare Trust was rated Requires Improvement for being safe, effective, responsive and well-led. It was rated Good for being caring, following the inspection which took place in July and August 2019.
The trust was rated Requires Improvement (RI) by NHS Improvement for the way it uses its resources. The combined CQC and NHSI Use of Resources rating was also RI.
However, inspectors did find areas of Outstanding practice in urgent and emergency services at Northwick Park Hospital with developments to support parents whose children have a fever or suspected infection and closer working with the local mental health trust.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said: “Although the trust remains RI overall we found evidence of improvement and a renewed energy and enthusiasm from trust leaders and staff to get things right, though there is still work to do.
“There seemed to be a greater sense of cohesion as a trust rather than people just identifying with the particular location they work in. This was helped by greater cross site working and medical rotations across the different hospitals.
“I was disappointed with services for children and young people at Central Middlesex Hospital. There was a lack of clear trust leadership and basic care standards needing improvement.
“The trust needs to improve its delayed discharge position which is having an adverse effect on patient flow and efficiency throughout the trust and a need to have more effective working relationships with local authorities to find suitable placements for discharged patients in care facilities. There was a need for the trust to increase collaboration with CCGs and local authorities.”
The trust did not always control infection risk well. Hand hygiene was not consistently being undertaken in maternity services. In children and young people services, the Rainbow Unit at Central Middlesex Hospital was found to be untidy and inspectors could not be assured that children’s toys were regularly cleaned.
Due to capacity issues in the emergency department at Northwick Park Hospital, patients were still being cared for on trolleys in the corridor, which meant private conversations could be overheard.
Some medicine storage areas did not meet national guidance for security for controlled drugs in the Northwick Park surgical service.
However, mandatory training compliance rates at Northwick Park and Ealing emergency departments had improved. Staff monitored patients who were at risk of deteriorating appropriately.
At a previous inspection CQC found that Ealing Hospital emergency department was still treating children instead of stabilising and transferring them. At this inspection, inspectors found that the service had overhauled its approach to paediatric patients presenting at the emergency department (ED). The service now had posters up both outside the service and within the waiting room, letting patients know that they did not treat acutely unwell paediatric patients. If an acutely unwell paediatric patient arrived at the service, they would stabilise and transfer to a neighbouring ED.
Previously CQC found that a lift that was designated for operating theatre staff and patients only was being used by members of the public. This had now been addressed. Direct access from the delivery suite to the theatres could now only be achieved with swipe card access.
Patients, families and carers were positive about the care across the service and CQC observed compassionate and courteous interactions between staff and patients.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients and relatives that inspectors engaged with consistently spoke about the kindness of the staff.
You can read the inspection report in full when the report has been published on the CQC website by clicking on www.cqc.org.uk/provider/R1K
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