The Care Quality Commission has rated The Hillingdon Hospitals Foundation Trust in north-west London as Requires Improvement overall.
The trust was rated Inadequate for being safe and Requires Improvement for being effective, responsive and well-led. The trust was rated Good for caring following the inspection in March and April 2018.
Inspectors did though find examples of outstanding practice in Maternity, Children and young people’s services and End of life care, all of which had improved in their ratings at this inspection.
This inspection concentrated on Hillingdon Hospital. Mount Vernon Hospital was not inspected on this occasion.
CQC’s overall rating for being safe went down and the trust is now rated as Inadequate in this category.
Matrons and managers within the trust did not have the capacity to effectively lead their teams due to pressures faced operationally. The senior management team had not taken note of all of the concerns raised at the previous inspection.
Staff struggled to locate clinical guidelines quickly as the trust intranet search engine was not user friendly.
Areas where the trust must now improve in Urgent and emergency services include:
- Monitoring the safety of the waiting room including clinical oversight of deteriorating patients.
- Improving infection prevention and control practices.
- Improving storage and checks of medicines.
- Ensuring the mental health interview room is fit for purpose.
Areas where the trust must now improve in medical care include:
- Ensuring safe levels of staff to ensure the provision of safe care and treatment.
- Ensuring staff keep appropriate records of patients’ care and treatment, in particular, dementia assessments, bed rail assessments and capacity assessments.
- Ensuring senior staff check agency staff competencies.
- Ensuring staff follow trust policy on the management of patients with a learning disability.
In surgery the trust must:
- Ensure that all staff are aware of sepsis and undertake training in identifying patients with sepsis.
- Ensure that senior staff are available to assist staff in planning and patient care.
In Critical care the trust must:
- Ensure effective systems and policies are in place for sepsis management, including sepsis training for staff.
In Outpatients the trust must:
- Ensure that clinical records are maintained in an orderly, clear and legible manner and that this is checked on a regular basis.
Since CQC’s previous reports published in January and August 2015, when inspectors highlighted the poor condition of the trust’s buildings and estate, there had been little or slow progress in addressing this issue. The trust had been seeking external support for a new external build on an adjacent site. The trust’s plans in this respect were not at an advanced stage.
The trust had the second highest backlog of estates maintenance issues in the country. The newly appointed director of estates was accomplishing a skilful role in overcoming serious faults which could potentially halt the trust’s operation in several areas and at any time.
The CQC has also published the trust’s Use of Resources report, which is based on an assessment undertaken by NHS Improvement. Various factors are considered by NHSI, including a combination of data on the trust’s financial performance over the previous 12 months, NHS Improvement’s local intelligence and the trust’s assessment of its performance. As a result of this review the trust has been rated as ‘Requires Improvement’ for use of its resources during the 2017/18 financial year.
The combined rating for the trust, taking into account CQC’s inspection for the quality of services and NHS Improvement’s assessment of the use of resources is Requires Improvement.
Ted Baker, England’s Chief Inspector of Hospitals said:
“There is much scope for improvement at The Hillingdon Hospitals NHS Foundation Trust and I expect the trust to address the safety issues we have highlighted urgently. It is essential that the overall quality of care has improved when we next inspect.
“While we did see some evidence of outstanding care in areas such as maternity, children and young people’s services and end of life care, there is still much to do.
“The planned and much needed building works will help the trust’s overall environment for both patients and staff.”
You can read the latest ratings table of pages 15,16 17 and 18 of the inspection report.
Ends
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There is much scope for improvement at The Hillingdon Hospitals NHS Foundation Trust
Professor Ted Baker, Chief Inspector of Hospitals