Imperial College Healthcare NHS Trust rated as Good for being effective and caring but Requires Improvement overall by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has rated the services provided by Imperial College Healthcare NHS Trust as Requires Improvement overall following a Care Quality Commission inspection in September.

Overall, the trust’s services were rated as Good for being effective and caring, but as Requires Improvement for being safe, responsive and well led.

Inspectors saw that patients were treated with dignity and respect by staff. People said that they felt involved in their care, and that staff were compassionate and considered their individual care needs. Clinical outcomes for patients were good, and there was a clear commitment to multi-disciplinary working.

CQC found that standards of cleanliness and infection control were inconsistent across the trust. Nurse staffing levels were not sufficient in some areas, especially in medical wards, and there was a high reliance on bank and agency staff.

At the time of the inspection, the surgical department had a significant backlog of patients waiting for elective surgery. Referral times in some specialties had breached national targets on an ongoing basis.

Inspectors found that appointment letters sometimes arrived late or not at all, and that internal targets regarding sending these out and responding to complaints were not consistently being met.

CQC found that executive and divisional director level leadership at the trust was effective, but there was variation in terms of the quality of leadership at a more local level. While communication had improved since the new CEO had been appointed, the trust had recognised that more work needed to be done to improve staff engagement, and plans were in place to address this. Staff had a clear sense of pride in their work and a commitment to support the clinical strategy for the trust.

CQC also rated each hospital inspected individually. Charing Cross Hospital was rated Requires Improvement overall. It was rated Good by inspectors for accident and emergency (A&E) and end of life care, Requires Improvement for medical care, surgery and critical care, and Inadequate for outpatient services.

Hammersmith Hospital was also rated as Requires Improvement overall by inspectors. CQC rated end of life care as Good, and outpatient services as Inadequate. All other core services at the hospital were rated as Requires Improvement.

CQC also rated St Mary’s Hospital as Requires Improvement overall. While critical care, maternity and family planning, children’s care and end of life care were all rated as Good by inspectors, A&E and outpatient services were rated Inadequate. Medical care and surgery were rated as Requires Improvement.

Following the inspection, CQC issued the trust with a formal warning in regards to cleanliness and hygiene issues in A&E at St Mary’s Hospital. Inspectors have since returned to the hospital and have found that the required improvements to A&E there have been made.

At Queen Charlotte’s & Chelsea Hospital, CQC inspected maternity and family planning services which were rated as Good, and neonatal services which were rated as Requires Improvement. This hospital was rated as Good overall. The full reports on the trust and on each hospital are available from: http://www.cqc.org.uk/provider/RYJ. (Note: will be available from here from 00:01 on Tuesday 16 December, links to all reports are at the bottom of this release)

Inspectors identified a number of areas of outstanding practice across the trust, including:

• Some clinical services which achieve nationally leading outcomes, including the Trauma Centre at St Mary’s Hospital and the stroke service at Charing Cross Hospital.
• The trust-hosted NIHR Biomedical Research Centre, and research programmes which were integral to many clinical services.
• Leadership programmes available to staff at different levels.
• The visibility and engagement carried out by the new CEO.

CQC identified a number of areas where the trust had to make improvements, including:

• At St Mary’s Hospital, standards of cleanliness of premises and equipment had to be improved. The trust was told to ensure that equipment was suitably maintained and checked, that arrangements for medicines management were reviewed, and that staff were brought up to date with their mandatory training. The trust was also told to make improvements in a number of other areas at St Mary’s Hospital (full details can be found in the report).
• At Charing Cross Hospital, the trust was told to address problems with the administration of appointments which were causing unnecessary delays and inconvenience to patients. The trust was also told to address high vacancy rates for nursing staff and healthcare assistants in the medical wards and out of hours medical staffing for ICU and high dependency beds.
• At Hammersmith Hospital, the trust was told to address problems with the administration of appointments, correct the high number of vacancies amongst nursing staff and healthcare assistants on the medical wards, and reduce the significant backlog of patients waiting for elective surgery.
• At Queen Charlotte & Chelsea Hospital, the trust were told to review staffing levels and take action to ensure they were in line with national guidance, and review the capacity of the maternity and neonatal units to ensure the services meet demand. The trust was also told to review the divisional risk register to ensure that historical risks were addressed and resolved in a timely manner.

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

“When we inspected the hospitals run by Imperial College Healthcare NHS Trust, we saw too much variation in the quality of services. Standards of cleanliness and management were inconsistent. The trust must take action to tackle surgical backlogs and to improve their systems to ensure people awaiting outpatient appointments do not experience unnecessary delays and inconvenience.

“Across all the hospitals, we saw staff delivering compassionate care. While this is something of which the trust should be proud, there is still more to do here to make sure that people receive the best possible care across the board.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. The trust has told us they have listened to our inspectors’ findings and begun to take action where it is required. We will return in due course to check that the improvements needed have been made.”

The inspection team, which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts, visited the hospitals over a period of three days. They also made unannounced visits as part of the inspection.

ENDS

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