Lewisham and Greenwich NHS Trust Requires Improvement says CQC

A major south London hospital trust has been rated Requires Improvement overall by the Care Quality Commission – the same rating it achieved three years ago during the last comprehensive inspection.

Lewisham and Greenwich NHS Trust was rated as Requires Improvement in all five categories rated by CQC: being safe; effective; caring; responsive and well-led, after the inspection in March 2017. However, CQC did rate community services in the London Borough of Lewisham as Outstanding overall during the most recent March 2017 inspection.

This latest inspection follows complaints and concerns reported by patients, relatives and staff in 2016. Then CQC undertook an urgent inspection of the emergency department and medical services at the Queen Elizabeth Hospital, Woolwich, in June 2016. It rated both services as Requires Improvement.

CQC’s key findings from the most recent March 2017 inspection, included:

In some areas, safeguarding training rates and mandatory training rates fell well below the trust’s target.

There were significant shortages of medical, nursing and allied health professional staff in most departments which were having an impact on delivery of care and patient safety.

In some areas, principally surgery, medicines management processes were not in line with hospital policy or national guidance.

In medical care, infection control processes, including waste management and adherence to the control of substances hazardous to health guidance, was variable.

In surgery, inspectors observed numerous breaches of Infection Prevention and Control (IPC) policy, potentially placing patients at significant risk of infection.

In maternity and gynaecology CQC found the cleanliness of the environment and some equipment to be of a poor standard, even where green ‘I am clean’ stickers had been used to show that surface areas and equipment had been cleaned that day.

In outpatients the environment in general diagnostic imaging was not fit for purpose.

The hospital was not providing responsive care in all areas.

The provision of end of life care at inadequate at Queen Elizabeth Hospital was Inadequate. It was Requires Improvement across the organisation as a whole.

Some progress had been made in meeting the needs of patients living with dementia including increased activities.

Staff had a good understanding of consent process and recognised when the best interests of the patients had to be considered.

However, inspectors did see some areas of Outstanding practice, which included:

The speech and language therapy manager had implemented a risk feeding protocol following a successful research pilot project. This resulted in demonstrable outcomes for patients, including a 10% reduction in the admission of patients with dysphagia through more effective feeding regimes.

Staff in the Trafalgar Clinic provided care and treatment for patients in a nearby prison. Each patient’s records were maintained on the service’s electronic patient record system. This meant when a patient left the prison service, there was no disruption in care or treatment because clinical staff always had access to this.

In critical care there was a dynamic programme of research and development enabled by the full time appointment of a research nurse working with doctors including consultants.

Areas where the trust must now make improvements include:

• Review and improve the systems for monitoring and improving the quality and safety of care including attendance at key meetings in the emergency department, surgery, critical care, services for children and young people and end of life care.
• The trust must ensure all risks are included on risk registers and are regularly reviewed and updated and carry out audits to monitor the effectiveness of treatment and care.
• Ensure all relevant risk assessments are carried out on patients.
• Ensure medical and nursing staffing levels are in line with national standards and service specifications.
• Ensure that patients are cared for in areas that are appropriate to their needs and have sufficient space to accommodate all equipment and does not compromise their safety and staff have the relevant skills and knowledge to care for them.
• Ensure patients requiring end of life care receive appropriate and timely care.
• Improve patient flow across the organisation.

The trust should now:

• Ensure staff comply with infection prevention and control policies and procedures.
• Ensure staff working on medical wards and in end of life care have the values and attitude necessary to treat patients, their relatives and visitors with dignity and respect.
• Ensure all patients have their pain assessed and receive analgesia in a timely manner.
• Improve compliance with mandatory training completion rates for modules that are below the trust target in all staff groups.
• Ensure there are ongoing arrangements for measuring and reporting patient satisfaction in critical care.
• Review the environment and waiting times for women using the gynaecology service.
• Ensure patients who are at the end of their life, and their relatives, are afforded privacy.
• Work to reduce the number of cancelled operations.
• Respond to complaints within agreed timescales.
• Provide sufficient staff to care for patients who need one to one care.

England’s Chief Inspector of Hospitals, Professor Ted Baker, said:

“The trust has not made sufficient progress since our last comprehensive inspection. There remain areas of unresolved risks and areas for significant improvement. This included the acute emergency pathway at Queen Elizabeth Hospital."

“However, we did see good and some outstanding practice in the trust’s community services, and great credit goes to the staff in these services for the quality of care they provide.”

Ends

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