North Middlesex University Hospital Requires Improvement says CQC

The Chief Inspector of Hospitals has published a report on North Middlesex University Hospital (NMUH) NHS Trust after a comprehensive inspection by the Care Quality Commission in September 2016. The trust has been rated as Requires Improvement overall.

The trust has been rated Requires Improvement for being safe, effective, caring, responsive and well-led.

Eight core services at North Middlesex were inspected. Seven have been rated as Requires Improvement. They are: urgent and emergency services; medical care (including older people’s care); critical care; maternity and gynaecology; services for children and young people; end of life care and outpatients and diagnostic imaging. Surgery was rated Good.

Earlier this year, CQC had rated urgent and emergency care services at North Middlesex University Hospital as Inadequate following an unannounced inspection in May 2016. At the time CQC issued a Warning Notice requiring significant improvements in the emergency department.

Professor Sir Mike Richards, Chief Inspector of Hospitals, said: “I am pleased to report that the situation in North Middlesex’s emergency department has improved from when we inspected in May 2016.  While services are no longer Inadequate, there is still a long way to go at the hospital as a whole.

“CQC has worked in partnership with other health sector bodies including NHS Improvement and NHS England to ensure there has been support for the trust over the months since our Warning Notice was issued.

“We have found improvements since the inspection in May. There is improved clinical governance and leadership at department level as well as better oversight at trust level.  A new chief executive and senior managers have been appointed and they are making a difference.

“We saw several areas of outstanding practice at North Middlesex. Outpatient and diagnostic services had strong leadership and staff were inspired to provide an excellent service, with patients at the centre of all that they do. Surgery was impressive too and we gave it a Good rating. However, there is still a lot to do. The task now is to ensure that the improvements we have seen are sustained and built on for the future. I have no doubt that before long we will return to check on the trust’s progress.”

Inspectors found that feedback on caring from patients and relatives was generally good and they felt they were treated with courtesy, respect and compassion by staff. Staff maintained patients’ privacy and dignity. In the Friends and Family Test the percentage of patients who said they would recommend the trust was consistently equal to or slightly lower than the England average.

The hospital consistently met the referral to treatment standard and performed better than an average English hospital. Care and treatment was consultant led and medical staffing levels met national best practice guidance. The percentage of patients seen within two weeks for all cancers was higher than the national average. Also, the cancer waiting times for people waiting less than 31 days from diagnosis to first definitive treatment were higher than the national average and above the standard target of 96%.

However, some of the key findings of the inspection team did highlight areas that do need to improve. These included:

Too many patients were waiting to be assessed after they arrived in the emergency department, and they were also waiting too long to be dealt with. The ED was not meeting the target time to admit, transfer or discharge 95% of patients within four hours of their arrival.

In maternity services, inspectors observed that privacy and dignity were not always protected and staff did not always address patients in the appropriate manner.

Nurse staffing levels could be unpredictable and did not always meet national guidance. Safety checks on agency nurses were inconsistent and poorly managed. Inspectors were not assured that patients were being cared for in the right place at the right time, by adequately qualified staff.

The culture was not consistently one of fairness, openness, transparency, honesty, challenge and candour. Staff reported bullying, harassment and discrimination amongst staff at all levels in the maternity unit. They said when they raised concerns they felt they were not treated with respect. The culture was in places defensive with poor collaboration between staff working in different departments. High levels of conflict in some departments were reported to CQC.

Included in the actions the trust must now take are:

• It must produce and ratify an end of life care strategy
• The trust must send out bereavement surveys to the relatives of patients who have died within the hospital. The trust developed a survey 18 months ago but did not send it out. The trust has acknowledged this and said the survey will be introduced as soon as possible
• It must ensure medical and nursing staff are fully trained and able to identify and support the needs of patients living with dementia
• It must provide one to one care to all women in labour
• It must improve mandatory training levels for medical and nursing staff
• The trust must ensure medical and nursing staff are fully trained and able to identify and support the needs of patients with learning disabilities.

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