North West London Hospitals NHS Trust rated as Requires Improvement by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has rated the services provided by North West London Hospitals NHS Trust as Requires Improvement following a Care Quality Commission inspection.

CQC rated the trust as Requires Improvement for being safe, effective, caring, responsive and well led. The trust runs three hospitals; Northwick Park Hospital and St Mark’s Hospital in Harrow, and Central Middlesex Hospital in Park Royal. The full reports on the trust and on each site are available here.

Inspectors found that staff shortages were having an impact on care in some parts of the trust, and that there were some concerns regarding middle grade doctors. Escalation procedures were not always followed, and were not always effective when followed.

CQC also identified that maternity services required improvement to ensure women received a safe and effective service. Maternity was rated as Inadequate for responsiveness, as women could not always summon the assistance they required and individual needs were not being met. The environment and equipment in paediatric services also needed to be improved.

Staff across the trust were found to be caring and compassionate towards patients, and their families and friends. Inspectors found that most areas of the trust were clean, and infection control practices and infection rates were good.

CQC identified a number of areas where the trust must make improvements, including making sure that:

• There are enough staff to meet the needs of patients in A&E, surgery and critical care at Northwick Park Hospital and St Mark's Hospital.
• There are systems in place to assess and monitor the quality of the service provided in A&E, critical care, surgery and maternity at Northwick Park Hospital, to ensure that services are safe and benchmarked against national standards.
• The environment is suitable and that appropriate equipment is available, safe and suitable in paediatric services at Northwick Park Hospital.

Inspectors also identified a number of areas of outstanding practice, including: 

• The stroke unit, which was providing a ‘gold standard service’ with seven-day working.
• The STARRS (short-term assessment, rehabilitation and reablement) service, which had strong ownership by geriatricians and the multi-disciplinary team. The STARRS team was aware of the needs of frail elderly patients who attended A&E, and had identified the number of these. This service had been introduced by the trust and its partners to mitigate one of the pressures on A&E and hospital beds.

CQC rated Northwick Park Hospital as Requires Improvement overall, as they rated A&E, surgery, maternity and family planning, children’s care and outpatient services. Medical care and end of life care were rated as Good, while critical care was rated as Inadequate.

Patient flow through Northwick Park Hospital was having an impact on people waiting in A&E, and pressure on the critical care units was so great that some people were being discharged too early and subsequently readmitted. Steps had been taken to address past issues identified in maternity services at the hospital, but further improvements were needed. Inspectors saw that, while the hospital was clean, some areas were in need of refurbishment.

Inspectors also rated St Mark’s Hospital as Requires Improvement overall, as they did medical care, surgery and outpatient services at the hospital due to lack of staff and of coherent processes.

Inspectors found that staffing levels were inadequate on Frederick Salmon Ward. Patients were sometimes transferred from the high dependency unit (HDU) to wards in which staff did not feel confident managing their conditions. CQC also identified that outpatient clinics often ran late, and that appointments were sometimes cancelled at very short notice. There were delays in emergency surgery taking place.

Central Middlesex Hospital was rated as Good overall by inspectors. A&E, medical care, surgery, end of life care and outpatient services were all rated as Good, while critical care and children’s care were rated as Requires Improvement due to lack of equipment and staffing in some areas.

Inspectors found that staff were caring and provided patients with individualised support, and that staffing levels in most areas of Central Middlesex Hospital were sufficient for care to be delivered in a timely way. The hospital was clean, and patients were complimentary about the food provided.

Inspectors also found, however, that staff at Central Middlesex Hospital felt disconnected from the main trust site. Outpatient facilities were not child friendly, and the Rainbow Centre was not staffed by paediatric nurses.

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

“When we inspected the hospitals run by North West London Hospitals NHS Trust we saw that while staff were caring and compassionate, staff shortages made it difficult for them to meet people’s individual needs.

“Particular attention needs to be paid here to the staffing issues identified and to improvements that need to be made to the patient environment. Ongoing improvements to maternity services also need to be sustained, and further changes be made at a much greater pace to ensure that women receive a service which is safe, caring, effective and responsive to their needs.

“We’ll return in due course to check that the improvements needed have been made.”

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts made an announced visit in May.
CQC inspectors will return to the hospital in due course to check that the improvements required have been made.

Ends

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The Chief Inspector of Hospitals, Professor Sir Mike Richards, leads significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model. Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?
The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

This report describes our judgement of the overall quality of care provided by this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations.

The overall trust, individual hospitals and individual services within those hospitals have been given one of the following ratings (on a four point scale): Outstanding, Good, Requires Improvement, or Inadequate.