London North West University Healthcare NHS Trust has been rated Requires Improvement overall by the Care Quality Commission.
It was rated Requires Improvement for being safe, effective, responsive and well-led. It was rated Good for being caring, following the inspection in June 2018.
CQC inspected six core services at Northwick Park Hospital and four core services at Ealing Hospital. CQC also inspected two community services.
CQC has told the trust that it must take action to bring services into line with legal requirements. These actions are related to six core services: medical care, urgent and emergency care, maternity, children and young people services, surgery and critical care.
Mandatory training completion rates for nursing and medical staff were not meeting the trust target. There had been insufficient improvement since the previous inspection.
Processes and systems were not reliably in place to protect children from abuse and harm. Children on the child protection register were not always identified, and arrangements for vulnerable patients between 16 and 18 years were not robust.
Nutrition and hydration assessments were not always completed. Inspectors found gaps in feeding charts and the frequency of patient assessment reviews.
The last inspection report included a requirement for the trust to ensure Control of Substances Hazardous to Health (COSHH) assessments were up to date and maintained. CQC found COSHH assessments on medical wards which were significantly out of date, and ward managers unaware if the assessment had been completed or not.
There was a lack of supervision for lower grade doctors and out of hours medical support to the wards in community services.
From March 2017 to February 2018, the trust’s unplanned re-attendance rate to accident and emergency within seven days was worse than the national standard of 5% and also consistently worse than the England average.
There were six patients at the emergency department who waited more than 12 hours from decision to admit until being admitted.
Referral to treatment times were not being met for some surgical specialities such as general surgery, oral surgery and ear nose and throat procedures. The trust performance for cancelled operations was worse than the England average.
Medical wards at Ealing Hospital followed the trust “+1” escalation policy. This stated that at times of high activity, an additional patient could be cared for in the corridor of the ward. Most staff CQC spoke to stated that this policy did not provide patients with sufficient privacy or dignity. CQC reached the same conclusion. Patients were spending long periods in corridors before being provided with a bed in a bay or being discharged.
CQC found numerous areas for improvement including six breaches of legal requirements that the trust must put right. Inspectors found 74 things that the trust should improve – these are all outlined in the inspection report.
Inspectors did find areas of outstanding practice. In surgery staff demonstrated a focus on improvement and dedication to adopting national pilot schemes and new strategies to their patient group. A matron had supported surgical staff in the implementation of a “make a difference” project to improve quality standards and opportunities for joint working. In community inpatients services relatives said that staff were caring and compassionate. They gave inspectors clear examples of how staff had made patient admissions a good experience which included for those who were more vulnerable or who had extra needs.
You can find the latest ratings tables for the trust on pages 17 - 22 of the report.
Professor Ted Baker, England’s Chief inspector of Hospitals, said:
“There is much scope for improvement at London North West University Healthcare NHS Trust. The trust has, as far as its rating is concerned stood still since its last inspection, and is again Requires Improvement overall.
“We will be returning to the trust in due course and at that time I expect to see improvements across the board.”
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.
There is much scope for improvement at London North West University Healthcare NHS Trust
CQC’s Chief Inspector of Hospitals, Professor Ted Baker