Chief Inspector of Hospitals publishes his findings on Croydon University Hospital

21 November 2013

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by Croydon Health Services NHS Trust at Croydon University Hospital.

The trust was one of the first to be inspected under radical changes which have been introduced by the Care Quality Commission which are designed to provide a much more detailed picture of care in hospitals than ever before.

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts spent two days announced at Croydon University Hospital during September. They examined the care provided in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients.

Inspectors also visited the hospital unannounced as part of the inspection, held focus groups with staff, and held a public listening event. The report which CQC publishes today is based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

Overall, the report concludes that the new senior management team at the trust are working hard to change its culture, and while it is early days, this seemed to be having a positive impact. Despite this there were still areas of the hospital where care needed to be significantly improved. CQC found that some outpatient clinics were poorly organised and significant numbers of older people were being discharged in the evening. Inspectors were also concerned about low staffing levels affecting patient care especially in wards for older people. The poor physical environment in A and E and in some other parts of the hospital made the delivery of care difficult.

CQC has told the trust that it must take action to improve in the following areas as a matter of priority:

• Staffing levels in older people’s wards.
• Reducing discharges in the evening, especially for older people.
• Improving outpatients to reduce waiting times, proving enough seating and communicating better about the reasons for and length of delays.
• Improving care plans to make sure that they involve people and reflect their needs.
• Arrangements between A&E and the Urgent Care Centre as far as the trust can influence.

CQC has also told the trust that it also needs to improve in a number of other areas, including:

• Staffing, cover and skill mix across a number of services.
• Improving the quality of care delivered to patients who are not being treated in the correct ward for their condition.
• Monitoring the availability of pain relief, especially for people moving between wards.
• Developing a stronger attention to detail on key practices including infection control.
• Improving the accuracy and storage of patient records.
• Supporting food choices for people with dementia.

CQC also found a number of areas of good practice which included:

• The ‘Listening into Action’ approach, designed to enable staff to contribute to finding solutions, was bringing about positive changes for both patients and staff.
• Sustained improvements in maternity services.
• The care of people with dementia in A&E.
• The new Acute Medical Unit.
• The Chronic Obstructive Pulmonary Disease (COPD) clinic, which was working well to prevent avoidable respiratory admissions.
• The palliative care team, who carried out good joint working with a local hospice.

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: "While most patients praised the care they had received, poor patient experience was still a theme across the trust. Long-standing staffing problems at the trust are currently being addressed by a large recruitment drive, but there were still significant staffing challenges in A&E and some inpatient wards.

"Whenever we inspect we 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?

Is it safe?

"At Croydon University Hospital, we found that while most services were being delivered safely, a number of areas needed to be improved as a matter of priority. There were staffing challenges in a number of areas of the hospital – including A&E and elderly care – despite an ongoing recruitment drive.

Is it effective?

"We found that services were largely being delivered effectively. While there was no evidence of concerns about infection rates or mortality rates, lessons learned from incidents and audits wasn’t always fully embedded at ward level.

Is it caring?

"Most people that we spoke to were positive about their care, and much of the care we saw during this inspection was good. We had concerns, however, about outpatients and also about the number of people – especially the elderly – who were being discharged in the evening. This is a trust where patient experience has been problematic in the past, and some recent cases were raised at the public listening event.

Is it responsive to people’s needs?

"The hospital needs to do more to be responsive to people’s needs, especially in A&E where large numbers of people are being discharged just before the four hour target is breached, and in appointments for orthopaedic and eye services. The physical environment especially in areas like A&E (which was crowded and badly designed) made the delivery of care difficult.

Is it well-led?

"The trust’s new senior management team has made impressive strides in the past six months in particular, and staff were keen to tell us about the impact they’d made. Despite this, more evidence of sustained improvement is needed. We found that complaints were not always responded to within an appropriate timetable, and some patients told us that staff were defensive when responding to their concerns."

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.

CQC inspectors will return to Croydon University Hospital in due course to follow up on the findings of this inspection and to report on the trust’s progress in making required improvements.

Ends

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Notes to editors

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, announced in July that he will lead significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike identified 18 NHS trusts representing the variation of care in hospitals in England. These will be the first hospitals to test the new inspection regime.

CQC inspectors have recently carried out a separate unannounced inspection at the Urgent Care Centre, run by another provider. The report from this inspection will be published in due course.