Archived: North West London Hospitals NHS Trust

We carried out this comprehensive inspection because North West London Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system.

North West London Hospitals NHS Trust is located in the London Boroughs of Brent and Harrow, and cares for more than half a million people living across the two boroughs, as well as patients from all over the country and internationally. The North West London Hospitals NHS Trust manages three main sites registered with the Care Quality Commission: Northwick Park Hospital and St Mark’s Hospitals in Harrow, and Central Middlesex Hospital in Park Royal. St Mark's Hospital is an internationally-renowned centre for specialist care for bowel diseases. The trust has a sustainable clinical strategy with Ealing Hospital that improves patient pathways, underpinned by combined ICT and estate strategies, and a vision to establish Northwick Park Hospital as the major acute hospital of choice for outer North West London.

Our key findings were as follows:

• Some areas had shortages of nursing and/or medical staff, which impacted on the care being given.
• Escalation procedures were not always followed or effective.
• Maternity services continue to require improvements to ensure a cohesive, safe, effective service for women.
• There were concerns about the competency and supervision of middle grade doctors.
• Appraisal rates for staff were, in some areas, poor.
• Auditing in the critical care area was poor and was not in line with national programmes.
• Equipment and the environment, particularly in paediatric services, required improvements in order to maintain the safety of children and young people.
• Policies, procedures and protocols were not always up to date and reflective of best practice guidance.
• There was inequity in discharge arrangements.
• Most areas were clean, and at the Central Middlesex Hospital patients were complimentary about the food they received.
• Infection control practices and rates of infection were good.

We saw several areas of outstanding practice including:

• The stroke unit was providing a ‘gold standard service’ with seven-day working. It had been the recipient of the prize for the 2013 Clinical Leadership Team at the British Medical Journal awards.
• The STARRS service had strong ownership by geriatricians and the multi-disciplinary team. The team was aware of the needs of frail elderly patients who attend A&E. It was introduced by the trust and its partners to mitigate one of the pressures on the A&E service and the hospital's beds.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Ensure that there are appropriate numbers of staff to meet the needs of patients in the A&E department, surgical areas and critical care (Northwick Park Hospital and St Mark's Hospital).
• Ensure that there are systems in place to assess and monitor the quality of the service provided in A&E, critical care, surgery and maternity, to ensure that services are safe and benchmarked against national standards (Northwick Park Hospital).
• Ensure that the environment is safe and suitable in paediatric services (Northwick Park Hospital).
• Ensure that equipment is available, safe and suitable within the paediatric service (Northwick Park Hospital).

Professor Sir Mike Richards

Chief Inspector of Hospitals