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Chief Inspector of Hospitals calls for improvements as Whipps Cross University Hospital is rated as Inadequate
England's Chief Inspector of Hospitals has rated the services provided by Whipps Cross University Hospital at Leytonstone in east London as Inadequate after inspection by the Care Quality Commission.
Inspectors found that urgent and emergency services, medical care, surgery, end of life care, outpatients and services for children and young people were all Inadequate. The hospital's critical care and maternity and gynaecology services were rated as Requires Improvement.
Immediately after the inspection in November, the Chief Inspector of Hospitals, Professor Sir Mike Richards passed on his concerns to the provider, Barts Health NHS Trust, seeking urgent action to improve the safety and quality of services.
Since the inspection CQC has issued four warning notices requiring the trust to improve the care and welfare of patients, its system for assessing and monitoring services, staffing levels, and handling of complaints.Inspectors will return to the hospital in the near future to check that those improvements have been made.
Members of the inspection team spent six days at Whipps Cross in November 2014, visiting the hospital twice unannounced. The team of 45 inspectors included CQC inspectors and a variety of specialists and experts by experience.
Inspectors found that staff morale was low. There was a culture of bullying and harassment, with some staff reluctant to speak to inspectors in case of repercussions.
There were not enough nurses or doctors to ensure safe care was provided. A reorganisation of staffing in 2013 had a damaging impact. Staff were overstretched - and there was an atmosphere which did not help in recruiting or retaining permanent staff. Some agency staff had not been trained properly in their roles.
The average bed occupancy was so high that it was affecting the flow of patients through the hospital, with patients admitted to wards which were not appropriate to their needs. Patients were cared for in recovery areas, others were transferred out of critical care beds, despite their clinical needs. People who were well enough to leave hospital experienced long delays in being discharged because paperwork had not been completed, or because transport was not ready.
The hospital was persistently failing to meet national waiting time targets. Some patients were waiting more than 18 weeks from referral to treatment. Too many operations were cancelled due to a lack of available beds.
When thing went wrong, staff did not have the time to report incidents, were not encouraged to report incidents, and were not aware of any improvements or learning. Even senior staff were unaware of serious incidents, and how they should have been involved in leading any required changes.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Our inspection of Whipps Cross University Hospital has highlighted a number of serious concerns surrounding poor leadership, a culture of bullying, and low staffing which has led to risks to patient safety.
"I note that many of the failings which we found on inspection in November 2013 are still not resolved. In some areas there has been little progress - and this has been affecting the quality and safety of patient care.
"I know that Whipps Cross University Hospital has been through a period of considerable upheaval, with the reorganisation and re-grading of nursing posts in 2013 still affecting morale even now. I do appreciate how unsettling this can be. There is a large section of the population in east London who depend on this hospital and they are entitled to services which provide safe, effective, compassionate and high quality care.
"Barts Health NHS Trust has not given sufficient priority to safety. We found frequent staff shortages and a reliance on agency and locum staff that increased the risk to patients. The trust must get a grip on what is happening here and on the low staff morale.
"We have recently inspected two of the trust's other hospitals and I will have more to say when we report on our findings from those inspections. In the meantime I will continue to monitor how Barts Health NHS Trust manages to deal with these longstanding issues. We will return in due course to check that the trust has made the immediate improvements we require.
“I have highlighted my concerns about the quality and safety of care at Whipps Cross to the Trust Development Authority.”
The inspection team identified 15 areas where the trust must make improvements including:
- Safety and effectiveness must be a priority in all core services
- There must be appropriate levels and skills mix of staffing to meet the needs of all patients.
- Bank and agency staff must be given full inductions to ensure they can access policies, be aware of practices and provide care and treatment in the areas they are required to work in.
- Patients must be able to leave hospital when they are well enough.
- Procedures for documenting the involvement of patients, relatives and the multi-disciplinary team in Do Not Attempt Cardiopulmonary Resuscitation forms must be followed at all times.
- Accurate records must be available for patients attending outpatient appointments.
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.
For media enquiries, contact CQC’s press office on 020 7448 9401, during office hours, or, out of hours, on 07789 876508. For general enquiries, call 03000 61 61 61.
- Last updated:
- 17 March 2015
Notes to editors
Whipps Cross University Hospital is one of six hospitals run by Barts Health NHS Trust which is the largest NHS Trust in the country. CQC has recently inspected Newham University Hospital and The Royal London Hospital. Those reports and the overall rating for the trust will be published in April.