Chief Inspector of Hospitals finds real improvement, but recommends that Barking, Havering and Redbridge University Hospitals NHS Trust remains in special measures

England's Chief Inspector of Hospitals has recommended that Barking, Havering and Redbridge University Hospitals NHS Trust should remain in special measures following the latest inspection by the Care Quality Commission.

CQC inspectors found that the trust had made significant progress since the last comprehensive inspection in October 2013. Overall the trust has been rated as Requires Improvement - although the trust was rated Inadequate for providing responsive services.

Full reports including ratings for all core services provided at Queen’s Hospital, Romford, and King George Hospital, Ilford are available at www.cqc.org.uk/directory/rf4.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"Eighteen months ago, I was so concerned by the serious failures in the quality of care that I recommended that Barking, Havering and Redbridge University Hospitals NHS Trust should go into special measures.

"I am pleased to report that with the package of support provided by the Trust Development Authority, and with a new leadership in place, the trust has shown that it made significant improvement.

"There is still much to do. Both Queen's Hospital and King George Hospital are rated as requires improvement. Despite considerable attention the trust is failing to meet waiting time targets in the emergency department. Outpatients and diagnostics can't cope with demand and the children's services do not meet local need.

"I am particularly concerned at the large backlog of investigations into serious incidents, which suggests that safety has not been given the priority it requires and lessons are not being learnt as they should.

"However, the new executive team has made significant improvement ensuring the overall culture of the trust was more open and transparent making it a much more positive place to work. On the whole patients we met appreciated the care and support provided by staff. Our inspection has identified those areas where the trust must make improvements.

“While I am satisfied that the trust has made real improvement, there are further improvements still to be developed and be implemented by the executive team. For that reason I feel that the trust should remain in special measures. A further period of support from the Trust Development Authority should ensure that the trust is better placed to embed those improvements for the longer term.“

The team of 60 inspectors and specialists including doctors, nurses, managers and experts by experience, visited the hospitals over seven days during March 2015.

Overall inspectors found end of life services to be Good at both hospitals. All other core services, including urgent and emergency services, medical care, surgery, critical care, maternity and gynaecology, services for children and young people, and outpatients required improvement.

Since the last inspection the trust had developed an improvement plan that had been monitored and updated by stakeholders on a monthly basis. Inspectors found that the access and flow of patients throughout the hospital had improved with the introduction of an Elderly Receiving Unit to meet patients' needs. Also, the trust was persistently failing to meet the national waiting times target and some patients were experiencing more than 18 weeks from referral to treatment.

Also, at the time of inspection there was a significant backlog in the completion of investigations and reports into serious incidents notably in emergency care, medicine and surgery, with some investigations still not started after six months. Investigation reports lacked detail or recommendations that could lead to improvement.

Recruitment of nurses was challenging, with high sickness rates in some areas contributing to low staffing levels. The number of consultants in some medical services fell below national guidelines.

The inspection identified a number of areas for improvement, including:

• The service planning and capacity of outpatients must be improved, continuing to reduce the backlog of patients as well as ensuring that no patients waiting for an appointment are coming to harm whilst they are delayed.
• The trust must ensure that all services for neonates, children and young people are responsive to their needs.
• Staffing levels must continue to be reviewed and acted on at all times of the day. The numbers of staff planned and actually on duty must be displayed at ward entrances in line with guidelines.
• Radiology services must be is fit for purpose, fulfilling reporting timescales, particularly for CT scans.
• Serious incidents must be understood and investigated promptly with lessons learned.

The reports highlight several areas of outstanding practice including:

• The hospital is a regional centre for upper gastrointestinal conditions. Outcomes for patients receiving oesophago-gastric cancer services were good.
• There were good outcomes for stroke patients and the stroke service demonstrated good teamwork.
• The development of the Elders Receiving Unit had improved frail, elderly patient care.
• The nurse-led oral chemotherapy service is the first in the country.

The three reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

On 30 June the Care Quality Commission 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.

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