Chief Inspector of Hospitals publishes his findings on Princess Royal University Hospital, Orpington

6 February 2014

England's Chief Inspector of Hospitals has published his first report on the quality of care provided at Princess Royal University Hospital, Orpington, Kent.

Princess Royal University Hospital was recently taken over by King’s College Hospital NHS Foundation Trust following the dissolution of South London Healthcare NHS Trust in October last year.

Overall, the report concludes the scale, number and longstanding nature of many of the problems that King’s College Hospital NHS Foundation Trust inherited at the Princess Royal University Hospital should not be underestimated, but that while the trust has already begun to tackle some of the challenges that it faces there is still more to do.

Read the full report on the Princess Royal University Hospital profile page.

Significant failings were identified in a number of areas, especially management of patient records. The lack of availability of medical records in the outpatients department meant that at times patients were undergoing complex medical procedures without clinicians having access to a complete set of notes.

Waiting times in the Accident and Emergency (A&E) department were far too long, and poor patient flow led to patients having elective surgery cancelled and difficulty in transferring patients from the critical care unit.

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

CQC has told the trust that it must take action to improve at Princess Royal University Hospital in a number of areas including:

• Urgently addressing long waiting times in the A&E department.
• Urgently addressing problems with access to and availability of medical records.
• Engaging with and supporting all senior medical staff.
• Embedding ownership for improvement at every level in the hospital.
• Addressing discharge planning and patient flow problems.
• Ensuring all action is taken to minimise the risk of elective surgery being cancelled, and improving capacity.
• Ensuring that documentation, including fluid balance charts, are accurately completed.
• Regularly reviewing decisions related to patients’ resuscitation status and accurately recording and sharing these with staff.
• Developing and embedding systems for monitoring performance, quality and safety of care at all levels in the hospital.
• Ensuring staff adhere to infection control policies and procedures.

CQC found good practice in the Critical Care Unit (CCU), where patient diaries were being used.

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts spent two days announced at the hospital during December. 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.

CQC’s Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: “The scale, number and longstanding nature of many of the problems that King’s College Hospital NHS Foundation Trust inherited at the Princess Royal University Hospital should not be underestimated. The Trust has told us that it is already aware of the issues and has developed action plans to begin to address them.

“We did find areas in which we thought the trust needed to take swift action to fix some of the problems, for example, improving the availability of medical records and waiting times in the A&E department. Since the inspection, the trust has taken some action and further action is planned. We will return in due course to check that this has been done.

“This is a hospital which has its problems, but my team were impressed by the motivation and morale of the staff they met. They are keen to engage with the improvement programme, and are to be commended for maintaining their commitment while working in difficult circumstances for a long period of time.”

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 Princess Royal 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.

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For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143. For general enquiries, call 03000 61 61 61.

Notes to editors

The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike is implementing his new approach to hospital inspection with 18 NHS trusts which represent variation of care across England. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model.

Whenever CQC inspects it 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?

This report describes our judgement of the overall quality of care provided by this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations.