Chief Inspector of Hospitals recommends that Barking, Havering and Redbridge University Hospitals NHS Trust is placed into special measures following in-depth inspection

18 December 2013

England's Chief Inspector of Hospitals, Professor Sir Mike Richards has recommended that Barking, Havering and Redbridge University Hospitals should be placed into special measures following his in-depth inspection of the trust in October. The Care Quality Commission (CQC) has published the report from that inspection this afternoon (18 December).

Overall, the report concludes that while there have been signs of sustained improvements in some areas, the long standing nature of CQC’s concerns suggests that the leadership of the trust needs support to tackle the scale of the problems it faces. While aware of many of the issues raised by CQC around patient safety and patient care, attempts to address these issues by the current leadership have had insufficient impact.

The trust had been included in the first wave of the new CQC inspection programme as it had been flagged as potentially high risk, and was one of the first to be inspected under radical changes introduced by the regulator earlier this year. The new approach is 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, visited the trust announced in October. It examined the care provided in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity services, children’s care, end of life care and outpatient services.

Inspectors also visited the hospital unannounced as part of the inspection, held focus groups with staff, and held a public listening event. The report 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.

Read the full report on the Barking, Havering and Redbridge University Hospitals NHS Trust page.

Individual reports on Queen’s Hospital and King George Hospital have also been published on the CQC website.

CQC has told the trust that it must take action to improve in the following areas:

• Resolving problems in the A&E departments of both hospitals which are resulting in unsafe care.
• Improving patient movement across both hospitals.
• Implementing infection control procedures consistently across the trust.
• Addressing discharge planning and patient flow problems, including better working within the wider health economy.
• Ensuring the Chief Operating Officer has appropriate management support to deliver improvements to patient safety and quality.
• Embedding ownership for improvement at every level of the Trust and improving the visibility of the Executive Team at Queen’s Hospital and King George Hospital.

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

• The e-handover system in the medical services which allows doctors to manage their workload more effectively.
• The virtual ward which was established in 2009 in the medical services. The ward allows patients to receive care at home and feedback from patients showed they valued the service.
• The inspection team was impressed with the care provided to patients who have had a stroke.
• Patients were positive about the care they received from staff, many of whom were positive about working for the Trust.

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: "This trust has demonstrated that it is capable of making significant changes to the quality of services. Maternity services have shown sustained improvement over time – and although the findings of last week’s maternity survey suggest there may still be more to do, there has been progress.

"It is very disappointing that this good work has not been replicated throughout the trust. The long-standing issues in the two A&E departments are clearly affecting patients – and all attempts to address these problems over the last few years have had insufficient impact.

"While we understand that this trust serves a large and diverse population, and that the leadership team is trying to resolve the issues, it’s clear to us the trust is unable to do so without help. That’s why I’ve recommended that the trust should be placed in special measures in order to give it the support it needs to tackle the issues it faces."

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?

Is it safe?

Many of the services at the trust are safe, but the A&E departments at both hospitals are at times unsafe because of the lack of full-time consultant and middle-grade doctors. There is an over-reliance on locum doctors with long waiting times for patients to be assessed to be assessed by specialist doctors.

Is it effective?

The trust had some arrangements in place to manage quality and ensure effective care, but more work is needed in medicine, children’s care, end of life care and outpatient services. Effective care in the A&E departments is hampered by long waiting times for patients to be seen by a specialist.

Is it caring?

Significant work has been undertaken to improve patient care and many patients and relatives were complimentary about their care. Inspectors observed that staff treated patients with dignity and respect. However, more work is required to ensure improvements are reflected in national patient surveys.

Is it responsive to people’s needs?

The longstanding problem of waiting times in the A&E department at Queen’s Hospital has not been addressed. Poor discharge planning and capacity planning is putting patients at risk of receiving unsafe care and causing unnecessary pressure in some departments.

Is it well-led?

Inspectors found examples of good clinical leadership at service level and staff were positive about their immediate line managers. The trust Executive Team needs to be more visible and greater focus is needed at Board level to resolve longstanding quality and patient safety issues.

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 was to develop a plan of action and recommendations based on the inspection team’s findings.

CQC inspectors will return in due course to follow up on the findings of this inspection.

ENDS

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 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 were the first hospitals to test the new inspection regime.