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The Care Quality Commission checks whether hospitals, care homes and care services are meeting government standards. Visit our website at www.cqc.org.uk.

University College Hospital & Elizabeth Garrett Anderson Wing

  • 235 Euston Road, London, NW1 2BU

  • Read more information about this hospital...

Type of service
Hospital, Diagnostic and/or screening service, Hospice, Long-term conditions service, Mobile doctors service, Urgent care service

Specialisms/services
Assessment or medical treatment for persons detained under the Mental Health Act 1983, Diagnostic and/or screening services, Family Planning services, Management of supply of blood and blood derived products, Maternity and midwifery services, Services for everyone, Surgical procedures, Termination of pregnancy, Transport services, triage and medical advice provided remotely, Treatment of disease, disorder or injury

Local Authority Area
Camden

These checks were made using our new inspection model for NHS hospitals. If we are taking enforcement action, we highlight it below.
Click on each area to read a summary

Summary of inspection on 12-14 and 20-21 November 2013

University College London Hospital is an acute hospital run by the University College Hospitals NHS Foundation Trust. It is located in central London and provides acute and specialist services to the local populations of the London Boroughs of Camden, Islington, Barnet, Haringey and Westminster as well as patients from further afield. It has a total of 650 beds and serves a population of 1.3 million people. The hospital includes the Elizabeth Garrett Anderson (EGA) Maternity Wing, and Macmillan Cancer Centre.

The trust also provides specialist services at the Hospital for Tropical Diseases, the Royal National Throat, Nose and Ear Hospital, the National Hospital for Neurology and Neurosurgery, the Royal London Hospital for Integrated Medicine, the Heart Hospital and the Eastman Dental Hospital. It was one of the first to gain foundation trust status.

Our focus on this inspection was on University College London Hospital as part of our acute hospital inspection programme. We did not inspect the specialist services.

We chose to inspect University College London Hospital as one of the Chief Inspector of Hospital’s first new inspections because we were keen to visit a range of different types of hospital varying from those considered to be high risk of poor care to those where the risk of poor care was judged to be lower. University College Hospital was considered to be a low risk provider. It has been visited by CQC five times since it was registered in October 2010 and has always been assessed as meeting the standards of care set out in legislation.

Our inspection team included CQC managers, inspectors and analysts as well as doctors, nurses, allied health professionals, a pharmacist, senior midwife, patient representatives and people who have used services (Experts by Experience) as well as senior NHS managers. The team spent three days visiting the hospital and conducted further unannounced visits six and seven days afterwards. We held a public listening event in Camden and heard directly from 30 people about their experiences of care.

Our analysis of data from CQC’s ‘Intelligent Monitoring’ system before the visit indicated that the trust was operating safely and effectively across all services. The trust’s mortality rates were as expected or better than expected for a trust of its type and size.

We found that, generally, services were safe, effective, caring, responsive to patients’ needs and well-led. When we inspected we saw many examples of good care. We were impressed by the dedication of the doctors and nurses we saw and the level of support that they were given as well as the mutual respect shown within teams, leading to high levels of care. We were also impressed with the emphasis placed at all levels from the trust’s board and governors down to ward level on putting the needs of patients first.

The vast majority of patients we spoke to at University College Hospital were very positive about the care they received. Many members of staff told us that they felt well supported by senior clinical staff who responded quickly to requests for help. Staff told us they were proud to work at the trust and proud of the level of care they were able to deliver.

It has a stable and experienced board and the trust’s Governors act very much as patient champions, providing challenge. There is a clear governance structure based in clinical divisions but with a corporate overlay and this has resulted in high levels of care being developed and maintained.

We wish to emphasise here some of the many good aspects of care we saw being delivered at this hospital,including:

  • The commitment of staff in A&E to delivering good care.
  • In medical care, examples of excellent caring staff, well supported, with good care and positive interaction with patients.
  • In surgery examples of excellent care, support for patients’ needs and a strong consultant presence.
  • In intensive/critical care, examples of caring efficient staff showing good multi-disciplinary working with good clinical outcomes.
  • Maternity services that overall were safe, caring, effective, responsive and well–led.
  • In children’s care a strong collaborative style of working for the benefit of children, young people and their families.

We did however note areas of the hospital where staff were delivering care under pressure and where the environment was less good:

  • In A&E we found that staff, to their credit, were delivering safe care but in very difficult circumstances. The physical environment was inadequate. Due to shortage of space, facilities and equipment and patients’ privacy and dignity was severely compromised. We also found that the emphasis on receiving large numbers of patients through A&E instead of direct to an appropriate receiving clinical area was making the situation worse.In failing to address these issues we found trust leadership in A&E needed to be strengthened and improved. We believe the trust should take action to alleviate those pressures.
  • We found a risk of unsafe surgery as the World Health Organisation (WHO) surgical safety checklist was not always fully completed.
  • On medical wards, we were concerned about written nursing assessments, care plans and care delivery records being insufficiently completed. Although we saw no evidence of unsafe care being delivered, insufficient recording meant there was an increased risk of inappropriate or unsafe care or treatment.
  • The management of outpatient clinic was not adequate resulting in overcrowding and patients being left without seating in busy periods.
  • During our visit we became aware that the trust may not be recording its cases of hospital acquired infection in accordance with national guidelines. We raised this with the trust at our inspection. It is currently in discussion with Public Health England on this issue.
  • The trust was not ensuring that the paperwork for patients who had been assessed as not requiring resuscitation was always fully completed.
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    Background information for inspection on 12-14 and 20-21 November 2013

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    Inspection areas

    Summary of inspection on 12-14 and 20-21 November 2013

    Services were generally safe. Staff assessed patients’ needs and provided care to meet those needs. There were procedures in place to keep people safe, for example from preventable falls. Records were maintained to a good standard in most areas.

    However we found deficiencies in recording of assessments in medical care. We found that the physical environment and patient throughput in A&E presented the staff there with considerable pressure. We have questioned the trust’s method of recording cases of C. difficile infections.

    Patients were not always protected against the risk of unsafe surgery because the WHO Surgical checklist was not always fully completed.

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    Summary of inspection on 12-14 and 20-21 November 2013

    Services were effective and focused on the needs of the patients. The trust’s latest Hospital Episode Statistics showed better or much better than expected performance in 10 of the 20 diagnostic groups. Key targets were being met or exceeded, but in outpatients some of the targets within the 18 week waiting for treatment indicators were not being met.

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    Summary of inspection on 12-14 and 20-21 November 2013

    The overwhelming majority of people told us about their positive experiences of care. The trust scores highly in patient survey results including cancer care, but excluding issues around communication and information in relation to cancer. Overall, patients said they were satisfied with how they had been treated and those doctors, nurses and other staff were caring and professional. We observed many instances of good and in some cases outstanding care. Staff respected patients’ dignity and privacy.

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    Summary of inspection on 12-14 and 20-21 November 2013

    Services were generally responsive to patients’ needs and they were kept well informed. Overall patients were treated promptly. Complaints and concerns were handled appropriately. However, we found that the environment in A&E prevented all patients’ needs being met. There were positive comments from patients who had been on A&E, but these were tempered by the environment.

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    Summary of inspection on 12-14 and 20-21 November 2013

    The trust was generally well-led. We saw high levels of efficiency at all levels. The Board of Governors acted as patient champions and exerted a positive influence. Ward leadership ensured highly motivated staff performing well.

    However, we had concerns that the trust needed to re-examine and bring forward its priorities in relation to re-developing A&E, and children’s A&E. Operational and strategic leadership in emergency needs to be strengthened and improved.

    The trust also needs to improve its monitoring and timely achievement of improvements in response to actions and learning from serious incidents.

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    Checks on specific services

    Summary of inspection on 12-14 and 20-21 November 2013

    The physical environment of A&E was inadequate and not responsive to the needs of patients, and we had concerns that the current environment and layout could compromise patient safety and requires considerable improvement. The staff in the A&E were caring with patients and supportive of each other, and as a team, through their attitude and practice, they mitigated the impact of the inadequacy of the A&E on patient care. However, at times of intense pressure, we had concerns that staff were disempowered from being able to care for patients appropriately.

    We also had concerns about the effectiveness and leadership of the A&E, and the trust’s response to known risks and failures. This includes allowing the pressure on the A&E to increase through routing referred medical and surgical patients through the department.

    In the context of the trust, what we found and what staff told us it was felt that the A&E service was not a priority. It is clear that not all staff were aware of the focus of the board in this area.

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    Summary of inspection on 12-14 and 20-21 November 2013

    The acute medical wards we visited provided people with safe care. However, people’s written nursing assessments, care plans and care delivery records were consistently inadequate, which meant there was an increased risk of inappropriate care or treatment.

    We found the majority of systems and processes in place made sure that people received effective care, including a good level of information sharing among professionals.

    We found the quality of care provided was excellent, and people we spoke with were extremely complimentary about the compassionate care and treatment they received. However, patients’ notes were on occasions held in areas that were not secure or supervised to ensure patient confidentiality.

    The acute medical wards were responsive to people’s needs, including operating appropriate systems for triaging, and procedures were in place in the event of medical emergencies.

    We found wards were well-led by competent and approachable senior staff. There was evidence at ward level of learning from incidents to ensure current and future safe practice. However, we saw less evidence of trust-wide learning from trends of incidents at ward level.

    Senior staff had recognised the need the need to improve nursing records but we found improvements had not been implemented.

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    Summary of inspection on 12-14 and 20-21 November 2013

    Surgical patients and their visitors told us staff were caring and they felt their needs had been met. Overall they were very satisfied with the care and treatment they received. This was reflected in the positive patient satisfaction survey results that the surgical division continuously achieved.

    Patients’ needs were met and clinical management guidelines were used. There was a strong consultant presence in the surgical division and all staff worked together to provide the best outcome for patients.

    On the wards we found staff were responsive to patients’ needs and kept them involved in their care and treatment. However, we found that the recovery area for patients did not have the capacity to care for and treat the high volume of patients.

    Services appeared safe. However there was a risk of unsafe surgery as the WHO surgical safety checklist was not always completed. Staffing arrangements enabled safe practice and agency staff were rarely used.

    There was leadership at all levels of the division and staff felt well supported to carry out their roles. A clinical governance framework was in operation to monitor the quality of the service; however, we found that when areas of improvement were identified, action was not promptly taken.

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    Summary of inspection on 12-14 and 20-21 November 2013

    There were enough specialist staff to meet people’s needs and ensure they had appropriate 24-hour care and treatment. People received care and treatment according to national guidelines and admissions were prompt and appropriate. The critical care service performs better than most other similar units across the country with a lower than expected mortality rate. Quality and safety was the focus for the service which was reviewed daily as well as formally through the hospital’s clinical governance and performance monitoring frameworks.

    Patients and relatives reported a caring, supportive environment with information sharing and input from families and patients so that care was holistic. Patient feedback reflected this with 92% saying they would recommend to family and friends.

    Patients’ welfare was continuously monitored and reviewed. There were links with external services, such as The Intensive Care National Audit, to enable the service to benchmark its services. There were processes for audit and the service was involved in clinical research. We saw that there was good communication between the critical care unit (CCU), the rest of the hospital and other hospitals.

    The critical care service was well-led. One staff member told us “I like it here, I respect and admire colleagues”. Staff reported good training and support.

    The CCU did not have an on-site 24-hour cleaning service and this could lead to delays out of hours. Some moveable equipment was stored on a corridor with no process of stock control and re-cleaning before use.

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    Summary of inspection on 12-14 and 20-21 November 2013

    We found overall the maternity services were safe, caring, effective, responsive and well-led.

    Staff were caring, attentive and professional in their roles. The women felt confident with the care provided. The wards were clean and safe and had good security measures in place to protect women and their babies. Most of the women that we spoke to told us they had positive experiences with the maternity care and felt confidence in the staff that cared for them.

    Maternity services were being planned to meet the increasing demand by extending the number of beds and recruiting more staff.

    There was insufficient evidence that all staff learned from incidents and complaints. There was a maternal death in the last year and it was unclear that the lessons learned from the incident had been shared.

    Midwives were well supported. The ratio of supervisors of midwives to midwives was 1:16.

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    Summary of inspection on 12-14 and 20-21 November 2013

    There were sufficient skilled staff to meet patients’ needs and there was prompt recruitment to vacant posts. Neonatal services were working to develop the skills and knowledge of their nursing team in order to retain staff and enhance their service in the face of a national shortage of experienced neonatal nurses. Children’s services had systems in place to effectively monitor and improve patient safety.

    There was good communication for the benefit of children and young people between different parts of the trust’s children’s services, and also with other hospitals and services that some patients used.

    All the staff displayed a warm and caring attitude towards the patients and their families, as well as to each other. Staff spoke with children and young people using age-appropriate language and we saw how they tried to engage with the children while they were treating or monitoring them.

    Children and young people with complex needs received individualised care and treatment .The strong link between audit findings and education meant that training could be provided if issues were identified.

    Without exception, staff members spoke well of management within the Paediatrics Division. Charge nurses and ward sisters provided effective leadership and the senior management within children’s services was supportive. However, we found less evidence that the children and young people’s agenda was given priority within the trust as a whole.

    The services delivered to children did not include A&E. The A&E section focuses on this issue.

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    Summary of inspection on 12-14 and 20-21 November 2013

    We found that the trust was improving support for people at the end of their lives.

    The trust had recognised the need to increase the staffing levels in its palliative care team and was taking action to do this.

    The trust was no longer using the Liverpool Care Pathway. It had been recently replaced by an interim “Excellent care in the last days of life – Individualised care plan.”

    We found that staff were caring and responsive to patients’ needs. There was a good working relationship between the different support services that were available. We received positive feedback from relatives of patients.

    However, the trust was not ensuring that the paperwork for patients who had been assessed as not requiring resuscitation (do not attempt resuscitation or DNAR) was always fully completed. We found examples where there was no evidence recorded of discussions with the person or their family members and there was no consultant signature to indicate they had reviewed the order.

    We found that the trust was seeking to develop and improve its End of Life service. It had an End of Life Board to provide senior leadership in developing the service at the trust. A five-year strategy for End of Life is currently at draft stage.

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    Summary of inspection on 12-14 and 20-21 November 2013

    The physical environment in the main central outpatient department was not adequate. During busy periods clinics were at times overcrowded and patients were without seating.

    The trust’s overall targets for patient waiting times from referral to treatment had improved and staff across all levels of the trust had been responsive to improving performance. However, the administrative processes across the entire outpatient services were not streamlined and were therefore working variably across the different patient pathways. In addition the trust had breached four of the cancer waiting time targets in July 2013 for both admitted and non-admitted pathways.

    Patients we spoke with and patient satisfaction survey results rated the overall care they received as good. However ratings were lower when asked about the respect and dignity they sometimes received in the main central outpatient department and when asked about waiting times past their booked appointment times across all the outpatient services. In addition some patients said they had experienced difficulties in accessing appointments. Staff informed us that there was very limited access to psychology services across the outpatient services.

    There were arrangements to enable safe practice across the outpatient services. There were arrangements for staff to respond appropriately to foreseeable medical emergencies. The provider also has clear arrangements in place for infection control, the management of medicines, the reporting of incidents and escalating safeguarding concerns.

    The trust supported professional development for its staff. Staff received mandatory training and annual appraisals.

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    Latest Inspection

    The latest check of this hospital was carried out on 12-14 and 20-21 November 2013 using our new inspection model.

    application/pdf icon Quality report published 14 January 2014 695.66KB

    Inspection Reports

    Carried out on 18 July 2012 during a routine inspection
    Carried out on 21 March 2012 during a themed inspection
    Carried out on 27 July 2011 during a routine inspection
    Carried out on 27 July 2011 during a routine inspection
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    Carried out on 9 March 2011 during a themed inspection

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    All standards were being met when we inspected the service. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.
    At least one standard in this area was not being met when we inspected the service and we required improvements.
    At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.


    What does a grey cross mean

    At least one standard in this area was not being met when we inspected the service and we required improvements.

    What happens next
    The service will tell us how it is making improvements. Once we are happy that the improvements have been made, we will update our judgement to show a green tick. Other times, we may have to carry out a 'follow-up' inspection to check improvements.


    How can I get more information
    Our inspector's report will give you more information about why the service received a grey cross. You can also contact the service directly or visit its website for more details on any improvements it has made.



    What does a red cross mean

    At least one standard was not being met when we inspected the service and we took enforcement action.

    What happens next
    The type of enforcement action we take depends on the seriousness of our inspector's findings, and the service must make improvements before we update the judgement on our website.


    How can I get more information
    Our inspector's report will give you more information about why the service received a red cross. You can also contact the service directly or visit its website for more details on any improvements it has made.