The Care Quality Commission
  • Hospital
  • NHS hospital

The Hillingdon Hospital

Overall: Inadequate read more about inspection ratings

Pield Heath Road, Uxbridge, Middlesex, UB8 3NN (01895) 238282

Provided and run by:
The Hillingdon Hospitals NHS Foundation Trust

All Inspections

08/08/2023

During an inspection looking at part of the service

Pages 1 to 3 of this report relate to the hospital and the ratings of that location, from page 4 the ratings and information relate to maternity services based at The Hillingdon Hospital.

We inspected the maternity service at The Hillingdon Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

The Hillingdon Hospital provides maternity services to the population of Hillingdon, Uxbridge, and surrounding areas.

Maternity services include an early pregnancy unit, maternal and fetal medicine, antenatal clinic, maternity day assessment unit, outpatient department, maternity assessment unit, antenatal ward (Katherine Ward), labour ward, midwifery led birthing centre (closed during our inspection), 2 maternity theatres, 2 postnatal wards (Alexandra Ward and Marina Ward), and an ultrasound department. Between April 2021 and March 2022 4,085 babies were born at The Hillingdon Hospital.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

Our rating for this hospital stayed the same. We rated it as inadequate.

Our rating of Requires Improvement for maternity services did not change ratings for the hospital overall. We rated safe as Requires Improvement and well-led as Requires Improvement.

How we carried out the inspection

We provided the service with 2 working days’ notice of our inspection.

We visited the maternity labour ward, triage service, the bereavement suite, theatres, and the antenatal and postnatal wards. We visited the 4-bedded midwifery led unit (MLU), but this was closed for births during the inspection.

We spoke with 12 midwives, 2 maternity support workers, 2 housekeepers, 4 women and birthing people and 2 birthing partners. We received 6 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 8 patient care records including observation and escalation charts and 8 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

01 November 2022

During an inspection looking at part of the service

We did not look at sufficient evidence to change the rating. Our rating of this location stayed the same.

This was a focused inspection it does not change the rating given at our previous comprehensive inspection in July 2018. Concerns raised by patients though our National Call Centre Service triggered an unannounced inspection to look at care of the elderly in medical wards at Hillingdon Hospital NHS Foundation Trust. In particular, safeguarding, environment and equipment, nursing staff, records, medicines, incidents, nutrition and hydration, pain relief, multidisciplinary working, compassionate care, understanding and involving patients and those close to them, complaints and culture. We found the following:

  • Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service kept good care records. They managed medicines well.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service made it easy for people to give feedback.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • The service did not always have enough staff to care for patients and keep them safe.
  • We observed telephone calls going unanswered.
  • Staff did not always adhere to the policy to keep medical records secure.
  • We saw no evidence of learned lessons learnt from incidents amongst front line staff outside the ward from where the incident occurred.
  • We were not assured how staff were able to communicate effectively with patients with confusion, learning difficulties or hearing impairments.

19 May 2021

During an inspection looking at part of the service

On 2 July 2020 a COVID-19 outbreak was declared by the Hillingdon Hospitals NHS Foundation Trust affecting staff in a single clinical area at Hillingdon Hospital, which resulted in a number of staff from that area and outside it having to self-isolate. On 30 June 2020, a staff study day had been held in the trust Education Centre lecture theatre which had been attended by some of the affected staff. Concerns were raised about alleged lack of social distancing maintained at this event both in the lecture theatre and adjacent social area where food was consumed during the lunch break. During the time of the outbreak Hillingdon Hospital was closed to emergency admissions with ambulances diverted to other NHS trusts in the sector. The trust re-opened to emergency admissions on 16 July 2020.

Following this incident, we undertook a focused inspection on 4 and 5 August 2020 at Hillingdon Hospital, specifically looking at infection prevention and control (IPC) generally and in relation to COVID-19. The inspection focused on the safe and well-led domains in the following areas: urgent and emergency care; Bevan Ward and the acute medical unit.

We visited the Education Centre on site at Hillingdon Hospital following the recent study day held there which had resulted in a number of staff self-isolating. We also viewed the hospital’s arrangements to ensure social distancing in relation to general areas of the hospital.

Following this inspection, we took immediate action and issued the trust with a Notice of Decision to impose conditions to their registration under Section 31 of the Health and Social Care Act 2008 requiring the trust to provide us with assurances to implement an effective system to assess, monitor, identify, mitigate and manage any risks relating to the health and safety of people using the service, staff and others. We inspected the trust again on 29 and 30 September 2020 to follow up on the issues we had identified in the August inspection.

As a further follow up we visited the Education Centre, emergency department and medical wards again on 19 and 20 May 2021 to assess the trust’s progress against the warning notice issued to them after the September 2020 inspection.

At our inspection of 4 and 5 August, we observed that it was difficult for staff and patients to maintain adequate social distancing in the general areas, entrances and corridors of the hospital. At the September inspection we noted that the trust had installed a two-way system for staff and patients to follow throughout the common areas and corridors of the trust. This was clearly marked using lines and markings on the floor. We noted at our latest inspection that this system remained in place and was being followed by staff and visitors. We also noted additional stations where staff and visitors were monitored for wearing masks and also changing masks when moving between different areas of the hospital.

During the August inspection, two retail outlets were open directly opposite each other in a narrow corridor leading to and from the main entrance of the hospital. This posed a risk of cross-infection as people would not be able to maintain social distancing. In response to our concerns, the trust had immediately closed the second outlet. During the September inspection there was only one retail outlet open. This remained the case in our latest inspection.

During our August inspection, there were no signs in lifts indicating the maximum number of persons allowed due to COVID-19. On our inspection on 29 September and again on an inspection of 19 and 20 May these signs were in place.

During the August inspection, there was a general lack of signage referring to COVID-19 awareness in the areas that we visited and in the corridors. During the September inspection, we noted an increase in COVID-19 awareness signs. At our latest inspection of inspection of 19 and 20 May we were aware of more prominent signage in relation to COVID-19 throughout the hospital. However, there was still room for improvement on medical wards.

During our August inspection, we saw patients congregating in the main hospital entrance area from their wards without adequate social distancing and inadequate policing. We saw patients standing in the corridor outside the urgent treatment centre, waiting to be assessed, and not social distancing. There was no challenge from staff or signage to maintain social distancing. During our September inspection, we did not see patients congregating as before and we observed staff to be vigilant in policing this. This remained the case at our latest inspection in May 2021, and patients were checked by staff to ensure that patients maintained social distancing.

Because the Education Centre and general areas did not fall under either the urgent and emergency care or medical departments, we have included our continued observations over three inspections in relation to them here.

At around the time of the outbreak a study day had taken place in the main lecture theatre of the Education Centre. The seating capacity of the lecture theatre was one hundred people in a tiered cinema formation. The room was accessed at the back, with a double fire exit at the front of the room. Also, on the ground floor of the Education Centre was a library, a small reception area and associated administrative offices and a seating area with a small kitchen. Upstairs there were two seminar/ training rooms of a small to medium size, used for small groups. There was also a clinical skills laboratory on the first floor.

During our August 2020 inspection, we learned that the Education Centre could be booked by a wide variety of staff members for various functions both educational, for example study days; and social, for example retirement celebrations. When we checked again during our September inspection, the Education Centre bookings had been limited to education events only.

At our latest inspection on 19 and 20 May we found that the same strict limitation to education only events had been maintained. In the intervening months the previous social area adjacent to the lecture theatre had been converted into a COVID-19 vaccination centre for trust staff with facilities also to vaccinate other non-trust public sector workers, such as the police. It was not a vaccination centre open to the public. The lecture theatre had been used as a socially distanced post vaccination recovery area. A timed video was used for those vaccinated to watch and to then know when their safe recovery time was completed, and they were free to leave the recovery area.

Previously there had been no prior policing or checking of the nature of bookings. Different members of Education Centre staff took bookings according to the groups of people wishing to book. During our September inspection, we found that there was a single booking system.

We also found during our September inspection, that there was only one permitted access to the Education Centre where previously there had been several access points. Access was supervised by one member of staff who ensured that all visitors signed in clearly indicating the event or room booked and also ensured hand sanitisation.

At our unannounced latest inspection on 19 and 20 May we found that the same diligence was being applied to controlling the access of people into the education centre and there was a strict rule of no food being allowed to be consumed on the premises except by education centre staff.

At the beginning of each lecture a member of education centre staff continued to explain as before the latest COVID-19 regulations as they applied to the facility. Members of education centre staff were encouraged to challenge anyone they could not account for, or who was not following, the wearing of masks or not adhering to other COVID-19 precautions.

The receptionist also checked rooms, library and lecture theatre for cleanliness and ensured surfaces were wiped clean following use, conducting a daily audit of rooms. There were wipes available in all of the education centre rooms. We noted that staff were able to use the library with socially distanced seating and tables.

During the August 2020 inspection, we were informed that food had been consumed on the study day. However, during the September 2020 inspection, we were informed that this practice had now stopped. An exception to this was made for education staff who had their own kitchen and were able to prepare and eat food within those confines. At our May 2020 inspection we noted that these restrictions on the consumption of food were still being rigorously applied.

We noted an improvement over time in relation to risk and the wearing of personal protective equipment (PPE) face masks within the Education Centre. During the August 2020 inspection, we noted that there was a risk assessment for every room in the Education Centre. During the September 2020 inspection, we observed all staff and visitors to the Education Centre were wearing face masks and observing social distancing. In our latest inspection on 19 and 20 May we noted that all staff and visitors were wearing face masks and a more sophisticated electronic risk assessment process was in place whereby a risk assessment had to be completed and approved before any meeting could go ahead in the education centre.

Following the September inspection, we took regulatory enforcement action as a result of our findings in emergency care and in medical care services. We issued a Warning Notice under section 29A of the Health and Social Care Act 2008.This means that we asked the trust to make significant improvements in the quality of healthcare it provides. In the intervening period between the September 2020 inspection and the latest inspection of 19 and 20 May the trust provided us with regular updates on their progress and improvement in the areas of infection prevention and control as requested by CQC.

We did not rate this service at this inspection.

See the Urgent and emergency care and Medical Care sections for what we found in those departments at Hillingdon Hospital.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

29 Sep to 30 Sep 2020

During an inspection looking at part of the service

Hillingdon Hospitals NHS Foundation Trust provides services from both Hillingdon Hospital and Mount Vernon Hospital. The trust has a turnover of around £222 million and employs over 3,300 staff. They deliver healthcare to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire, giving them a total catchment population of over 350,000 people.

Hillingdon Hospital is an acute and specialist services provider in North West London, close to Heathrow Airport for which it is the nearest hospital for those receiving emergency treatment. Providing the majority of services from the trust, Hillingdon Hospital is the only acute hospital in Hillingdon with a busy Accident and Emergency, inpatients, day surgery, and outpatient clinics. The trust also provides some services at Mount Vernon Hospital, in co-operation with a neighbouring NHS Trust.

The trust has 443 beds including:

• 265 medical care beds; -

• 67 surgery beds (including gynaecology beds ); -

• 62 maternity beds;

• 22 paediatric beds;

• 18 neonate beds;

• and 9 ITU beds

On 2 July 2020 a COVID-19 outbreak was declared by the Hillingdon Hospitals NHS Foundation Trust affecting staff in a single clinical area at Hillingdon Hospital, which resulted in a number of staff from that area and outside it having to self-isolate. On 30 June 2020, a staff study day had been held in the trust Education Centre lecture theatre which had been attended by some of the affected staff. Concerns were raised about alleged lack of social distancing maintained at this event both in the lecture theatre and adjacent social area where food was consumed during the lunch break. During the time of the outbreak Hillingdon Hospital was closed to emergency admissions with ambulances diverted to other NHS trusts in the sector. The trust re-opened to emergency admissions on 16 July 2020.

Following this incident, we undertook a focused inspection on 4 and 5 August 2020 at Hillingdon Hospital, specifically looking at infection prevention and control (IPC) generally and in relation to COVID-19. The inspection focused on the safe and well-led domains in the following areas: urgent and emergency care; Bevan Ward and the acute medical unit.

We visited the Education Centre on site at Hillingdon Hospital following the recent study day held there which had resulted in a number of staff self-isolating. We also viewed the hospital’s arrangements to ensure social distancing in relation to general areas of the hospital.

Following this inspection, we took immediate action and issued the trust with a Notice of Decision under Section 31 of the Health and Social Care Act 2008 requiring the trust to provide us with assurances to implement an effective system to assess, monitor, identify, mitigate and manage any risks relating to the health and safety of people using the service, staff and others.

We inspected the trust again on 29 and 30 September 2020 to follow up on the issues we had identified in the August inspection.

At our inspection of 4 and 5 August, we observed that it was difficult for staff and patients to maintain adequate social distancing in the general areas, entrances and corridors of the hospital. At the September inspection we noted that the trust had installed a two-way system for staff and patients to follow throughout the common areas and corridors of the trust. This was clearly marked using lines and markings on the floor.

During the August inspection, two retail outlets were open directly opposite each other in a narrow corridor leading to and from the main entrance of the hospital. This posed a risk of cross-infection as people would not be able to maintain social distancing. In response to our concerns, the trust had immediately closed the second outlet. During the September inspection there was only one retail outlet open.

During our August inspection, there were no signs in lifts (patient or staff) indicating the maximum number of persons allowed due to COVID-19. On our inspection on 29 September these signs were in place.

During the August inspection, there was a general lack of signage referring to COVID-19 awareness in the areas that we visited and in the corridors. During the September inspection, we noted an increase in COVID-19 awareness signs.

During our August inspection, we saw patients congregating in the main hospital entrance area from their wards without adequate social distancing and inadequate policing. We saw patients standing in the corridor outside the urgent treatment centre, waiting to be assessed, and not social distancing. There was no challenge from staff or signage to maintain social distancing. During our September inspection, we did not see patients congregating as before and we observed staff to be vigilant in policing this.

Because the Education Centre and general areas did not fall under either the urgent and emergency care or medical departments we have included our observations in relation to them here.

At around the time of the outbreak a study day had taken place in the main lecture theatre of the Education Centre. The seating capacity of the lecture theatre was one hundred people in a tiered cinema formation. The room was accessed at the back, with a double fire exit at the front of the room. Also, on the ground floor of the Education Centre was a library, a small reception area and associated administrative offices, and a seating area with a small kitchen. Upstairs there were two seminar/ training rooms of a small to medium size, used for small groups. There was also a clinical skills laboratory on the first floor.

During our August inspection, we learned that the Education Centre could be booked by a wide variety of staff members for various functions both educational, for example study days; and social, for example retirement celebrations. When we checked again during our September inspection, the Education Centre bookings had been limited to education events only.

Previously there had been no prior policing or checking of the nature of bookings. Different members of Education Centre staff took bookings according to the groups of people wishing to book. During our September inspection, we found that there was a single booking system.

We also found during our September inspection, that there was only one permitted access to the Education Centre where previously there had been several access points. Access was supervised by one member of staff who ensured that all visitors signed in clearly indicating the event or room booked, and also ensured hand sanitisation. However, we noted that while people were requested to sign in, there was no signing out procedure. We were told that people were counted in and out but this depended on individual memory. In the event of a fire or other emergency, staff, we felt, would not be able confirm by record to the emergency services who was still in or out of the building.

The trust subsequently explained to us that there was a sign-in request at the entrance to the Education Centre which was solely for the purpose of identifying who makes use of the Education Centre each day. This enabled a COVID-19 track/trace facility should there be any need to follow up members of staff who have used the centre. The sign-in and sign-out sheets were not used to establish who was in the building at a given time which was in line with trust and national fire safety guidance (HTM-05) and the Regulatory Reform (Fire Safety) Order 2005 whereby sweep and search is the preferred recommended method to establish that the building is empty. However, the trust recognised that this process was not clearly understood by senior managers and some front line staff and the trust was addressing this concern by potential additional and frequent training to staff.

At the beginning of each lecture a member of education centre staff now explained the latest COVID-19 regulations as they applied to the facility. Members of education centre staff were encouraged to challenge anyone they could not account for or who was not following the wearing of masks or not adhering to other COVID-19 precautions.

The receptionist also checked rooms and lecture theatre for cleanliness and ensured surfaces were wiped clean following use, conducting a daily audit of rooms. There were wipes available in all of the education centre rooms.

The study day which had occurred at the time of the original outbreak had in excess of 40 people attending. Now the maximum number of people allowed to attend was eight. We saw the lecture theatre clearly showing seats cordoned off. We observed a lecture in progress and this was being conducted with social distancing and also via electronic video. During the August inspection, we were informed that food had been consumed on the study day. However, during the September inspection, we were informed that this practice had now stopped. An exception to this was made for education staff who had their own kitchen and were able to prepare and eat food within those confines.

During the August inspection. we noted that there had been several risk assessments undertaken for the Education Centre, finally arriving at a maximum of eight occupancy in the lecture theatre. During the September inspection, we noted that there was a risk assessment for every room in the Education Centre.

During the September inspection, we observed all staff and visitors to the Education Centre were wearing face masks and observing social distancing.

Following the September inspection, we took regulatory enforcement action as a result of our findings in emergency care and in medical care services. We issued a Warning Notice under section 29A of the Health and Social Care Act 2008. This means that we asked the trust to make significant improvements in the quality of healthcare it provides.

For more information, see the ‘Areas for Improvement’ sections of this report.

04 August to 05 August 2020

During an inspection looking at part of the service

Hillingdon Hospitals NHS Foundation Trust provides services from both Hillingdon Hospital and Mount Vernon Hospital.

The trust has a turnover of around £222 million and employs over 3,300 staff. They deliver healthcare to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire, giving them a total catchment population of over 350,000 people.

Hillingdon Hospital is an acute and specialist services provider in North West London, close to Heathrow Airport for which it is the nearest hospital for those receiving emergency treatment. Providing the majority of services from the trust, Hillingdon Hospital is the only acute hospital in Hillingdon with a busy Accident and Emergency, inpatients, day surgery, and outpatient clinics. The trust also provides some services at Mount Vernon Hospital, in co-operation with a neighbouring NHS Trust.

The trust has 452 beds including:

• 275 medical care beds;

• 66 surgery beds (including gynaecology beds );

• 62 maternity beds;

• 22 paediatric beds;

• 18 neonate beds;

• and 9 ITU beds

On 2 July 2020 a COVID-19 outbreak was declared by the Hillingdon Hospitals NHS Foundation Trust affecting staff in a single clinical area at Hillingdon Hospital, which resulted in a number of staff from that area and outside it having to self-isolate. On 30 June 2020, a staff study day had been held in the trust Education Centre lecture theatre which had been attended by some of the affected staff. Concerns were raised about alleged lack of social distancing maintained at this event both in the lecture theatre and adjacent social area where food was consumed during the lunch break. During the time of the outbreak Hillingdon Hospital was closed to emergency admissions with ambulances diverted to other NHS trusts in the sector. The trust re-opened to emergency admissions on 16 July 2020.

Following this incident, we undertook a focused inspection on 4/5 August 2020 at Hillingdon Hospital, specifically looking at infection prevention and control (IPC) generally and in relation to COVID-19. The inspection focused on the safe and well-led domains in the following areas: urgent and emergency care; Bevan Ward and the acute medical unit. We visited the Education Centre on site at Hillingdon Hospital following the recent study day held there which had resulted in a number of staff self-isolating. We also viewed the hospital’s arrangements to ensure social distancing in relation to general areas of the hospital.

Following this inspection, we took immediate action and issued the trust with a Notice of Decision under Section 31 of the Health and Social Care Act 2008 requiring the trust to provide us with assurances to implement an effective system to assess, monitor, identify, mitigate and manage any risks relating to the health and safety of people using the service, staff and others.

Because the Education Centre and general areas did not fall under either the urgent and emergency care or medical departments we have included our observations in relation to them here.

We observed that it was difficult for staff and patients to maintain adequate social distancing in the general areas, entrances and corridors of the hospital. On the day of inspection, two retail outlets were open directly opposite each other in a narrow corridor leading to and from the main entrance of the hospital. This posed a risk of cross-infection as people would not be able to maintain social distancing. When we raised this with the trust, we were told that one of the two retail outlets had only opened on 4 August and was closed later on the same day.

We found that a two-way system of entrance and exit at the main entrance was in operation. This prevented adequate social distancing due to the narrow corridor.

There were no signs in lifts (patient or staff) indicating the maximum number of persons allowed due to COVID-19 precautions and to maintain social distancing.

There was a general lack of signage referring to COVID-19 awareness in the areas that we visited and in the corridors.

We saw in-patients congregating in the main hospital entrance area from their wards without adequate social distancing and inadequate policing. We saw patients standing in the corridor outside the urgent treatment centre, waiting to be assessed, and not social distancing. There was no challenge from staff or signage to maintain social distancing.

At around the time of the outbreak a study day had taken place in the main lecture theatre of the Education Centre. The seating capacity of the lecture theatre was one hundred people in a tiered cinema formation. The room was accessed at the back, with a double fire exit at the front of the room. Also, on the ground floor of the Education Centre was a small reception area and associated administrative offices, and a seating area with a small kitchen. Upstairs there were two seminar/ training rooms of a small to medium size, used for small groups. There was also a clinical skills laboratory on the first floor.

The Education Centre could be booked by a wide variety of staff members for various functions both educational, for example study days; and social, for example retirement celebrations. We checked and there was no prior policing or checking of the nature of bookings. Different members of Education Centre staff took bookings according to the groups of people wishing to book. Bookings for nursing staff, for example, were handled by a different section to the one handling bookings for medical staff. Staff in the Education Centre appeared to work largely in isolation, referring to different parts of the organisation for different issues such as estates matters.

Senior staff within the trust told us that they did not have prior knowledge of the study day involved in the outbreak/staff self-solation. During our inspection we learned that study days and other events had taken place regularly during the height of the COVID-19 lockdown period. We saw the calendar showing Education Centre bookings which confirmed this. We were shown and took possession of a copy of the attendance sheet for the study day in question. There were 56 names on the attendance sheet including 12 which had been added outside of the attendance grid and three names added on a yellow post-it note. These included one duplicate name leaving 55 remaining names. The trust subsequently told us after the inspection that of these, five staff that were acting as faculty and were present at different times during the day, two staff were the Medical Education Centre staff who did not participate in the study day and one member of staff who was supporting the refreshments. The trust told us that there were 40 staff who did attend all or part of the study day and seven staff members who had not signed in and did not attend the study day. However, none of this detail was apparent on the attendance sheet which showed names only and did not state assigned duties for the day; departments, or full or part time attendance.

Study days did not normally offer food to participants but on the day in question a donation of food had been given. This involved food contained in separate paper bags handed out to staff with cups of tea or other liquid refreshment provided. Staff were able either to sit in easy chairs in the social area or stand or go outside, as on the day in question the weather was warm and sunny. We verified that there was no checking of social distancing by Education Centre staff during the event and this was also not routinely checked at any event.

We asked what risk assessments had been undertaken to ascertain the safe levels of occupancy particularly in the lecture theatre. Different occupancy levels had been determined by different risk assessments. The trust provided the risk assessment for Medical Education Centre that was carried out on 11 June 2020. This included risk assessments for the lecture theatre and seminar rooms. The risk assessment for the lecture theatre allowed a capacity of 25 people unless wearing masks but allowed 50 people if all were wearing masks. The risk assessment for the Medical Education Centre was revised on 11 August, following our inspection. The revised risk assessment limited lecture theatre occupancy to 8 people including faculty and delegates with masks worn at all times.

On the day of our visit the lecture theatre was empty. We observed a small number of people in the upstairs seminar rooms social distancing and wearing face masks.

6 March 2018

During a routine inspection

Our rating of services went down. We rated them as inadequate because:

  • There was a deterioration in infection prevention and control since the time of the last inspection. We found inconsistencies in hand hygiene practice amongst staff, during ward rounds.
  • Medicines were not always appropriately stored or checked in emergency department (ED).
  • There was poor recognition of sepsis.
  • There had been an improvement in safe levels of staffing although the trust needed to continue to work to increase substantive staff in post and reduce reliance on temporary staffing. Some services within the trust did not have enough permanent nursing and medical staff to ensure the provision of safe care and treatment. However, they used bank and agency staff to cover gaps in the staff provision.
  • We found out of date copies of the major incident plan on some wards and this was against the trust’s own policy.
  • The trust had not improved in relation to the testing of portable electrical equipment. We found that not all portable appliances had been tested.
  • We were not assured that high-risk patient groups were screened for MRSA at pre-admission.
  • Staff did not always maintain appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care.
  • We were not assured that the laser service met the Medicines and Healthcare Products Regulatory Agency safety standards.
  • There was low participation in clinical audits and the trust performed poorly in some.
  • Appraisal rates were low in some areas.
  • Staff did not always understand their roles and responsibilities in relation to the Mental Capacity Act 2005, in particular in relation to Deprivation of Liberty Safeguards (DoLS).
  • The trust did not audit the World Health Organisation (WHO) five steps to safer surgery in 2017.
  • There were no pre-operative fasting audits for patients fasting before surgery.
  • The trust did not always actively monitor the effectiveness of care and treatment and use this information to improve services.
  • The trust did not meet the target to admit, discharge, or transfer and did not meet the standard that patients should wait no more than one hour for initial treatment.
  • The A&E waiting area for patients who attended by their own means was very crowded with insufficient seating.
  • We found that staff had poor awareness of the needs of people with learning disabilities.
  • Translation services were not always offered to patients.
  • The trust provided a range of information leaflets including support groups. However, similarly to the last inspection we did not see any information printed in any other language.
  • Spaces within the were surgery division was not suitable for inpatients due to the lack of essential equipment and washing facilities.
  • The trust’s investigation and closure of complaints was not in line with their complaints policy which states complaints should be completed in 30 days.
  • Since the last inspection, there had been limited improvement in the facilities on the ITU for relatives and visitors.
  • There were limited examples of departments supporting patients to manage their own health.
  • The bereavement service had limited opening hours and inappropriate waiting areas for bereaved family members
  • There was a large backlog of estates maintenance.
  • Local risk registers did not always reflect risks described by staff in some areas.
  • Matrons and managers within the trust did not have the capacity to effectively lead their teams due to pressures faced operationally.
  • The senior management team had not taken note of all of the concerns raised at the previous inspection.
  • We found that divisional and executive team were not visible in some areas and rarely some visited departments.
  • Staff struggled to locate clinical guidelines quickly as the trust intranet search engine was not user friendly.
  • The department had managers with the right skills to run the service; however senior nurses felt that their managerial duties were at times excessive of their role.
  • We were not assured that there were adequate governance procedures for the laser service as set by the Medicines and Healthcare Products Regulatory Agency safety standards.

5 and 7 May 2015

During an inspection looking at part of the service

When we inspected in October 2014, we told that the trust that it must make improvements, which included:

  • Make sure it complies with infection prevention and control standards and monitors cleanliness against national standards.
  • Assure itself that the ventilation of all theatres meets required standards.
  • Make sure that staff are appropriately trained in safeguarding both adults and children, and that the trust regularly monitors and assesses the completion of actions agreed at weekly ‘safety net’ meetings.
  • Make sure that all staff understand their responsibilities in relation to the trust’s systems and processes that exist to safeguard children.
  • Make sure patients and visitors are protected against the risks associated with unsafe or unsuitable premises.
  • Make sure that there equipment is properly maintained and suitable for its purpose.
  • Make sure that equipment is available in sufficient quantities in order to ensure the safety of patients and to meet their assessed needs.
  • Make sure that all staff receive the full suite of mandatory training that is required to minimise risks to patient safety.
  • Make sure patients are protected against the risks associated with the unsafe use and management of medicines.
  • Make sure that early warning system documentation is appropriately maintained and that all staff react appropriately to triggers and prompts.

Our key findings from this inspection were as follows:

  • The inspection took place approximately three months after we published our comprehensive inspection report in February 2015. We found that the trust had responded appropriately to many of the key issues we highlighted at that time. In some areas however, custom and practice had not changed, despite systems and processes being implemented to deliver changes in practice.
  • We observed improved practice in some areas in relation to hand hygiene and the use of personal protective equipment, however, some staff in A&E and on medical wards were not following best practice.
  • We observed improved practice in the management of medicines in most departments. Where there were known issues plans were in place and steps had been taken to begin to address these issues and mitigate the risks. However, we found best practice was not always followed by all staff, with daily checks occasionally not happening as necessary and some areas left unsecured.
  • It was evident that the trust had taken significant action to address estates deficiencies highlighted by the previous inspection. The trust had restructured its estates function, provided the capital works to the operating theatres and had moved to a less reactive, more planned maintenance service.
  • The comprehensive work programme for theatres was on going at the time of our visit. The works to the operating theatres, both to date and planned, and the commitment to annual maintenance were in line with the Health Technical Memorandum (HTM) 03-01.
  • The trust had implemented a new estates compliance reporting process to provide the organisation with a collective understanding of its risks and level of compliance against best practice and legal requirements.
  • The trust was cleaning and auditing in line with the National Specifications for Cleanliness in the NHS.
  • Children presenting to the trust's A&E were appropriately safeguarded as effective systems and processes were in place. Staff received appropriate training which had increased their awareness and key staff were deployed to oversee practice and promote good practice.
  • Equipment was clean and staff had enough equipment to meet patient needs. Further supplies could be accessed in a timely way when required.
  • Mandatory training figures had improved, the divisions we reviewed having made sure the targeted number of staff received mandatory training, including for infection prevention and control and safeguarding.
  • Early warning score documentation was completed accurately and staff responded correctly to triggers and prompts as required.

Areas for improvement:

The provider should consider the concerns of the staff on children's wards about whether locks could hamper access in an emergency.

Professor Sir Mike Richards

Chief Inspector of Hospitals

 

1,2,3, 15 and 16 October 2014

During a routine inspection

We carried out this inspection as part of our comprehensive inspection programme of all NHS acute providers.

Overall, this hospital was rated as requires improvement and we found that each of the eight core services we inspected at Hillingdon Hospital require improvement.

Our key findings were as follows:

  • So far this year (2014/15), 87% of attendances in the trust’s accident and emergency department had been admitted, transferred or discharged within four hours, against a national target of 95% of attendances.
  • The trust had a very committed workforce, but there was a significant shortage of nursing staff which was compounded by additional wards being open.
  • The trust was not complying with infection prevention and control standards.
  • The trust performed better than expected in the number of patients acquiring clostridium difficile, however, they performed worse than expected for patients acquiring MRSA bacteraemia.
  • Staff records regarding training showed poor performance in key areas such as infection prevention and control, safeguarding and moving and handling.
  • The trust is failing to effectively assess and monitor the quality of care it provides.
  • There were many areas where the trust was aware of the challenges and risks and had logged these risks on local and corporate risk registers, however, there were often no plans or measures for implementation for when the risks were going to be addressed or when changes had been made, including:
  • The risk that child protection issues could be missed due to a failure to follow agreed processes had been identified, but not addressed;
  • The risk of admitting children with high dependencies to wards that aren’t appropriately staffed to meet their needs, has been on a risk register for over a year without being appropriately addressed; and
  • There were risks identified with the management of the storage of anaesthetic drugs where changes had been implemented, but were not sufficient to manage the risks.

We saw several areas of good practice including:

  • The effective management of 18 week referral to treatment times for patients.
  • The specialist care for children with diabetes, specifically the outreach work into schools.
  • A maternity triage care bundle to promote consistency of care provided for women.
  • Announced and unannounced “skills drills” training to rehearse obstetric emergencies.
  • Trainee doctors commented very positively on the support and mentorship they received while working at the trust.
  • Good multidisciplinary team working to support one stop outpatient clinics.
  • The critical care unit had a physiotherapy presence seven days a week, and undertook ward rounds each day, as well as being available on call.
  • The trust had a proactive specialist nurse for organ donation.

However, there were also areas of poor practice where the trust needs to make improvements:

The trust MUST

  • Make sure it complies with infection prevention and control standards and that it monitors cleanliness against national standards.
  • Assure itself that the ventilation of all theatres meets required standards.
  • Manage the risks associated with the numerous staffing establishment shortages across the trust.
  • Make sure that staff are appropriately trained in safeguarding both adults and children, and that the trust regularly monitors and assesses the completion of actions agreed at weekly ‘safety net’ meetings.
  • Make sure that all staff understand their responsibilities in relation to the trust’s systems and processes that exist to safeguard children.
  • Make sure staff are trained and understand their responsibilities in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.
  • Make sure that the use of keypads on wards does not unlawfully restrict patients’ liberty.
  • Make sure that all staff receive the full suite of mandatory training that is required to ensure patient safety.
  • Make sure that there are adequate numbers of paediatric staff trained in Advanced Paediatric Life Support as per the Royal College of Nursing’s recommended standard.
  • Make sure of the effective operation of systems to enable the trust to identify, assess and manage risks relating to the health, welfare and safety of patients.
  • Make sure that local leaders are held accountable if they do not routinely and accurately complete required audits.
  • Make sure that trust premises are secure and that maternity and children’s areas and wards cannot be accessed by the public without staff knowledge and appropriate challenge when necessary.
  • Make sure patients are protected against the risks associated with the unsafe use and management of medicines.
  • Make sure patients and visitors are protected against the risks associated with unsafe or unsuitable premises.
  • Make sure that equipment is properly maintained and suitable for its purpose and that out of date single use equipment is disposed of appropriately.
  • Make sure that equipment is available in sufficient quantities in order to ensure the safety of patients and to meet their assessed needs.
  • Make sure that records are accurately and appropriately maintained, are kept securely and can be located promptly when required.
  • Make sure that early warning system documentation is appropriately maintained and that all staff react appropriately to triggers and prompts.

The trust should:

  • Review the process for admitting patients to wards from the accident and emergency department to make sure the process is effectively managed and that unnecessary delays in transferring patients are not occurring.
  • Review the resourcing of medical secretaries to make sure they can meet patient need and the trust’s own targets for sending GP letters.
  • Ensure there is a fixed rota for consultant cover out-of-hours for the critical care unit.
  • Consider providing support from a Practice Nurse Educator for critical care nursing staff.
  • Consider contributing to ICNARC data collection.
  • Confirm the trust’s permanent bed capacity and an accurate base staffing establishment figure the trust projects it needs to deliver safe and effective care for this number of beds.
  • Engage with local end of life care leadership to establish the trust’s strategy for the service.
  • Make sure that appropriate translation services are available and are being utilised to meet patient need.

Professor Sir Mike Richards

Chief Inspector of Hospitals

4, 5, 7 October 2013

During a routine inspection

We inspected Hillingdon Hospital over three days, including visits to the Accident and Emergency (A&E) department from 6.30pm ' 11pm on a Friday and other wards and departments on a Saturday and Monday. We were accompanied by specialist advisors for maternity and elderly care services and a Care Quality Commission expert by experience.

We visited at least twelve wards and departments, including the A&E areas for children and adults, maternity services, wards for elderly people and other surgical / medical wards. We followed the patient pathway from A&E to the wards. We spoke with people using the service, families or carers and staff in every area we visited. We also spoke with senior management staff including the Chief Executive, a Medical Director, the Director of Patient Experience and Nursing and the Assistant Director for Corporate Governance.

Overall, we found that staff were open and friendly and good leadership was provided on the wards and departments we visited. Staff told us they were happy to work at the hospital and wanted to tell us about the work they did and how they tried to improve the experiences of people using the service.

Most people told us they had experienced good care and treatment in the hospital. They said they had been treated with dignity and respect and were complimentary about staff. Most people told us the nurses, doctors and other healthcare professionals provided them with enough information and involved them or their relatives in making decisions about their care and treatment.

Whilst most people were satisfied with their care and treatment, many were concerned that there were not always sufficient numbers of staff on duty to meet their needs. This was confirmed by staff we spoke with and the records we checked. People were therefore faced with increased risks of receiving unsafe and inappropriate care and treatment.

The hospital occupied premises that were relatively old. However, a lack of maintenance meant that the hospital did not always provide a safe and comfortable environment for people.

There were many areas in the hospital that were clean and we observed many good practices in relation to infection control. However, we also noted some shortfalls in regards to cleanliness and infection control which could be putting people at risk from the spread of infection.

The trust had systems and processes in place to monitor the quality of the service people received. Where areas for improvement were identified appropriate action plans were drawn up, implemented and monitored to ensure better outcomes for people who use the service.

5 December 2012

During a routine inspection

During our inspection of Hillingdon Hospital we visited the accident and emergency department, the maternity unit, care of older people wards, the stroke unit, children's in patient wards and other in patient wards.

Patients confirmed staff treated them with respect and some patients described staff as 'friendly and professional'. One patient said,' staff were very caring'. They don't talk about you, they talk to you'. Another patient said 'age has no bearing on how you are treated'. They said they were involved with their treatment and had this explained to them so they understood what their diagnosis was and the treatment available to them.

Patients told us they were able to discuss and ask questions about their diagnosis and treatment, which the doctors listened to and answered.

Patients said staff asked them how they would like to be addressed and used their preferred term of address. Patients in shared bays told us staff always drew the curtains if they needed any treatment, to maintain their privacy and dignity.

Patients told us they were asked about their religious and cultural needs and the hospital Chaplain provided support. A relative told us, 'bad news is discussed with sensitivity, empathy and care'.

The hospital had also received a number of good reviews on the NHS choices website, with comments such as,' I was treated with dignity and respect by the hospital staff', and 'the hospital staff worked well together and I would recommend it to my friends and family'.

Patients told us they were happy with the food that was served to them. Comments included,' we can not fault the food'; we are happy with the variety of choices offered'.

We observed that people were treated with kindness and respect. They were involved in planning their care and were informed about their treatment. People received the care and treatment they needed from a team of different professionals who worked closely together.

People received a choice of different meals and their nutritional needs were assessed and monitored. People were provided with opportunities to give feedback on the care and treatment they were receiving or had received.

22 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

13 January 2011

During a routine inspection

People using the service told us that the options for their care were explained to them. They said that that staff answered questions about their care and that they were able to make choices about how they were looked after. They said that staff had asked their permission before giving care or treatment and had explained why they were prescribed the medicines they were taking. The consensus of opinion of the food on offer was that it was 'fine'. People said they had access to water at all times. They felt that their privacy and dignity was respected by staff and that they knew how to complain if they needed to. Everyone we spoke to was happy with the care and treatment they received at Hillingdon Hospital and praised the staff both for their hard work and for always being available to them.