The Care Quality Commission has rated Barts NHS Trust as Requires Improvement overall - an improvement from its previous rating of Inadequate - after recent core service inspections and a well-led review.
Barts was rated Requires Improvement for being safe, effective, caring, responsive and well-led, following the inspection in June 2017. It does though remain in special measures.
This inspection was specifically designed to test the requirement for the continued application of special measures to the trust. Prior to inspection CQC risk assessed
services provided by the trust using national and local data and intelligence received from a number of sources. CQC re-inspected all core services that had received a rating of Inadequate to test whether significant improvements had been made since the previous inspection.
At Whipps Cross University Hospital inspectors gave the service an overall rating of Requires Improvement. Safe, responsive and well-led domains were rated as Requires Improvement. Caring was rated as Good.
At The Royal London Hospital CQC gave the service an overall rating of Requires Improvement: effective was rated Good, It was Requires Improvement in the safe, caring, responsive and well-led domains.
At St Bartholomew’s Hospital all core services received an overall rating of Good; however, CQC rated the overarching well-led domain as Outstanding. This was based on an Outstanding rating in the well-led domain in both surgery and critical care.
At Newham University Hospital inspectors found maternity services continued to Require Improvement and rated the safe domain as Inadequate. There were improvements in both medical care and surgery, where both core services were rated Good overall. Newham University Hospital remains Requires Improvement overall.
The trust rating for well-led was Requires Improvement which had improved from the previous Inadequate rating afforded in 2015. The senior leadership team were visible, across the large multi-site organisation and described as approachable.
Time and resource had been invested into improving the leadership and governance structures, risk management, culture of the organisation, including better staff engagement. It is apparent that the trust is on a journey of improvement and significant progress has been made. However, it is also clear that many implemented changes remain in their infancy and are not fully embedded. There is still significant further work to do to ensure that governance is managed consistently and service improvements are achieved across all sites.
Inspectors found several areas of Outstanding practice, including:
The environment for cardiac patients at St Bartholomew’s Hospital was newly refurbished to a high standard. CQC received positive messages from staff about the positive impact of the recent investment and refurbishment of services.
In outpatients at Whipps Cross University Hospital staff spoke positively about a new system in place where notes were delivered the night before morning clinics. This meant staff could check the patient list to identify any missing records and make an urgent request for them.
Results from the national lung cancer audit indicated St Bartholomew’s Hospital performed better than the national average in every indicator.
The trust’s carers’ policy allowed flexible visiting hours for carers of people living with dementia. Carers were encouraged to be as involved as much as possible in the patient’s care.
The trust consistently performed better than the national operational waiting time indicators for cancer care.
The development programme designed to support Black, Asian, and minority ethnic staff had won national recognition.
However, there were also areas of poor practice where the trust needs to make improvements. Importantly, the trust must:
- Address the environment within theatres at Whipps Cross University Hospital to ensure this meets the Department of Health’s standards around infection control.
- Ensure out-of-date equipment is removed from theatres at Whipps Cross University Hospital and ensure a robust process is in place to address this in a proactive manner. According to the trust this has now been actioned.
- Ensure daily cleaning records within the theatres’ anaesthetic rooms at Whipps Cross University Hospital are fully completed and that a robust audit process in place to provide organisational assurance.
- Put measures in place to ensure staff are compliant with the hospital’s ‘arms bare below the elbow’ and hand hygiene policies.
- Ensure there are adequate numbers of staff trained to level 3 children’s safeguarding across the trust.
- Take appropriate action to address out of date policies and procedures for infection prevention and control. Take appropriate action to address concerns with the instrument decontamination service at Whipps Cross University Hospital.
- Take appropriate action to ensure that patient’s privacy and dignity is maintained in the changing cubicles in the dental, inpatient and chest x-ray area of diagnostic imaging at Whipps Cross University Hospital.
Chief Inspector of Hospitals, Ted Baker, said:
“We were particularly encouraged by the improvements that have been made by the trust since our inspections of 2016. Our overall rating for the trust has improved from Inadequate to Requires Improvement."
“However, while surgery at Whipps Cross University Hospital remains rated as Inadequate, we were encouraged by the improvements seen in a number of areas, these included: improvements in a number of the core services we inspected; improvements in governance framework of the organisation and the embedding of the site based leadership."
“There is still much to do but the trust is improving and this reflects the hard work by the leadership and the staff addressing the problems we have found.”
You can read the report in full on our website.
Ends
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There is still much to do but the trust is improving
CQC’s Chief Inspector of Hospitals, Professor Ted Baker