Two out of three outpatients and diagnostic imaging departments at London hospitals run by Imperial College Healthcare NHS Trust have been rated as Good by the Care Quality Commission. The third was rated as Requires Improvement.
Hammersmith Hospital and St Mary’s Hospital diagnostic and imaging departments (OPD) were both rated Good, while Charing Cross Hospital’s Requires Improvement, following inspections in November 2016.
All three departments were rated Inadequate by CQC Inspectors previously. The OPD at each location had improved since the last inspection.
Hammersmith Hospital OPD
There were numerous reasons CQC rated this service Good including:
At a previous inspection CQC found clinics often started late but the trust was not monitoring this. At this inspection inspectors found the trust had started to monitor when clinics started and how long patients were waiting.
Medicines at the location were stored securely and appropriately.
83% of staff working in outpatients felt encouraged to report errors and near misses.
Clinical areas in the outpatient department were clean and tidy and staff told us they were responsible for ensuring clinic rooms were cleaned daily.
There were hand-washing facilities and hand gel dispensers in every consultation room and inspectors observed staff washing their hands and using hand gel between treating patients.
There were warning signs informing staff and patients not to enter rooms when x-rays and other diagnostic test were underway.
Inspectors found the trust was moving towards an electronic system for all patient records and the retrieval of paper records had improved.
Arrangements were in place to safeguard patients from abuse.
The diagnostic imaging department was working towards achieving the Royal College of Radiologist Imaging Accreditation scheme.
However, some patients also told us their appointments had been cancelled and re-arranged several times or they had arrived for their appointment to find the clinic
had been cancelled.
An outpatient improvement programme had been developed which had resulted in a number of improvements but many of the objectives had still to be achieved.
Waiting times for patients in clinic were still a problem with clinics being overbooked or cancelled.
Several patients told us they had attended clinic in the summer months and found the temperature in the outpatient clinics uncomfortable. Temperatures sometimes reached 30 degrees.
St Mary’s Hospital Paddington OPD
There were numerous reasons CQC rated this service Good including:
Staff felt there was a positive incident reporting culture that promoted honesty with a ‘no blame’ culture.
Staff said they felt supported when they submitted incident reports.
All areas met or exceeded the trust’s 90% compliance target with hand hygiene and ‘bare below the elbow’ policies.
Staff followed appropriate medicine management procedures that reduced the risk of incorrect doses and administration.
The number of patients seen in outpatients with temporary notes as a result of their case records being unavailable was better than the national benchmark maximum of 4% of patients.
Safeguarding processes were well established and staff demonstrated appropriate knowledge of them.
Children and young people seen outside of paediatric services were cared for using appropriate safeguarding policies.
Staff in diagnostic imaging used the World Health Organisation (WHO) surgical safety checklist for radiological interventions and the Society of Radiographer’s ‘pause and check’ process as part of a robust risk management process.
Between January 2016 and December 2016, the hospital met the two week wait target for cancer referrals in every month.
Staff spoke positively about the annual appraisal and professional development record process and said they had been able to secure training and development activities as a result.
Staff treated patients with kindness and a friendly manner during all of CQC’s observations, including in clinical and non-clinical settings.
However, inspectors did find fire risk assessments had highlighted a significant
number of failings in fire safety. This meant buildings, treatment and waiting environments were not safe for patients, staff and visitors.
Mandatory training completion rates were variable across staff groups and subjects.
Local audits in January 2016 identified a lack of space for waiting patients in the
urology-gynaecology and fracture clinics as an area for improvement but no action had been taken to date to improve this.
The trust underperformed against the two week wait (2WW) GP referral to first outpatient appointment standard for cancer and underperformed against the 62-day GP referral to first treatment standard.
Charing Cross Hospital OPD
Charing Cross Hospital was rated Requires Improvement because:
The trust consistently did not meet national targets for a variety of performance indicators.
The majority of patients we spoke with in the outpatient and radiology departments commented negatively in regards to waiting times.
The majority of staff we spoke with felt that that senior management focused on other trust sites more than Charing Cross.
All non-managerial staff inspectors spoke with across the whole hospital said that the executive team was not visible enough at Charing Cross.
The majority of staff we spoke with could not tell us the hospital’s vision or values.
Inspectors were told by staff of a blame culture in radiotherapy with friction between the different radiographer staffing groups.
The majority of non-managerial nursing staff told us they felt tired and overworked.
However, the outpatient department consistently met its compliance target for hand hygiene and ‘bare below the elbow’. The department also scored 100% for cleanliness in the patient-led assessments of the care environment (PLACE) audits for 2016.
CQC observed that there were a sufficient number of doctors to run the scheduled outpatient clinics and the clinics were consultant led.
Friends and family score for October 2016 demonstrated 88% and 97% of outpatient and radiology patients would recommend the service.
A trust wide outpatient improvement plan which laid out five key areas of improvement was being implemented.
England’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“It is encouraging that all three of these Imperial College Healthcare NHS Trust outpatients and diagnostic imaging departments have improved since CQC last inspected them."
“However, there is still room for improvement at all three sites, especially at Charing Cross Hospital. We will continue to work with the trust to improve care at all its hospitals.”
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