The Care Quality Commission
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Homerton Healthcare NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings

All Inspections

10 April 2018

During a routine inspection

Our rating of the trust stayed the same. We rated it as good because:

  • Overall, we rated Homerton University Hospital as ‘good’.
  • We took into account the current ratings of the four core services that were not inspected at this time and aggregated the ratings with the four core services we did inspect at Homerton University Hospital.
  • We rated urgent and emergency services as ‘outstanding’ overall, with an ‘outstanding’ rating applied to the caring, responsive and well-led domains. We also rated medical care (including care of the older person) as ‘outstanding’ overall, with an ‘outstanding’ rating applied to responsive and well-led domains.
  • All other services at Homerton University Hospital we rated ‘good’. However, we rated the well-led domain in maternity services as ‘requires improvement’.
  • We carried out a well-led review of the trust and gave an overall rating of ‘good’ for this domain and considered this when aggregating the overall trust rating.
  • We inspected community health services in 2017. Both adult community health services and community health services for children, young people and families were rated ‘good’ across all domains and this was considered when aggregating the combined overall rating for the trust.
  • We also inspected the Mary Seacole Nursing Home in 2017 and rated this as ‘good’.

31 January to 3 February 2017

During an inspection of Community health services for children, young people and families

Overall rating for this core service is good because:

  • The community health services for children, young people and families (CYP) service had systems for identifying, reporting, and managing safeguarding risks. The child safeguarding team provided good support to staff across CYP services through supervision, training and monitoring of incidents.

  • Professionals from different teams in the service worked well with each other and those from external organisations to make sure each child had the best possible care. Health centres housed a variety of services, which meant CYP was able to work closely with partners such as GPs. CYP staff provided competent care in line with best practice and national guidance.

  • The trust health centres and children centres we inspected were clean, tidy, and clutter free. Waiting rooms and clinic rooms were child friendly with toys, books and other resources appropriate for different ages. CYP services completed regular infection control audits across locations and most staff demonstrated good hygiene and infection control procedures.

  • Staff supported the patients and families they worked with, and provided patient-centred support in clinics and in homes. Staff planned and delivered services in line with local needs including for vulnerable patients and those who spoke limited English.

  • Staff told us they could find policies easily on the trust intranet. Staff who worked in the CYP service followed the trust’s lone working policy. Staff we spoke with had good awareness of lone working arrangements.

  • Patients we spoke with told us they were very happy with the care and treatment provided and had good access to translation services.

  • Staff told us they valued working for the trust and said the trust had involved staff in different ways such as through focus groups. Staff told us that service leaders were supportive, accessible and approachable.

However:

  • The CYP service completion rate for infection prevention and control level two was 61 % against the trust’s mandatory training target of 90%. Similarly, the service's completion rate for paediatric basic life support (PBLS) was below the trust target and averaged at 51%.

  • Staff did not always recognise the terminology of ‘duty of candour’ although they had an honest approach and were open with patients when things went wrong.

  • The trust-wide response rate for the NHS Friends and Family Test was 2% for September and October 2016, which is lower than the national response rate at 3.5%. Most patients told us that staff did not encourage them to give feedback on the care they received or provide any information on how to make a complaint if needed.

31 January to 3 February 2017

During an inspection of Community health services for adults

We found that community health services for adults at Homerton University Hospital NHS Foundation Trust were 'good' in terms of safety, effectiveness, caring, responsiveness and well-led. This was because:

  • There was a good overall safety performance across community adults services and effective processes for identifying and managing risks. There were very low levels of reported serious incidents and incidents resulting in harm. Staffing levels, infection prevention and control, medications and completion of mandatory training were overall well managed.
  • Practitioners across services demonstrated effective evidence based care and treatment in accordance with national guidelines and good practice. Services measured outcomes using objective and patient reported measures. Staff had good access to training and development. There was good multi-disciplinary working between staff and with external partners.
  • Patients reported positive feedback about the care and treatment they received. Staff treated patients in a kind and compassionate manner. Patients and their relatives were encouraged to be partners in their care planning and were enabled to participate in care activities.
  • Community adults services had a model of integrated community teams across health and social care to ensure patients received joined up working. Staff were responsive to the needs of different communities and vulnerable patients. Community adults services demonstrated learning from complaints.
  • There were appropriate plans in place to develop the community adults service. There were effective governance and reporting structures in place for the escalation of performance and risk information. Senior leaders had a clear understanding of their services, local risks and challenges and realistic plans to develop their services. Staff told us managers were accessible and supportive. Patients were involved in service development. There were some areas of innovation including the introduction of extended scope practitioners.

However:

  • Overall compliance with completion of mandatory safeguarding level 2 training (and Mental Capacity Act and Deprivation of Liberty Safeguards training which was incorporated in the same module) needed to improve to meet the trust's local target. The trust was aware of this and had put in place actions to improve training completion.
  • The trust’s new online appraisal reporting system did not provide sufficiently accurate data to present a complete record of completed staff appraisals. The trust was aware of this and was working to identify those staff who needed to have their appraisal.
  • There were separate electronic record systems used in the hospital and community teams. Staff told us this could sometimes lead to problems with effective transfer of information from acute to community practitioners.
  • Some of the trust's staff and partners identified a need for greater out of hours community nursing input, which was not provided by the trust.

5-7 February 2014

During a routine inspection

Homerton Hospital became Homerton University Hospital NHS Foundation Trust on 1 April 2004 – one of the first 10 trusts in the country to achieve foundation status. The trust comprised a medium-sized hospital providing acute, specialist and community services to Hackney and the City of London. The trust also owned Mary Seacole Nursing Home and was responsible for Hackney and City community health services.

The trust served a diverse population: the London Borough of Hackney and the City of London. In 2010, the Indices of Deprivation showed that Hackney was the second most deprived local authority in the country, although there was evidence of less deprivation period 2007 to 2010. In contrast, the City of London (which is the country’s smallest county and holds city status in its own right) was judged as being the 262nd most deprived local authority (there were 326 local authorities with the first being the most deprived). Both Hackney and the City of London had increasing populations and higher than average numbers of patients from Black, Asian and minority ethnic communities. There was a consensus view from local stakeholders, patients and staff that The Homerton was part of the local community and met the needs of its local population well.

The trust provided specialist care in obstetrics and neonatology, foetal medicine, fertility, HIV, keyhole surgery, asthma and allergies, bariatric surgery and neuro-rehabilitation across east London and beyond. The trust had seen some changes in leadership in 2013 with three out of five executive directors having been appointed in 2013. However, only one of these three executive directors, the Chief Nurse and Director of Governance, joined the trust from an external organisation. The Chief Executive and the Chief Operating Officer were internal appointments and were working in other senior roles within the trust prior to taking up their new posts in 2013.

Staffing

The trust had over 500 beds and employed over 3,500 staff. A further 1,000 staff were either contracted to work or placed for training in the Homerton. Many of the senior staff at the trust had been working at the hospital for a number of years and students we spoke with said they were keen to come back to work at the trust when they qualified. However, in the medical wards we found there were nursing staff shortages, and that these were having an impact on patient care in being able to provide care in a timely manner. The trust spent 9.9% of total staffing costs on agency staff, nearly double the spend across London. Staff sickness rates overall at the trust were just below London and England averages, midwifery staffing sickness levels, were significantly lower and were 2% compared with an England average of 4.3%.

Cleanliness and infection control

All areas visited at the Homerton were clean and levels of cleanliness were the same on our unannounced inspection visits. In the NHS staff survey of 2012, 47% of staff said that hand washing facilities were always available which was worse than expected. However, when we visited, we saw there were adequate hand washing facilities and staff and visitors had access to liquid soap hand cleansing gel. During the 12 months from August 2012 to July 2013, the trust reported four cases of meticillin-resistant staphylococcus aureus (MRSA) infection; this was within a statistically acceptable range relative to the trust’s size and the national level of infection. During the same time period, there were 10 reported cases of Clostridium difficile, which was also within a statistically acceptable range given the size of the trust.

We rated the Homerton as a good hospital with an outstanding accident and emergency (A&E) department. Staff felt valued and enjoyed working in the hospital, and patients felt cared for and had faith in the staff looking after them.                              

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.