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Provider: Imperial College Healthcare NHS Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 February 2018

Hammersmith Hospital

  • Our rating of Hammersmith Hospital stayed the same. We rated it as requires improvement because safe, responsive and well-led require improvement and effective and caring were good.
  • The ratings for each of the key questions remained the same since our last inspection.
  • We inspected Surgery during this inspection to check if improvements had been made. Our rating of the service improved. We rated it as good because effective, caring, responsive and well-led were good, and safe required improvement. The rating for responsive and well-led improved and the ratings for each of the other key questions remained the same.
  • We inspected the Medical care (including older people’s care) service in October 2017 because we had concerns about the quality of the service. Our rating of the service stayed the same. We rated it as requires improvement because safe and responsive required improvement, and effective, caring and well-led were good, the rating for well-led improved and the ratings for each of the other key questions remained the same.
  • We inspected the Outpatients and diagnostic imaging service in May 2017 to check if improvements had been made. Our rating of the service significantly improved. We rated it as good because safe, caring and well-led were good and responsive required improvement. The ratings for responsive improved and the rating for well-led significantly improved; the rating for safe went down. We did not rate effective.
Inspection areas

Safe

Requires improvement

Updated 28 February 2018

Our rating of safe stayed the same. We took into account the current ratings of services not inspected this time. We rated safe as requires improvement because:

  • The trust did not always assess risks to the safety of patients in a timely way to support them to stay safe. For example, in the ED, the trust was not meeting national standards for median time from arrival to initial assessment or treatment.
  • The trust did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. There were high vacancy rates in some service areas.
  • The trust provided mandatory training in key skills to all staff, but rates of completion were below the trust’s target.
  • Medicines were not consistently prescribed, given, recorded and stored well.
  • In some areas, the premises and equipment were unsuitable. For example, seven theatres at St Mary’s hospital were in a poor state of repair and presented significant infection control risks to patients. Infection control and environmental control strategies in these areas were insufficient to address the risks.
  • The trust was taking action to improve the management of patient safety incidents. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • The service planned for emergencies and staff understood their roles if one should happen.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Effective

Good

Updated 28 February 2018

  • The department were performing below the national average in many of the Royal College of Emergency Medicine (RCEM) audits.

Caring

Good

Updated 28 February 2018

  • In Urgent and emergency services we found capacity issues and space limitations impacted on the ability of staff to provide care in a way that maintained the privacy and dignity of patients. Sensitive conversations were easily overheard when patients were nursed on trolleys in the corridor. We witnessed that no screens or barriers were used when examination was taking place on these patients. Cubicles within the majors department at St Mary’s Hospital were too small to allow direct transfer hoist transfers, or trolley to bed transfers using patient transfer slides, so patients had to be moved out to the corridor space in order to do this

Responsive

Requires improvement

Updated 28 February 2018

  • The trust took account of patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

Well-led

Requires improvement

Updated 28 February 2018