All inspections: Queens Urgent Treatment Centre

This service is rated as requires improvement overall.

The service had previously been inspected between 25 March and 15 April 2021, with a follow up inspection taking place between 10 November and 8 December 2021 The latter inspection rated the service as requires improvement overall and in the safe, effective and well led key questions. The caring and responsive key questions were rated as good. The service was found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008, and requirement notices were served. A further inspection was carried out on 20 and 21 October, and 7 November 2022. In this inspection the service was again found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008. The service was rated inadequate, conditions were issued and the service was placed into special measures.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Queens Urgent Treatment Centre on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre on 6, 7, 20 and 21 June 2023. We found that some of the breaches of regulation from the previous inspection had been fully addressed, but for others whilst progress had been made there was more to do. Following this inspection, the key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

At this inspection we found:

The rating of the service had improved from inadequate to requires improvement. Significant work had taken place to address the breaches identified at the previous inspections, however in a few areas whilst there was progress there was still more improvements needed.
The service had begun to monitor more effectively the safety of the care it provided, and its performance was improving, but was still not meeting requirements specified by NHS England. Systems were now in place to monitor the time taken for patients to have their initial clinical assessment. However only 76% of patients were having this assessment within the 15 minute target. This meant there was an ongoing risk of patients needing urgent medical attention not being identified in a timely manner. An action plan was in place to continue to make improvements in meeting this target.
Patients were not consistently able to access care and treatment at the service in a timely way. The service had a target to provide treatment and discharge the patient within 4 hours. The service was meant to achieve this for 95% of patients but the average was 70-80% so below the target.
Staffing at the service was not in line with the rotas that workforce planning exercises had deemed necessary. The rotas showed that there was a gap of up to 20% for the urgent care practitioners each month, meaning there were times when there were not enough staff working.
The service was not consistently monitoring the effectiveness of the work of individual clinicians. Not all the clinicians were receiving consistent regular and high-quality clinical supervision. In addition the audits of clinicians notes were not taking place as robustly as needed to ensure all clinicians were delivering appropriate clinical care.
The service did not yet have formal mechanisms to engage with patient groups.
Whilst governance processes had improved, there was still scope for these to be further strengthened, particularly in terms of ensuring staff performance was adequately monitored.

However, the following areas had been addressed:

The service had improved the management of incidents and complaints, and mechanisms were in place to share learning.
Leaders now had the capacity and skills to deliver high-quality, sustainable care.
The service had developed a clear vision and credible strategy to deliver high quality care.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure care and treatment is provided in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The areas where the provider should make improvements are:

Review the detail required in the review of clinical competencies.
Review the physical patient pathway from initial clinical assessment to the Emergency Department.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

This service is rated as Inadequate overall. The service had previously been inspected between 25 March and 15 April 2021, with a follow up inspection taking place between 10 November and 8 December 2021 The latter inspection rated the service as requires improvement overall and in the safe, effective and well led key questions. The caring and responsive key questions were rated as good. The service was found to be in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008, and requirement notices were served.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Queens Urgent Treatment Centre on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre on 20 and 21 October, and 7 and 8 November 2022. We found that some of the breaches of regulation from the previous inspection had been addressed, but others had not been. We also found breaches in other areas.

This inspection was part of a follow up on our previous system wide review of urgent and emergency care services across the North East London (NEL) integrated care system that was carried out in November 2021. At that time, we identified issues with flow in and through the urgent and emergency (UEC) pathway and had significant concerns regarding the impact of this on safety and quality of care. Due to ongoing concerns regarding the UEC pathway and patient safety, during November 2022 we inspected all four urgent treatment centres (UTC) provided by the Partnership of East London Cooperatives (PELC), and both emergency departments (ED) and medical care provided by Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT). Subsequent to significant concerns that were identified at these locations, the Commission found that the challenges these services faced were also complicated by wider challenges within the health and social care system. A Quality Summit with NHS England and system wide partners was convened to devise an action plan to address the concerns identified.

Following this inspection, the key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? – Inadequate

At this inspection we found:

The service could not be assured that it was providing safe care to patients attending the service, particularly those with potentially serious conditions.
There were insufficient procedures and processes in place to ensure learning from incidents and complaints. There were not clear systems in place for demonstrating improvements when things went wrong.
The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, the service was not meeting the targets specified by its commissioners.
The organisation did not have sufficient procedures in place to ensure that effective staffing was being provided.
Staff involved and treated people with compassion, kindness, dignity and respect.
Patients were not able to access care and treatment at the service in a timely way.
Leaders did not have the capacity and skills to deliver high-quality, sustainable care.
There were some clear responsibilities, roles and systems of accountability to support good governance and management. However, line of accountability and designated decision-making authority were unclear.
The service did not have a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of safe care and treatment.
Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance.
Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good staffing.

The areas where the provider should make improvements are:

Review compliance with infection protection and control guidance at the site.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

This service is rated as Requires Improvement overall. The service had previously been inspected on between 25 March and 15 April 2021. That report rated the service as requires improvement overall and in the safe key question, inadequate for well led, and good for the effective, caring and responsive key questions. The service was found to be in breach of regulations 12 and 17 of HSCA (RA) 2014, and two warning notices were issued. The specific issues found which breached regulation 12 related to infection prevention and control procedures not being followed. The breaches of regulation 17 related to a lack of leadership and clear governance processes, and the culture within the organisation.

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre on 10, 11, 17, 18 and 25 November, and 8 December 2021. We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We found that some of the breaches of regulation from the previous inspection had been addressed, but others had not been. We also found breaches in other areas. Following this inspection, the key questions are rated as:

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

At this inspection we found:

The service had good systems to manage risk in most areas so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes. However, incidents were not being processed within their own specified timelines.
The organisations own audits showed that best infection prevention and control practice was not being consistently followed.
The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, the service was not meeting the targets specified by its commissioners.
The organisation did not have sufficient procedures in place to ensure that effective staffing was being provided.
Staff involved and treated people with compassion, kindness, dignity and respect.
Patients were able to access care and treatment from the service, although it was not routinely meeting the four-hour target for patient throughput.
The leadership and governance functions at the organisation had been improved and were mostly in line with its constitution. However, some governance functions did not meet the needs of the organisation
Staff that we spoke with stated that the culture of the organisation had improved since the previous inspection, although some staff said that they were not listened to.
Communication procedures with the hospital provider who provided the co-located emergency department service were unclear.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure that care and treatment is provided in a safe way to patients. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good staffing. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The inspection of Queens Urgent Treatment Centre also formed part of a system review of urgent and emergency care provision in North-East London. The findings of this review relate to the overall system of care provision in this area, and are not all specific to this provider alone. The following details the findings of this system wide review:

A summary of CQC findings on urgent and emergency care services in North East London.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for North East London below:

North East London

Provision of urgent and emergency care in Northeast London was supported by services, stakeholders, commissioners and the local authority. The health and care system in this area is complex, made up of a large number of health and social care providers. We did not inspect all providers within the system and did not inspect any GP services.

We undertook these inspections during the COVID-19 pandemic; the pandemic had put significant pressure on health and social care services and the staff working within them. Despite the challenging circumstances, we found examples of staff working in partnership. For example, there was good engagement between service leaders to understand the impact of demand on different services and to discuss opportunities to signpost patients to services under less pressure. However, system wide collaboration was needed to alleviate the pressure and risks to patient safety identified in the emergency department we inspected.

We were told there were capacity issues, especially in primary care, resulting in delays for patients trying to access urgent care or patients being signposted from 111 to acute services. We were told appointments for out of hours GPs were often unavailable. We observed patients queuing to access both the urgent treatment centre and emergency department and were told patients attended these services due to an inability to access their own GP. This put additional demand on the hospital and caused further delays in patients accessing treatment.

In addition, there had been an increase in the number of 111 calls from patients requiring dental treatment and patients reported a local reduction in dental providers accepting new patients.

There are opportunities for more effective integration between 999 and 111 services. Due to the way 111 and 999 services integrate nationally, the call system for the 999 service was unable to electronically send information to the 111 service if it was decided the caller did not meet the criteria for an ambulance. The caller was asked to redial 111. In contrast, 111 were able to communicate directly with 999 if they felt their caller required an ambulance. Ambulance service leaders in London were fully sighted on a national pilot to improve this issue and hoped this would improve people’s experience of urgent and emergency care, wherever they live.

We inspected one emergency department in North East London and found that local services did not always work together to reduce attendances or the length of stay in the emergency department. This resulted in situations of overcrowding, compromised infection control and extended waits for treatment which impacted on outcomes for patients. The ambulance service had commenced daily calls with system partners to try and reduce ambulance handover delays and to monitor demand across North East London. Leaders from services in North East London acknowledged their responsibility to support the emergency department and are working to implement improvement plans with colleagues from primary care and community services.

We identified an opportunity for more effective collaborative working and communication between an emergency department and the co-located urgent treatment centre resulting to improve people’s experience of accessing urgent and emergency care. Different digital operating systems within these services did not promote effective communication or integration between services and impacted on how services could work collaboratively to deliver safe, effective and timely patient care. These issues resulted in some people being sent from the urgent treatment centre to the emergency department without an effective referral mechanism and meant they experienced further delays whilst in another queue to be assessed. Leaders from a range of services were looking to further integrate services in the area and, in response to our findings, were collaborating to implement new and innovative ways of assessing patients safely and in a timely way.

We found examples of delays in discharge from acute medical care impacting on patient flow across urgent and emergency care pathways. This also resulted in delays in handovers from ambulance crews and prolonged waits in the Emergency Department due to the lack of bed capacity. We also found patients in the emergency department for whom a decision to admit had been made; however, they were still waiting in excess of 24 hours before being transferred to a bed on the ward. These delays exposed people to a risk of harm.

We identified a significant number of patients unable to leave hospital to return to their own home or move into community care. This was due to a number of complex reasons including delays in the provision of care packages due to lack of availability, a lack of residential and/or nursing care beds and because of a shortage of social care staff and the impact of vaccination as a condition of deployment. We were told that Local Authorities were working to increase capacity in social care and that they regularly met with system partners to discuss the provision of urgent and emergency care in London; however, the impact on patient flow through urgent and emergency care pathways remained a significant challenge across North East London. Increased collaboration and support from system partners was required to manage the risk being held in the emergency department we inspected.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This service is rated as requires improvement overall. The service had previously been inspected between 5 and 13 February 2020. That report was unrated, but the service was found to be in breach of regulations 12 and 17 of HSCA (RA) 2014, and requirement notices were issued. The specific issues found which beached regulation 12 and 17 were in regards to staff recruitment, competence, training and supervision, the system to direct patients safely when they first accessed the service, the safe handling of medicines, the prevention and management of infectious diseases. In addition, leaders had not fully established systems, policies, procedures and activities to ensure safety and assure themselves they were operating as intended.

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre between 25 March and 15 April 2021. We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We found that some of the breaches of regulation from the previous inspection had been addressed, but other breaches of regulation were identified. Following this inspection, the key questions are rated as:

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

At this inspection we found:

Leadership processes at the service were unclear.
The organisation was not following its own constitution, and was not able to demonstrate a clear vision, a positive culture or clear and consistent governance processes.
The service had some systems to manage risk so that safety incidents were less likely to happen. However, we noted that infection control processes were not consistently followed, and that significant event processes were unclear.
The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
Staff involved and treated people with compassion, kindness, dignity and respect.
Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure that care and treatment is provided in a safe way to patients. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance. Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The areas where the provider should make improvements are:

Ensure that the website is available to meet patient needs.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre, Rom Valley Way, Romford, Essex, RM7 0AG on 5, 12 and 13 February 2020.

We have taken the decision not to rate this service because Queens Urgent Treatment Centre’s date of registration with the CQC was 23 January 2020.

At this inspection we found:

The service was led by a chief executive who was supported by a senior leadership team that reported to the PELC council. Local clinical and performance meetings fed into the integrated clinical governance committee, management executive team, and finance, audit and remuneration meetings which in turn fed into the PELC council meetings (Board). We found the service held monthly integrated governance committee meetings.
The service mostly had clear systems to keep people safe and safeguarded from abuse.
The service learned and made improvements when things went wrong and responded to and learnt from complaints.
To improve the service, staff had completed 24 audits over a period of 18 months, two of the audits were two cycle audits.
The provider has increased the number of patients seen in the urgent treatment centre from 41% to over 70% since taking over the service, which resulted on less pressure in the A&E department at the hospital.
The service was open 24 hours a day, seven days a week, and adjusted their staff according to patient demand.
At the time of our inspection, the management team did not have effective oversight of staff recruitment and training. However, following the inspection, the provider employed a human resource compliance officer whose role was to ensure that all staff have completed the appropriate training for their role and to ensure the service's recruitment system is effective.
The system for the management of the emergency medicines and patient group directions used by non-prescribers was sometimes not fully effective or fully embedded. However, immediately following the inspection, the provider took immediate action to ensure an improved and effective system.
The protocols in place did not provide the streamers with a consistent approach to aid the safe direction of patients. In addition, staff were not always following the guidance provided and completing observations prior to streaming patients to all areas. However, immediately following the inspection, the provider submitted information to demonstrate that they had introduced new streaming guidance regarding children. They also, summitted an action plan that included to review all the streaming guidelines, to ensure adequate detail was provided by the patient and recorded. In addition, they had changed the patient record system to ensure staff always completed and documented the necessary observations.
The provider had introduced a streaming competencies framework in 2018, however the management team had failed to ensure this system was adhered to and completed by all required staff. In addition, we found a new process for clinical supervision for streaming staff had been commenced, but the process was not formalised or embedded. However, immediately following the inspection, the provider submitted an action plan that included to further develop a performance management process for streamers, improving training, and review the competency framework. The provider has also changed the patient record system to ensure streaming staff complete and record patient observations. In addition, the provider was planning to change the patients notes audit system so that it included streamers record keeping.
The Trust, where the service was located managed the prevention of infectious diseases at the service, however, we found the service did not always have full oversight of these arrangement.
Although, the management team robustly monitored patient feedback and provided the information to the local clinical commissioning group, we were not provided with any evidence of how they had responded to lower patient survey results.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure care and treatment is provided in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report)

The areas where the provider should make improvements are:

Follow the correct system for the review of non-medicine Central Alerting System (CAS) and Medicines and Healthcare products Regulatory alerts (MHRA).
Continue to improve the privacy and dignity of patients in the waiting room.
Improve the process in place to navigate patients to the major’s lite service so that it includes information regarding the streaming process, colour coding and is available in other languages.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Queens Urgent Treatment Centre

All Inspections

6, 7, 20 and 21 June 2023

During a routine inspection

20 and 21 October, and 7 and 8 November 2022

During a routine inspection

10, 11, 17, 18 and 25 November, and 8 December 2021

During a routine inspection

25, 26, 29, 30 March, 14 and 15 April 2021

During a routine inspection

5 to 13 Febraury 2020

During a routine inspection