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Archived: Northwick Park Hospital Requires improvement

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Inspection carried out on 20 May 2014

During Reference: not found

Inspection carried out on 20-23 May 2014

During a routine inspection

We carried out this comprehensive inspection because North West London Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. We carried out an announced inspection of Northwick Park Hospital between 20 and 23 May 2014. Northwick Park is the main location of the trust and accommodates the senior management team.

North West London Hospitals NHS Trust is located in the London Boroughs of Brent and Harrow, and cares for more than half a million people living across the two boroughs, as well as patients from all over the country and internationally. The North West London Hospitals NHS Trust manages three main sites registered with the Care Quality Commission: Northwick Park Hospital and St Mark’s Hospitals in Harrow, and Central Middlesex Hospital in Park Royal. St Mark’s Hospital as an internationally-renowned centre for specialist care for bowel diseases. The trust has a sustainable clinical strategy with Ealing Hospital to improve patient pathways, and is underpinned by combined ICT and estate strategies, and a vision to establish Northwick Park Hospital as the major acute hospital of choice for outer North West London.

The hospital has had some issues in the past, particularly around its maternity services. However, the management team has worked hard to address these. We saw a number of areas where improvements had been made to the maternity services, but it still requires further improvements in order to provide a safe, effective, caring and responsive service.

Overwhelmingly across the trust, staff were found to be caring and compassionate towards patients, their family and friends. The management of areas at a local level required some improvement for services to develop and provide good care.

Our key findings were as follows:

  • The patient flow through the hospital impacted on patients waiting in the A&E department, in that patients were often 'bedded down' in A&E until a bed became available. 
  • Middle grade doctors did not always receive the training and supervision they required.
  • Policies and protocols, particularly in surgery and critical care, were not always up to date and reflective of national guidance.
  • Pressures on the critical care units were such that some patients were discharged too early and had to be re-admitted on some occasions.
  • The pace of change in maternity was slow, leading to potential risks for women using the service.
  • In most areas the hospital, while clean, was in need of refurbishment.

We saw an area of outstanding practice:

  • The stroke unit was providing a ‘gold standard service’ with seven-day working. It had been the recipient of the prize for the 2013 Clinical Leadership Team at the British Medical Journal awards.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure that there are appropriate numbers of staff to meet the needs of patients in the A&E department, surgical areas and critical care.
  • Ensure that there are systems in place to assess and monitor the quality of the service provided in A&E, critical care, surgery and maternity, to ensure that services are safe and benchmarked against national standards.
  • Ensure that the environment is safe and suitable in paediatric services.
  • Ensure that equipment is available, safe and suitable within the paediatric service.

In addition the trust should:

  • Review the coping strategies within A&E during periods of excessive demand for services.
  • Empower senior staff to make changes to ensure that patients are safe in A&E and maternity.
  • Ensure that planned changes are undertaken in a timely manner in surgery and in maternity.
  • Review discharge arrangements in A&E and critical care to avoid re-admission to these areas.
  • Encourage a proactive midwifery department.
  • Encourage increased multidisciplinary working in areas such as maternity.
  • Review the confidentiality of medical records within the outpatients department.
  • Review the effectiveness of clinics to prevent overbooking, late running and cancellations.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 17 September 2013

During an inspection to make sure that the improvements required had been made

We carried out this unannounced inspection to check if the provider had complied with a compliance action from a previous inspection of the service carried out in May 2013.

We visited five wards, spoke with the Director of Governance, the Deputy Head of Nursing, three senior staff nurses, four nurses, two consultants and seven doctors. We checked the records of twenty patients.

We did this to make a judgement as to whether the provider was meeting Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 (Outcome 2 - Consent to care and treatment).

From the interviews with staff and documented evidence provided, we found that the provider had responded appropriately and complied with the compliance action made.

Inspection carried out on 9 May 2013

During an inspection in response to concerns

During this inspection we focused on Accident and Emergency (A&E), Older People, Maternity and Children’s Wards.

We spent time on Fielding Ward, Jack's Place, Florence Ward, Edith Ward and A&E.

We spent time talking with patients and observing their experience of using the service at Northwick Park Hospital.

Our inspection team was supported by an external specialist advisor and an expert by experience.

During the course of the day we spoke with 21 patients and two of their relatives.

We pathway tracked eight patients to look at their experience of the care and support that they received.

We also spoke with 22 staff from various disciplines.

Patients we spoke with were satisfied with the care they received. Their comments included,

"I am not happy being here in hospital, but they treat me well."

"I have no problems, I am very happy with all staff."

"The midwives are lovely and very kind."

"The doctors are amazing I would recommend the hospital to others."

"I feel safe here."

Staff worked hard to uphold the dignity and promote the privacy of patients.

Patients told us that they had given their consent for the treatment they had received following an explanation from doctors and nurses. We found that 'Do Not Attempt Resuscitation' (DNAR) notices were not always completed appropriately.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Inspection carried out on 8, 9 November 2012

During a routine inspection

The inspection team was led by a Care Quality Commission (CQC) inspector joined by three other CQC compliance inspectors and a practising professional with operating theatre experience. The inspection took place over two days, during the first day we visited two wards and an operating theatre and on the second we carried out an out of hours inspection of the Accident and Emergency department (A&E).

People told us what it was like to be a patient in Northwick Park Hospital (NPH). We looked at people’s care records that showed us individual records of consent to treatment were signed by the patient and care records that were personalised for the individuals included assessed potential risks and the action required to minimise those risks.

People who attended the hospital through the accident and emergency department (A&E) and were waiting to be seen were supported by staff that regularly assessed those waiting; ensuring people with high level needs were prioritised.

Patients were generally positive about the hospital regarding the information they received about their care and treatment, ward environment, choice of menu, facilities and their surroundings.

Areas inspected were clean and appropriate, hand hygiene procedures minimising the risk of spreading infections were followed.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 30 December 2011

During an inspection in response to concerns

We spoke to patients being treated in the Accident and Emergency (A&E). They told us that A&E staff were ‘helpful’ and ‘very pleasant’. Tests and treatment were explained to patients in a way they could understand and they were kept informed of their progress and what would happen next. Patients felt able to ask questions of doctors and nurses and said they were listened to. Most patients were happy with the care and treatment they received but some were frustrated that they had not been informed how long they might have to wait. Issues were also raised about some cubicle curtains which were ill-fitting and could have compromised the dignity of patients. Trust managers told us these issues would be addressed.

Inspection carried out on 20 September 2011

During a routine inspection

The majority of patients we spoke to during our visit to the hospital were very positive about the care and treatment they had received at Northwick Park Hospital. ‘Staff are excellent and look after me well’ was typical of the comments we received. Patients had been treated with dignity and respect and felt fully informed about their treatment. Treatment was explained in a way that patients could understand. Views on the meals provided varied greatly with some describing the food as ‘amazing’ and ‘pretty good’, whilst others said it was ‘not very appetising’ or even ‘inedible’. Patients felt safe in the hospital and confident in the skills of staff and care provided by them.

Inspection carried out on 5 September 2011

During a routine inspection

We visited the antenatal ward, postnatal ward and delivery suite in the maternity unit and spoke to a number of women and their partners. All of the women told us of positive experiences in the unit. They described the midwives as competent and caring and said they always had time for them. A range of information was provided to women and their partners both antenatally and postnatally thus enabling women to take decisions about their care and the birth of their baby. Women felt safe and said staff were approachable. One-to-one care from a midwife was provided once a woman was in established labour and all women were offered skin to skin contact with their baby immediately after delivery.

Inspection carried out on 17 March 2011

During a themed inspection looking at Dignity and Nutrition

Patients that we spoke to were happy with the care they were receiving and said that they had been treated with dignity and respect by staff. On Fletcher Ward staff were described as ‘hot on closing curtains’ when giving personal care. There were mixed views about the quality of food provided, although the majority of people said it was acceptable and there was ‘plenty of it’. Some patients told us they were helped by staff with their meals and that snacks and drinks were readily available.