Archived: St Mark's Hospital

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 undertook an announced inspection at St Mark's Hospital between 20 and 23 May 2014. St Mark's Hospital specialises in gastro-intestinal services and sits within the main trust location at Northwick Park Hospital.

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 Hospital in Harrow, and Central Middlesex Hospital in Park Royal. St Mark’s Hospital is an internationally-renowned centre for specialist care for bowel diseases. The trust has a sustainable clinical strategy with Ealing Hospital that improves patient pathways, 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.

Overall, we found the services provided at St Mark's Hospital require improvement to ensure that they are safe, effective and well-led. All services at this hospital were rated as requiring improvement due to lack of staff and coherent processes.

Our key findings were as follows:

• There was inadequate staffing on Frederick Salmon Ward.
• Patients were transferred out of the high dependency unit (HDU) to wards in which staff did not feel confident to manage their conditions. 
• There was a lack of junior doctors, and this affected teaching and appraisal opportunities.
• There were delays in emergency surgery taking place.
• Outpatients clinics in the main outpatients department often ran late and appointments were cancelled, sometimes at very short notice.
• Clinics were often overbooked and the delays were not always clearly explained to the patients.
• Staffing was not always sufficiently organised to support and respond to patients waiting for treatment.

We saw areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Ensure that there are adequate numbers of medical and nursing staff on Frederick Salmon Ward to provide care for patients.

In addition the trust should:

• Review the discharge arrangements for patients transferring from HDU facilities, to ensure appropriately trained staff are available to provide safe care.
• Review the availability of elective surgery allocations.
• Review the booking of outpatients appointments to reduce the cancellations and waiting times experienced by patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals