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Chief Inspector of Hospitals rates West Hertfordshire Hospitals NHS Trust as ‘Requires Improvement’

1 March 2017
West Hertfordshire Hospitals NHS Trust
  • Media,
  • Hospitals

England's Chief Inspector of Hospitals has rated West Hertfordshire Hospitals NHS Trust as ‘Requires Improvement’ following a Care Quality Commission (CQC) inspection.

The trust was rated ‘Inadequate’ overall and placed into special measures in September 2015, following a CQC inspection, but during CQC’s return to the trust, in September 2016, inspectors found a significant number of improvements had been made. 

The trust is now rated ‘Requires Improvement’ overall but, as some further improvements are needed, it is recommended that the trust remains in special measures.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Our return to West Hertfordshire Hospitals NHS Trust showed that, while improvements were still needed, much change had taken place since our last visit and this is reflected in the trust’s new rating."

“There had been a change in leadership at the trust since our last inspection and, good progress had been made, particularly with regard to improving safety."

“However, we also found a number of areas where further work was needed to ensure people received the kind of service they should be able to expect. This included emergency care at the trust’s three hospitals and some aspects of medical care where we gave immediate feedback on our concerns to the trust’s leadership."

“While we are aware that the trust has already implemented some changes, and this is reassuring to know, I am recommending that the trust remains in special measures so that it can continue to receive the right support to ensure further improvements are made."

“Special measures are designed to provide intensive support to struggling trusts and it was clear the trust had gained from the support it has been receiving through the special measures regime."

“The trust leadership knows what it must do now to ensure further changes take place. We will continue to monitor the situation at the trust and this will include further inspections.”

The areas where the trust has been told it must make improvements include:

  • Ensuring care for patients with mental health issues in the emergency department is safe by making sure their safety is risk assessed and staff are suitably trained to meet their needs.
  • Observations of patients who could be acutely unwell must be undertaken in a timely way and escalated as required.
  • Consistently complete patient records.
  • Patients who have been in the emergency department for more than six hours must be reviewed by a senior clinician and be risk assessed.
  • Ensuring management of medicines at the hospital complies with Home Office 2016 guidelines on the security of controlled medicines. This includes patients’ own medication.
  • Mandatory training compliance must meet trust targets of 90%, including blood transfusion training.
  • Processes must be in place to monitor arrival time to initial clinical assessment for patients in the urgent care centre and minor injury unit. A process for children to be seen by a clinician within 15 minutes of arrival in the urgent care centre and minor injury unit must also be in place. 
  • Non-clinical staff in the urgent care centre and minor injury unit must receive sufficient support or training to provide oversight to recognise a deteriorating patient.
  • Improve the flow of patients through the trust to reduce the number of bed moves patients have to make, particularly out of hours, and work with partners to reduce the number of delays in people being able to leave hospital and benefit from other care services.

Inspectors also found some examples of outstanding practice at the trust, which included:

  • The children’s emergency department was outstanding in terms of its environment. Children and young people had a dedicated resuscitation area away from the adult department, which was set up with equipment and medicines for people up to the age of 16 years.
  • The trust had reduced the mortality rate for hip fractures, from February 2013 to February 2016 from 12% to 4%, with a continuing downward trajectory, by reviewing its hip fracture care pathway. The hip fracture care pathway supported good communication between the emergency department and the orthopaedic service and there were dedicated beds to support fast treatment.
  • The trust has Hospital Standardised Mortality Ratio (HSMR) rates lower than expected, sustained for 18 months.

West Hertfordshire Hospitals NHS Trust provides acute healthcare services to a population of approximately half a million people living in west Hertfordshire and the surrounding area. It also provides a range of specialist services to a wider population, serving residents of North London, Bedfordshire, Buckinghamshire and East Hertfordshire.

Following CQC’s most recent inspection the trust is now rated ‘Requires Improvement’ overall, ‘Requires Improvement’ for whether services are safe, effective, responsive and well-led and ‘Good’ for whether services are caring.

Full copies of inspection reports relating to the trust can be found on our website.


For media enquiries, contact CQC’s press office on 020 7448 9401, during office hours

Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here.

Please note: the press office is unable to advise members of the public on health or social care matters. For general enquiries, please call 03000 61 61 61.

Last updated:
29 May 2017

Notes to editors

The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public.
Whenever CQC inspects it will always ask the following five questions of every service:
  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people’s needs?
  • Are they well-led?
Since 1 April, registered providers of health and social care services have been required to display their ratings on their premises and on their websites so that the public can see their rating quickly and easily.

This report describes our judgement of the overall quality of care provided by this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations


The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.


About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.