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CQC inspectors find emergency care at North Middlesex University Hospital to be Inadequate
The Chief Inspector of Hospitals has published a report on urgent and emergency care services at North Middlesex University Hospital following an unannounced inspection by the Care Quality Commission in April. The service has been rated Inadequate.
The inspection of the emergency department and two of the hospital’s medical wards was in response to a number of serious incidents which had raised concerns about the standards of care. CQC was also aware of a number of safeguarding incidents for patients on the hospital’s medical wards.
At the time of the inspection, CQC inspectors raised their immediate concerns, and subsequently issued a Warning Notice requiring the trust to significantly improve the treatment of patients attending the emergency department.
CQC has been working closely with colleagues at NHS Improvement, NHS England, Health Education England and the General Medical Council to ensure patient safety is improved.
Last week inspectors returned to the accident and emergency department to check on steps taken by the trust to deal with CQC’s main concerns.
The Chief Inspector of Hospitals, Sir Mike Richards said: "People going to the emergency department at the North Middlesex University Hospital NHS Trust are entitled to a service that provides safe, effective, compassionate and high quality care. When we inspected we found that patients were waiting for a long time to be seen, without being assessed by a doctor in the first place.
“North Middlesex University Hospital is one of the busiest A and E departments in London - so it is worrying that we found that there were not enough experienced doctors on call to deal with demand. We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue.
“We have already seen some progress since that original inspection. A new leadership team is in place in the emergency department, there are moves to appoint more senior doctors – and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed.
“The evidence from our latest inspection last week is that North Middlesex’s emergency department has turned a corner, but there is still much more that needs to be done. We will be watching their progress very closely.”
During the inspection in April inspectors found there were significant delays in the initial assessment of patients on arrival, in their subsequent assessment by a doctor, and in moving them to specialist wards. They also raised concerns there were insufficient middle grade doctors and consultants on duty. Doctors from other parts of the trust were slow to come and review patients and were not supportive of staff in the emergency department.
The rapid assessment and treatment of all patients arriving by ambulance was led and undertaken by nurses without an input from a doctor.
Patient flow was poorly managed and the trust’s performance waiting times, were poor. In February 2016, only 67.2% of patients were seen and treated within the national four hour target, compared to an England average of 88%.
At the time of the inspection the emergency department had lacked an established clinical director to provide leadership for more than six months. Trust management was seen by staff as overbearing and unsupportive to staff. The culture meant that staff did not feel comfortable in raising concerns.
On the medical wards inspectors found there was good consultant support and availability and the number and skill mix of doctors was satisfactory. Inspectors observed daily multidisciplinary team meetings and good team working in patient care and on ward rounds. However, there were, on occasions, insufficient numbers of nurses per shift.
There was a lack of respect and dignity in the way patients were treated on the medical wards and inspectors found that patients’ needs were not always met appropriately. Patients’ safety was being compromised through omissions in risk assessments, and through inconsistencies and inaccuracy in completing care records and observation charts.
Patients were not getting the food and drink they needed. Trained staff were not following the medication policy in the safe storage, recording and administration of medicines.
The trust has supplied an action plan setting out the steps it will take to address the concerns identified in the Warning Notice and report. CQC will continue to monitor the trust closely and inspectors will return in the near future to check that the required improvements have been made and are being sustained. A full report of the latest inspection will be published in due course.
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- Last updated:
- 29 May 2017
Notes to editors
North Middlesex University Hospital NHS Trust is medium-sized acute trust with around 450 beds. The hospital serves more than 350,000 people living in Enfield and Haringey and the surrounding areas, including Barnet and Waltham Forest.
CQC’s inspection team included inspectors covering emergency care and medical care. The team was supported by Specialist Professional Advisors including; two consultant physicians and two senior nurses with experience in the emergency department and general medicine. The team was also supported by four Experts by Experience, who undertook a large number of face to face interviews with patients and their families/carers.