The Chief Inspector of Hospitals has rated Guy's and St Thomas' NHS Foundation Trust as Good following its first comprehensive inspection by the Care Quality Commission.
Both Guy's Hospital and St Thomas' Hospital were found to be Good overall. The trust’s community health services were also rated Good.
Full reports on all core services have been published on the CQC website: www.cqc.org.uk/provider/RJ1.
The CQC inspection team, which included specialist advisors and experts by experience, visited the trust over a period of four days during September 2015. There were four further unannounced visits.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“Guy's and St Thomas' sets out to provide world class clinical care, education and research that improves the health of the local community and of the wider population – and if you ask their patients, the vast majority would tell you that is their experience.
“Throughout our inspection we found evidence of clear supportive leadership and staff who are highly committed to the trust, delivering high quality, compassionate, patient care. Patients were positive about the care they received and felt staff treated them with dignity and respect.
“Many of the services we inspected were rated as good, with urgent and emergency services, and services for children and young people (Evelina London Children’s Hospital), St Thomas’ Hospital Outstanding.
“Although there were vacancies in all areas, the trust was recruiting to ensure that staffing levels were maintained at safe levels. However, the trust had not fully implemented the World Health Organisation surgical safety checklist. Staff knew how to report incidents, but there was only limited learning from Never events across directorates. I note that the trust has not been meeting the 62-day target on access to cancer treatment for some time.
“I know that the trust is facing increasing demand on its services, and we will continue to monitor its performance in these challenging times.”
The inspectors found that the majority of patients were treated in a timely manner, with the trust meeting most national access targets. Patient movement through the hospitals was well managed with a low number of cancelled operations, and systems in place to minimise delays experienced by patients that were being discharged.
Urgent and emergency services at St Thomas’ Hospital were found to be Outstanding. Staff were compassionate and flexible to ensure they supported people well. The role of the emergency services security team was embedded in the day to day running of the service. The team was multilingual and trained in effective de-escalation techniques and demonstrated outstanding empathy with patients.
In children’s services, the paediatric cardiology service had introduced a home monitoring programme for infants following surgery, which allowed them to live safely at home with their families while they recovered and prepared for the second stage of their treatment.
Although most services were providing safe care, inspectors found that improvements were needed in critical care and maternity and gynaecology services at St Thomas' Hospital and surgical services at both Guy's Hospital and St Thomas' Hospital. Across the trust most services were responsible for their own governance arrangements. While there was some oversight by the board, inspectors found that there was an over reliance that issues were being addressed at a service level.
The report highlights a number of areas of outstanding practice including:
- The trust had developed a dementia training film Barbara's story, to raise awareness of dementia and see it from the patient's perspective, which had changed the way staff carried out their role. The film has been used by other health providers.
- The Proactive Care of Older People Service (POPS), provided specific care for patients aged 65 years and above to improve their medical health before and after surgery through continuous assessment and collaborative working with consultants and ward staff.
- In community services, patients' families and people close to them were given a leaflet that provided clear information about the dying process to help them understand the signs of a dying person, why some interventions were stopped and what to expect in the final stages of death.
Inspectors also identified areas for improvement which included:
- The trust must improve links between directorates responsible for surgical activity to ensure learning and concerns from incidents are shared. The trust should continue to improve governance and assurance systems and reduce the backlog of complaints and investigations into serious incidents. The Care Quality Commission will present 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.
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