Croydon Health Services NHS Trust has been rated Requires Improvement (RI) overall by the Care Quality Commission, the same as its previous rating.
The trust was rated RI for all the main categories CQC rates, for being safe, effective, caring, responsive and well-led, following the inspection in October 2019.
During this inspection CQC visited Croydon University Hospital (CUH) and Purley War Memorial Hospital (PWMH). CQC inspected medical care (including older people’s care) and diagnostic imaging. Inspectors also visited critical care and urgent and emergency care.
CQC’s Deputy Chief Inspector of Hospitals, Nigel Acheson, said:
“At this inspection we found improvements in critical care but medical care (including older people’s care) remains Requires Improvement and urgent and emergency care has gone from Good to RI. The overall rating for caring has gone down from Good to RI.
“Inspectors found problems with the systems for monitoring the quality and safety of care and the trust had not always taken swift effective action in response to concerns raised in some of the services (diagnostic imaging is an example) and provided the support that was necessary to make the improvements.
“Although CQC observed staff being kind and compassionate towards patients the results of the trust’s inpatient survey were very poor.
“The trust was moving towards closer integration with the Clinical Commissioning Group to improve access and services for the people of Croydon. Several joint posts with the CCG had been created including joint chief nurse and chief financial officer. The trust was performing well in terms of access to treatment and had low mortality rates.”
In urgent and emergency care staff were not always identifying and responding to risks and they did not always comply with infection prevention and control procedures.
Some patient records in urgent and emergency care and medical care (including older people’s care) were not fully complete. In all the services inspected some staff had not completed their mandatory training.
Systems to monitor the effectiveness of care and treatment were not always effective and services were not always meeting the national standards for treatment and care. In diagnostic imaging staff were not able to provide evidence of competency.
There was a downward trend in response rates and feedback from patients about services. The trust was assessed ‘as much worse’ when compared with similar trusts for the 2018 inpatient survey a trend which had continued since 2013. Although the trust had developed action plans to address these areas, they had not translated into any significant improvements in the survey results.
In urgent and emergency care there was a lack of privacy for patients in some areas. There was a low response rate to the Family and Friends Test and the number of people who would recommend the service had decreased.
The trust experienced high bed occupancy, 97-99% which meant that some patients were cared for in areas, not always primarily designed for inpatients. Some patients experienced delays in being discharged from critical care.
The trust had a strategy in place which focused on building the ‘One Croydon Alliance’, a partnership between local GPs, Croydon CCG, the local NHS mental health trust, local authority and Age UK Croydon. The aim of which was to build a totally integrated health and care system to improve services for local people. Members of the executive team now had joint posts, however more capacity was required to support them to undertake this cross-sector role whilst focusing on the challenges within the trust itself.
In urgent and emergency care some of the data used to inform the quality and safety of care was inaccurate or unreliable.
However, CQC found improvements in the equipment maintenance and areas we inspected appeared clean. There was good multidisciplinary working in all the services and with external partners.
Following previous inspections, the trust had employed dedicated mental health nurses to support staff care for patients with mental health needs.
Staff in all the services inspected said they were supported and valued by their local leaders and felt they were accessible.
NHS Improvement has conducted a Use of Resources assessment of the trust. The aim of Use of Resources assessments is to understand how effectively providers are using their resources to provide high quality, efficient and sustainable care for patients. Croydon Health Services NHS Trust were rated Requires Improvement for the way it used its resources. The combined quality and resources rating were Requires Improvement.