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Three Imperial College Healthcare NHS Trust reports published by CQC
The Care Quality Commission has today (19 October 2017) published three reports relating to services at hospitals run by Imperial College Healthcare NHS Trust: Charing Cross Hospital; Hammersmith Hospitals and St Mary’s Hospital. All of the inspections were carried out in March 2017.
Charing Cross Hospital
Medical care (including older people’s care) at Charing Cross Hospital was rated Good overall by CQC. For being effective and caring it was rated Outstanding. For being responsive and well-led it was rated Good and for being safe it was rated Requires Improvement.
CQC last inspected the medicine and elderly care service in September 2014 as part of our comprehensive inspection programme and rated the service as Requires Improvement.
Our Key findings included:
All staff were actively engaged in activities to monitor and improve qualities and outcomes.
The hospital was the second best performing hospital in the country among the trusts taking part in the Sentinel Stroke National Audit Programme (SSNAP) for the hyper acute stroke unit.
The trust was consistently monitoring and improving their mortality rate and remained in the top five lowest-risk acute trust.
There was a strong, caring and visible-centred culture, which was fully rooted on all the medical wards visited. Staff inspectors spoke to were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
The service provided care that took account of people’s personal, cultural, social and religious needs. Patients and relatives gave positive feedback about the manner and attitude of staff. During inspection people were treatment with kindness and respect by staff from all disciplines.
However, staff did not follow the trust policies and national guidelines in the management and disposal of medicines, including controlled drugs and medical gases. Mandatory training rates for scientific and technical staff (31.4%) were significantly lower than the trust’s 90% target. There was a high usage of nursing bank and agency staff due to the high number of vacancies.
The trust needs to make some improvements. It must:
- Make sure that staff follow the trust’s medicine management policies concerning safe storage of medicines and medical gases.
- Take action to ensure medical wards are meeting mandatory training including the resuscitation training requirements for staff.
CQC last inspected the medicine and elderly care service in September 2014 and rated the service as Requires Improvement.
During this latest inspection inspectors found the overall quality of the medicine and elderly care services had stayed the same, but there were some positive changes. The service was rated as Requires Improvement overall. Being safe and responsive were rated as Requires Improvement, while being effective, caring, and well-led were rated as Good.
CQC’s key findings included:
Signage on site was poor and therefore, there were many visitors and members of the public lost and wondering how to get to their desired location.
The environment on some wards was poor. Staff submitted requests for repairs but the work took a long time to be carried out.
Liquid medicines on two wards did not have a date recorded for when they were opened. One of those medicines was used to relieve severe pain and should be used within 90 days of opening.
The results of the national diabetes audit showed patient experience was rated below the national average and the rate of foot assessments was worse than other services.
Patients could not access the patient advice and liaison service at Hammersmith Hospital. The service was advertised as being available but the office was closed and the telephone number provided was not manned.
The trust must now:
- Ensure all wards and departments follow the trust’s medicine management policies so that medicines are safe for administration to patients. In particular for date checking medicines and storing medicines in refrigerators.
- Improve the proportion of medical staff completing mandatory training, level 2 adult safeguarding training in particular.
St Mary’s Hospital
At St Mary’s Hospital CQC inspected Maternity (inpatient services) and medical care (including older people’s care). Both were rated Requires Improvement overall.
During this inspection the quality of the maternity service had changed from Good to Requires Improvement. Safe, responsive and well-led were rated as Requires Improvement. Being effective and caring was rated as Good.
The overall quality of the medicine and elderly care services had stayed the same as at the previous 2014 inspection; although there had been some positive changes, the service continued to be rated as Requires Improvement overall. Being safe and responsive was rated as Requires Improvement. Effective, caring, and well-led was rated Good.
There were though several areas of Outstanding practice including:
The trust had introduced ‘Side by Side’ for Alzheimer’s patients, an initiative by the Alzheimer's Society which helps people with dementia to access recreational activities. This included arts and crafts, harmony singing and Friday afternoon tea parties.
The trust developed a nutrition pathway called the Nutrition Support in Hospital (NoSH) which was designed to ensure patients particularly people with dementia, received the food and drink they need while in hospital without losing the independence they had before being admitted to the hospital.
The Medicine and Integrated Care Division introduced a nurse-led cirrhosis clinic offering improved screening to patients at high risk of developing of severe complications from substance misuse, such as liver cancer. The clinic recently won the ‘Innovative Project of the Year’ award from St Mungo’s homelessness charity.
Our key findings in maternity included:
The environment was challenging due to the nature of the building and in need of repair.
Between April 2016 and February 2017, 90% of women had a named midwife, which was below target of 100%.
There was limited information available on the wards for women and their relatives about how to make a complaint and how to access the Patient Advice and Liaison Service (PALS).
Two clinical guidelines were out of date.
Only 84% of midwifery staff had bereavement training.
There was lack of visibility of executive team and senior leadership team on the floor.
Our key findings in medicine included:
Staff on medical wards were not meeting the trust targets for mandatory training, including safeguarding, resuscitation, and infection prevention and control.
Medical wards were not meeting targets for MRSA screening set by the trust.
The vacancy rate for nursing staff across medical wards at St Mary’s Hospital was significantly higher than the England average.
Inspectors noted that a number of medications checked on the medical wards had passed their expiry date, and some wards were not following the trust policy on refrigerator temperatures.
Staff we spoke with stated that security could be slow to respond to incidents, and there were concerns this could result in staff being more exposed to aggressive or threatening patients.
However in maternity services: staff had good understanding of the major incident and fire safety plans; consent to care and treatment was obtained in line with legislation and guidance; staff were conscious of the need to protect the dignity and privacy of women in all areas of the service.
In the medicine service: Patients were very positive about their experiences on the medical wards, particularly regarding their interactions with staff. Inspectors observed positive interactions between staff and patients throughout the medical wards visited; the introduction of complaints investigators had much improved response times and the quality of investigations for complaints.
The trust must now:
- Ensure the maternity and medical service follows the trust’s medicine management policies so that medicines are safe for administration to patients. In particular for date checking medicines and storing medicines in refrigerators.
- Improve compliance with its mandatory training for all staff.
- Take action to ensure medical wards are meeting resuscitation training requirements for their staff.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“We saw several areas of outstanding practice at Charing Cross Hospital. Without exception, patients told us they were treated with kindness, dignity, respect and compassion. There was a high standard of care provided for patients on the medical wards, and we saw that staff went to great lengths to respect and accommodate the wishes of patients and their loved ones. There was a strong, caring and visible-centred culture, which was fully rooted on all the medical wards visited. Staff we spoke to were highly motivated and inspired to offer care that was kind, respectful and promotes people’s dignity. Staff consistently considered people’s personal, cultural, social and religious needs and delivered kind and compassionate care."
“At Hammersmith Hospitals staff told us patient transport between sites was a problem and patients were unhappy about the length of time they waited for transport between sites and for going home after treatment. Staff told us executive directors did not often visit the site. However, the service managed patient safety incidents well. Staff received feedback from incidents they had reported. Learning from incidents was included in a staff bulletin, which was circulated to staff in the medicine and integrated care division. Results of patient safety monitoring were displayed on ward noticeboards for patients and visitors."
“While there were some examples of Outstanding care at St Mary’s Hospital there are areas for improvement and I look forward to standards improving across the hospital in due course.”
You will be able to read the reports in full on our website.
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- Last updated:
- 18 October 2017
Notes to editors
Imperial College Healthcare NHS Trust provides acute and specialist healthcare for a population of around two million people in north-west London and the surrounding areas. The trust has five hospitals Charing Cross, Hammersmith, Queen Charlotte’s & Chelsea, St Mary’s and the Western Eye. Charing Cross Hospital is an acute general teaching hospital located in Hammersmith, London.
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to people’s needs?
- Are they well-led?