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Weak leadership at St George's cardiac surgery unit must improve says CQC

7 December 2018
St George's University Hospitals NHS Foundation Trust
  • Media

The Care Quality Commission has warned St George’s University Hospitals NHS Trust that its cardiac surgery unit in Tooting must improve.

CQC carried out a focused inspection at St George’s Hospital on dates in August and September 2018, following concerns about patient outcomes, mortality rates and the culture and leadership of the cardiac surgery unit.

Inspectors found that the leadership of the unit was weak, but was being revised in an attempt to improve the service. CQC found that consultant surgeons mistrusted each other, as did cardiologists, anaesthetists and senior leaders.

Several consultant surgeons said that morale was low. There was a reduction in the number of patients using the service, as high-risk patients were being diverted to other hospitals.

CQC findings included: that there was a lack of cohesion and poor working conditions between surgeons; a culture of not learning from incidents; the quality of mortality and morbidity meetings were poor; multiple patient record systems were problematic; low morale; a lack of ongoing and regular oversight.

England’s Chief Inspector of Hospitals, Professor Ted Baker, said: “Issues such as weak leadership, internal unrest and multiple electronic patient record systems are just some of the problems affecting St George’s Hospital cardiac surgery unit.

“We have told the trust it must now take steps to improve the morale, culture and systems within the unit. Colleagues at NHS Improvement have set up an independent scrutiny panel for cardiac surgery, to advise, challenge and support the trust through this difficult time.

“I expect to see improvements at the cardiac surgery unit and CQC will be monitoring the situation closely. We did note that there were no immediate concerns regarding patient safety, which is our paramount concern at all times.”

The trust must now:

  • Resolve issues relating to the leadership structure and support the service to improve.
  • Review the quality of mortality and morbidity meetings and include evidence of learning and how this is shared.
  • Support staff working in the unit to improve morale and well-being.
  • Review and improve governance systems for the unit.
  • Address cultural issues within the service.

Action the trust should now take include:

  • Reviewing the multiple medical record systems - because there was a risk that patient information might not be accessible.
  • Ensuring all medical staff understand their responsibilities to raise concerns.
  • Ensuring all staff understand and apply the Duty of Candour procedure.

However, CQC did find that comprehensive risk assessment of patients were being carried out. There was an appropriate hospital-wide approach to the detection of deterioration of patients’ health. There was no immediate concerns with regard to patient safety and patients were well prepared for surgery.

An independent scrutiny panel for cardiac surgery, set up by NHS Improvement, was appointed to advise, challenge and support the trust.

You can read the inspection report in full when it is published on CQC website by clicking on this link


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Last updated:
29 January 2019

Notes to editors


St George’s Hospital is in Tooting, south- west London, and is managed by St George’s University Hospitals NHS Foundation Trust. The hospital serves a population of around 1.3 million people in south west London, with services commissioned by Wandsworth, Merton and Lambeth Clinical Commissioning Groups. The trust two hospital locations, St George’s and Queen Mary's Hospitals in Roehampton. Both hospitals are based in the London Borough of Wandsworth.


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.