The Care Quality Commission (CQC) has rated leadership at St George's University Hospitals NHS Foundation Trust as requires improvement following an inspection in February.
The trust provides services from St George's Hospital in Tooting and Queen Mary's Hospital in Roehampton, alongside a range of community services in south west London.
The trust is part of a group with Epsom and St Helier University Hospitals NHS Trust. The two share an executive team and strategy but remain distinct trusts. This inspection looked specifically at the leadership of St George's University Hospitals NHS Foundation Trust.
CQC currently gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level. CQC is consulting on this approach following recent feedback from those in the sector and learning from the reviews by Dr Penny Dash, Sir Mike Richards and the Care Provider Alliance.
CQC previously rated how well-led the trust is as requires improvement in an inspection using its previous methodology for trust ratings.
Antoinette Smith, CQC deputy director of operations in London, said:
“During our well-led inspection of St George's University Hospitals NHS Foundation Trust, we found senior leaders were committed to learning from and improving people’s care, but were struggling to implement some of these improvements or change the trust’s culture, which was very poor in places.
“Some staff didn’t feel safe speaking up when they had concerns, including those which could impact the quality and safety of people’s care. They told us leaders didn’t always act on their concerns, and some described abusive behaviour and discrimination from some leaders against staff based on their race or disability.
“It’s absolutely critical that the trust tackle this as a priority. Everyone should feel respected, and able to speak up and be listened to. Staff have important information to share that can keep people safe.
“Some leaders also told us they’d also had some difficulty merging the trust’s culture and leadership with that of Epsom and St Helier University Hospitals NHS Trust, with whom they now share an executive team.
“We found leaders had missed some opportunities to work together or learn from each other, and we saw disconnects between the executive and front-line leaders. This had slowed down improvements to people’s care, particularly on their maternity wards.
“However, we also saw examples of great partnership working, such as improvements to people’s care in urology, made particularly significant given long waits in urology nationally. St George’s had also embarked on several projects to improve care in their local communities, such as by offering extra services for people with frailty-related conditions, and sought feedback from those communities.
“We’ve shared our findings with the trust’s management, and they’ve shown us their plans to address our concerns. We’ll continue to monitor the trust, including through future inspections, to ensure people are safe while the necessary improvements are made.”
Inspectors found:
- Leaders didn’t always have clear oversight of safety risks, meaning they couldn’t always act quickly to keep people safe.
- More staff contacted CQC anonymously after this inspection with further concerns they didn’t feel safe to raise openly, including a blame culture.
- CQC identified discrimination in recruitment and career progression at a previous inspection, but improvements to this remained ineffective.
- Leaders hadn’t fully embedded the group strategy they published in May 2023, and not all staff understood their place in this to improve services.
However:
- Leaders had worked with other trusts in their area to open a new orthopaedic centre, which helped people spend less time in hospital.
- The trust had a dedicated research and innovation team, involved in over 300 clinical trials to improve people’s healthcare.