12 February 2019
Barts Health NHS Trust is one of the largest NHS trusts in the country, having been formed by the merger of Barts and the London NHS trust, Newham University Hospital NHS Trust and Whipps Cross University Hospital NHS Trust in April 2012. The trust serves a population of over 2.6 million and growing in the area of east London, characterized by significant diversity and health inequalities.
The trusts’ group of hospitals provide specialist and acute health services that treat almost one million individual patients each year. The trust accounts for 1.5 percent of hospital activity in England.
The Royal London Hospital in Whitechapel is a major teaching hospital providing local and specialist services. Housed in the largest PFI building in the country, the hospital has renowned trauma team, and is the home of the London Air Ambulance. The Royal London Hospital also houses one of the largest children’s hospitals in the UK, a major dental hospital, and leading stroke and renal units.
Whipps Cross University Hospital in Leytonstone is a busy general hospital with a range of services that serves a large ageing population.
Newham University Hospital in Plaistow is also a busy general hospital that includes a specialist orthopaedic centre.
Mile End Hospital is a shared facility from where the trust provides rehabilitation, outpatient, x-ray and community services.
St Bartholomew’s Hospital in the City, and London’s oldest hospital, is the largest cardiovascular centre in the UK and the second largest cancer centre in London.
The trust has nine other locations registered with CQC, including two stand-alone birthing centres and a number of dental and primary medical service locations. Across its multiple sites the trust has 1706 general and acute beds, 220 maternity beds and 177 critical care beds. The trust employs over 16000 staff and has a turnover of £1.4billion.
12 February 2019
Our rating of the trust stayed the same. We rated it as requires improvement because:
- All three hospitals we inspected on this occasion were each rated requires improvement overall.
- Services at Whipps Cross University Hospital had improved. The previous Section 29a Warning Notice (Health and Social Care Act 2008), issued to the surgery service had been addressed. We rated the hospital as good in the effective and caring domains, and requires improvement in the safe, responsive and well-led domains.
- The Royal London Hospital saw improvements across the services we inspected. We rated the hospital good in the effective and caring domains, and requires improvement in the safe, responsive and well-led domains.
- We were disappointed to find that concerns in the maternity services at Newham University Hospital persisted and rated the service inadequate overall and issued the trust a Section 29a Warning Notice (Health and Social Care Act 2008) to address our concerns of poor quality care and leadership. We also rated the diagnostic service inadequate for the well-led domain. Overall, we rated the hospital requires improvement in the safe, effective, responsive, and well-led domains. Caring was rated as good.
- We aggregated the rating for each domain at each location and then subsequently collated the overall aggregation to determine the trust rating across the safe, effective, caring and responsive domains. The effective and caring domains were aggregated as good, whereas the other domains were aggregated as requires improvement.
- Between 9–11 October we carried out a ‘well-led’ review of the trust. Despite recognition there remained areas for improvement, partly evidenced by the concerns we found in maternity and diagnostics services at Newham University Hospital, we found demonstrable improvements to the leadership, governance and culture of the organisation and determined the trust well-led domain as good overall.
- A follow up inspection of maternity services at Newham University Hospital on 14 and 15 January 2019 assessed progress in response to the Section 29a Warning Notice we issued to the trust. We found that appropriate steps to address these concerns had been taken and there was evidence of improvement to the safety and governance of the service.
16 January 2017
Essential elements to keeping the service safe were being routinely collected and regularly monitored. Individual assessments monitored specific areas of patient risk although subsequent action plans had not always been documented. The trust had taken appropriate action over safeguarding concerns that had been raised and had acted on poor practice.
Referrals came from the trust’s local acute hospital and consultants worked across both sites for continuity of care. Therapy teams worked with patients and their families towards more independent living and the service was hoping to improve upon discharge processes and had taken on a discharge coordinator.
We observed staff and patients interacting in a positive way. All of the patients we spoke with were positive about the friendliness of staff and their readiness to offer help and support. We also came across examples where people had not been treated or spoken to with due dignity and respect. Senior staff had recently taken action on this and expressed a desire to raise standards of kindness and compassion.