Updated 10 February 2023
Barking, Havering and Redbridge University Hospitals NHS Trust is a large provider of acute services, serving a population of approximately 800,000 in outer North East London and Essex. The trust operates from two sites; Queen's Hospital and King George Hospital, with approximately 900 beds across both sites. The trust employs over 8000 permanent staff, sees over 300,000 attendees through their emergency departments and delivers over 7000 babies a year.
This inspection was part of a follow up on our previous system wide review of urgent and emergency care services across the North East London (NEL) integrated care system that was carried out in November 2021. At that time, we identified issues with flow in and through the urgent and emergency (UEC) pathway and had significant concerns regarding the impact of this on safety and quality of care. Due to ongoing concerns regarding the UEC pathway and patient safety, during November 2022 we inspected all four urgent treatment centres (UTC) provided by the Partnership of East London Cooperatives (PELC), and both emergency departments (ED) and medical care provided by Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT).
Subsequent to significant concerns that were identified at these locations, the Commission found that the challenges these services faced were also complicated by wider challenges within the health and social care system. A Quality Summit with NHS England and system wide partners was convened to devise an action plan to address the concerns identified.
Overall summary
- The trust faced continued challenges with access and flow into and out of the emergency department. Patients who accessed the emergency pathway did not always receive timely treatment when needed and were not always cared for in the best place for their treatment needs. Patients in the emergency department could not be moved promptly to specialist wards or mental health facilities due to lack of capacity.
- The trust had declared a serious incident in August 2022 relating to the accuracy of their patient tracking list (PTL), where it was found that patients who should have been on the PTL awaiting an appointment for diagnostic imaging had not been. it was not clear at the time of inspection what the outcome of any clinical harm review was, either in relation to the extent of the harm or the number of people impacted.
- The trust had committed to fostering an open culture where patients, their families and staff could raise concerns without fear. However, some staff did not always feel respected, supported and valued.
- Senior leaders and teams used systems to manage performance. However, they did not always identify and escalate relevant risks and issues, and initiate actions to reduce their impact, in a timely way. The effectiveness of divisional risk management and oversight was variable.
- The trust was improving the way staff could find the data they needed in more easily accessible formats, to understand performance, make decisions and improvements. However, the current information systems were not well integrated, and the use of paper records meant that patient’s records were not completely secure.
However:
- Services had enough nursing staff to care for patients, although there were some gaps in medical staffing provision.
- Senior leaders had the skills and abilities to perform their roles. They understood and managed the priorities and issues the trust faced. They were visible and approachable to staff and patients.
- The trust had a vision for what it wanted to achieve and was developing a strategy to turn it into action, through engaging with relevant stakeholders.
- The trust promoted equality and diversity in daily work and were developing opportunities and strategies for staff career development.
- Senior leaders were reviewing and redesigning governance processes throughout the trust and with partner organisations. The effectiveness in monitoring quality and risk was being assessed and the trust was working to identify how to improve processes.
- The trust planned care to meet the needs of local people and engaged well with other healthcare providers and system partners to plan and manage care.
- There was improved engagement from senior staff in understanding the financial challenges the trust faced.
- Staff treated patients with compassion and kindness. We found examples of staff delivering good care in a difficult working environment. However, ensuring privacy and dignity within the busy environment of the emergency department was not always possible.
- Senior leaders were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.