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Provider: Whittington Health NHS Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 3 December 2019 to 15 January 2020

During a routine inspection

Our rating of the trust stayed the same. We rated it as good because:

  • We rated effective, responsive, and well-led as good, safe as requires improvement and caring as outstanding.
  • We rated four of the five services inspected as good, and one as requires improvement.
  • In rating the trust, we also took into account the current ratings of the services not inspected this time. We found improvements during this inspection that meant the overall rating for the trust’s community services had now improved from good to outstanding.
  • As an integrated care organisation, the trust was leading the way in the provision of well-integrated community, mental health and acute hospital services. The trust planned services effectively to meet the needs of the local population. For example, the trust had an emergency response ‘Hospital at Home’ team who worked with health and social care partners to prevent patients having to be admitted to the hospital. By investing in community services for elderly patients, the trust had been successful in reducing the number of patients who needed to be readmitted to hospital. As a result, the trust was one of the best performing trusts in the country for emergency readmission rates.
  • The trust had enough staff to care for patients and keep them safe. The trust managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. Staff went the extra mile to make sure their approach was friendly and inclusive. Patients and their families were treated as equal partners and empowered to make decisions about care and treatment.
  • The trust planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access services when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. The trust level leadership team had the appropriate range of skills, knowledge and experience. The trust had effective structures, systems and processes in place to support the delivery of its strategy. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Previous concerns around bullying and harassment had reduced and staff survey involvement and outcomes had improved. Staff were clear about their roles and accountabilities. Overall, the trust engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Not all staff had completed mandatory training in key skills. In some areas, staff did not always control infection risk well. Staff did not always fully assess and record risks to patients with mental health conditions. In some areas, staff did not always follow best practice when storing and disposing of medicines.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website –


CQC inspections of services

Service reports published 20 March 2020
Inspection carried out on 3 December 2019 to 15 January 2020 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 3 December 2019 to 15 January 2020 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 28 February 2018
Inspection carried out on 31 October 2017 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 31 October 2017 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 8 July 2016
Inspection carried out on 8-11 December 2015 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 8 - 11 December 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 8-11 December 2015 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 8-11 December 2015 During an inspection of Community dental services Download report PDF (opens in a new tab)
Inspection carried out on 8-11 December 2015 During an inspection of Community end of life care Download report PDF (opens in a new tab)
Inspection carried out on 8-11 December 2015 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
See more service reports published 8 July 2016
Inspection carried out on 31 October 2017

During a routine inspection

Our rating of the trust stayed the same. We rated it as good because:

  • We rated effective, responsive, and well-led as good, safe as requires improvement and caring as outstanding.
  • We rated two of the trust’s 14 services as good and two as requires improvement. In rating the trust, we took into account the current ratings of the 10 services not inspected this time.
  • We rated well-led for the trust overall as good.

Inspection carried out on 8 - 11 December 2015

During a routine inspection

Whittington Health was established in April 2011 bringing together Islington and Haringey community services with Whittington Hospital’s acute services to form a new Integrated Care Organisation (ICO). Whittington Health provides acute and community services to 500,000 people living in Islington and Haringey as well as other London boroughs including Barnet, Enfield, Camden and Hackney.

The hospital has approximately 320 beds, and is registered across 3 locations registered with CQC: Whittington Hospital (includes community services) , Hanley Primary Care Centre (GP practice and community centre) and St Luke's Hospital (Simmons House) multi-disciplinary MH service for 13-18 year olds with emotional and mental health problems.

We carried out an announced inspection between 8 and 11 December 2015. We also undertook unannounced visits on 14, 15 and 17 December 2015.

We inspected Whittington Health NHS Trust acute hospital, including the right core services: Urgent and Emergency Care, Medicine (including older people’s care, Surgery, Critical Care, Maternity and Gynaecology, Services for children, End of life and Outpatients and diagnostic services.

We inspected Whittington Health NHS Trust CAMHS services, Whittington Health community services for adults, children and young people and families, and patients receiving end of life care.

This was the first inspection of Whittington Health NHS Trust under the new methodology. We have rated the trust as good overall, with some individual core services as requires improvement.

In relation to core services most were rated good with critical care and outpatients and diagnostics rated as requires improvement. Community end of life care and community dental services were rated as outstanding.

Our key findings were as follows:

  • During our inspection we found staff to be highly committed to the trust and delivering high quality patient care.

  • We saw staff provided compassionate and patients were positive about the care they received and felt staff treated them with dignity and respect.

  • The trust had vacancies across all staff groups, but was recruiting staff and staffing levels were maintained in services through the use of bank and agency staff.

  • Staff were aware of how to recognise if a child or adult was being abused and received good support and training from the trust's safeguarding team.

  • The trust had an incident reporting process and staff were reporting incidents and receiving feedback. Learning was shared across ICSU’s which encompassed acute and community service.

  • The Trust had promoted duty of candour and this was seen to be cascaded through the organisation.

  • We observed effective infection prevention and control practices in the majority of areas we inspected.

  • Patient care was informed by national guidance and best practice guidelines and staff had access to polices and procedures.

  • Patients had their nutritional needs met and received support with eating and drinking.

  • There was good team and multidisciplinary working across all staff groups and with clinical commissioning groups, voluntary organisations and social services to deliver effective patient care.

  • We found evidence of good compliance with the World Health Organisation (WHO) surgical safety checklist, with good completion of the three compulsory elements: sign in, time out and sign out.

  • There were processes in place to ensure staff attended training on the Mental Capacity Act 2005 and the majority of staff demonstrated a good practical understanding of this, with variability in some services,

  • Staff understood and responded to the needs of the different population groups the trust served and worked hard to meet the needs of individual patients.

  • Patients were largely treated in timely manner with the trust meeting national access targets and performing higher than the England average, with the exception of the cancer two week wait standard, although it was noted that improvements were being made against that standard.

  • The emergency department (ED) performed better than the average ED in England in the speed of initial assessment, the timeliness of ambulance handover, and the percentage of people staying for more four hours in the department. However, there were times when there were no in-patient beds available and patients remained in ED for a long time.

  • The trust had introduced the ambulatory care unit, which engaged stakeholders across the health and social care economy to avoid unnecessary hospital admissions and transfer their ongoing care needs to the most appropriate provider.

  • Patient flow out of theatres and critical care, impacted on patient movement and service capacity.

  • Executive and non executive members of the trust were visible in most areas, in both acute and community settings.

  • The trust had a clear vision and strategy , the development of this into local strategies were in place in some areas, but were still being developed in some cases.

  • Staff were positive about how their local and senior managers engaged with them.

We saw several areas of outstanding practice including:

At the Whittington Hospital:

  • Whittington Health NHS Trust worked with clinical commissioning groups (CCGs) and other providers to improve the responsiveness of emergency and urgent care services for local people. The Ambulatory Care Centre, which opened in 2014, provided person-centred hospital level treatment without the need for admission.

  • Within he Ambulatory Care Centre we observed good multidisciplinary working across hospital services, including diagnostics, care of the elderly physicians, therapists, pharmacists, and medical and surgery specialities to provide effective treatment and care.

  • Elderly care pathways had been well thought out and designed to either avoid elderly patients having to go to ED or if they do, making sure that their medical and social care needs are quickly assessed.

  • Within the ED there was outstanding work to protect people from abuse. The lead consultant and nurse for safeguarding coordinated weekly meetings attended by relevant trust wide staff to discuss people at risk and to make plans to keep them safe.

  • Within children and young people’s services responsiveness was demonstrated through close working arrangements with community-based services including the ‘hospital at home’ service which ensured that children could expect to be cared for at home via community nursing services.

  • The trust provided ‘Hope courses’ for patients who had been on cancer pathways to get together outside of hospital, and hear from motivational speakers including talks on personal wellbeing, nutrition and recovery care.

  • At Whittington Health community sites:

  • Community teams told us they felt very integrated with the trust hospital services, GPs and nurses. We found examples of shared assessments within community settings, for example joint podiatry and diabetes assessments.

  • Within community dental services we received consistently positive responses from patients, some describing the services as “Life changing” and others rating services as five-star on the NHS Choices website.

  • Within community end of life care we found the service provided outstanding, effective services to children, young people and their families. We saw examples of very good multidisciplinary working and effective partnerships with the local GPs, other providers and hospices.

  • Within community end of life care services we observed exemplary care, delivered with respect and dignity. Everyone we spoke with told us they had entirely positive experiences of the service.

  • Within community end of life services there was a commitment to offering an equitable service across the three boroughs. Data was collected on the patient’s preferred place of death and discussed at a specialist network level.

  • The service worked well with the local hospice to make the best use of day care and hospice at home services in response to patient need.

  • The children’s community palliative care service, Lifeforce, was exceptionally well led. The service was committed, adaptable and flexible to meet the needs of the patients and their families. The term going, ‘over and above’ was used on many occasions to describe the team’s approach to their work.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Trust wide:

  • Review bed capacity to assess capacity across medicine, surgery and critical care to ensure patients are appropriately placed within the correct specialism and enhance hospital flow.

At the Whittington hospital site:

  • Within the Emergency Department (ED) there was not sufficient consultant cover and there were vacant middle grade medical posts, covered by locum (temporary) doctors, which poses a risk to delivery of care and training staff.

  • Within acute outpatient departments the hospital must improve storage of records and ensure patient’s personally identifiable information is kept confidential.

  • Within the acute outpatient setting, departments improve disposal of confidential waste bags were left in reception areas overnight.

  • Within surgery and theatres review bed capacity to ensure patients are not staying in recovery beds overnight.

  • Within critical care the trust must review capacity and outflow of patients. We observed significant issues with the flow of patients out of critical care and found data suggesting 20% of patient bed days were attributed to patients who should have been cared for in a general ward environment. This led to mixed sex accommodation breaches, a high proportion of delayed discharges from critical care and a number of patients discharged home directly from the unit

  • Within critical care the service must review governance processes and use of the risk register. We were concerned there was a culture of underreporting incidents and near misses and the importance of proactive incident reporting be promoted.

  • Within critical care staff did not challenge visitors entering the unit and we were concerned patients could be at risk if the unit was accessed inappropriately.

  • Within maternity services the department must ensure the information captured for the safety thermometer tool is visible and shared with both patients and staff in accessible way.

  • Within maternity the service must ensure the safety of women undergoing elective procedures in the second obstetric theatre and agree formal cover arrangements.

  • Within palliative care the service did not meet the requirement set by the Association for Palliative Medicine of Great Britain and Ireland, and the National Council for Palliative Care related to number of palliative care consultant working at the hospital.

  • Within palliative care services staff were not always aware of patient’s wishes in regards to their ‘preferred place of death’. They did not always record and analyse if patients were cared for at their ‘preferred place of care’.

At CAHMS inpatient services

  • Improve ligature risk assessments and the identification of associated risks

Professor Sir Mike Richards

Chief Inspector of Hospitals

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.