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Provider: University College London Hospitals NHS Foundation Trust Good

On 11 December 2018, we published a report on how well University College London Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Good  
  • Combined rating: Good  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Good

Updated 11 December 2018

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

  • We rated effective, caring and responsive as good, and safe as requires improvement.
  • We rated well-led for the trust overall as good.
  • We rated 10 of the 11 services inspected as good. In rating the trust, we also took into account the current ratings of the services not inspected this time.
  • The trust managed patient safety incidents well. Staff recognised incidents and reported them appropriately. There were systematic and established systems in place for reporting, investigating and sharing learning from incidents and near-misses.
  • Staff followed national professional standards and guidelines to achieve the best possible outcomes for patients receiving care and treatment. Audits and quality outcomes were conducted at departmental level to monitor the effectiveness of care and treatment.
  • Different groups of staff worked together as a team to benefit patients. Medical staff, nurses, midwives and allied health professionals supported each other and worked collaboratively to deliver effective, patient-centred care.
  • Patients and their families were treated and cared for with compassion, patience and respect. Feedback from patients about their experience of care was consistently positive.
  • Services were planned and provided in a way that met and supported the needs of local people, including those with complex or additional needs. The trust worked closely with the commissioners, clinical networks, patients and other stakeholders to plan the delivery of care and treatment.
  • There was a positive and friendly culture. Staff told us that they were proud to work for the trust and were well supported by their colleagues.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Leaders were knowledgeable about service performance, priorities, as well as challenges and risks.
  • There was a strong culture of improvement, research and innovation. There was a commitment to improving services by learning both when things went well and when they went wrong. Safe innovation and team success was celebrated.

However:

  • The trust failed to reach key national performance targets for example the 62-day cancer and four-hour ED targets, where performance also fell below the England average.
  • BME staff were not well represented in senior positions in the trust. Board members recognised that they had work to do to improve diversity representation across the trust at a senior level.
  • The trust did not have a fully collaborative approach with its NHS mental health partner trust to ensure the best patient pathways for patients living with mental health conditions.
  • Mandatory training in key skills for medical staff fell below the trust’s target for compliance.
  • We observed a number of lapses in good infection prevention and control measures including some staff not following trust procedures and the cleanliness of the environment and equipment in some areas presented an infection control risk.
  • Whilst we saw many examples of good practice in relation to medicines management, the trust’s policies for safe storage and management of medicines were not always followed consistently.

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 – www.cqc.org.uk/provider/RRV/reports.

Inspection areas

Safe

Requires improvement

Updated 11 December 2018

Our rating of safe stayed the same. We took into account the current ratings of services not inspected this time. We rated it as requires improvement because:

  • Mandatory training in key skills for medical staff fell below the trust’s target for compliance.
  • We observed a number of lapses in good infection prevention and control measures including some staff not following trust procedures and the cleanliness of the environment and equipment in some areas presented an infection control risk.
  • Whilst we saw many examples of good practice in relation to medicines management, the trust’s policies for safe storage and management of medicines were not always followed consistently.
  • There were not always enough appropriately qualified staff to meet national professional standards.

However:

  • The hospital had systematic and established systems in place for reporting, investigating and acting on incidents and serious adverse events. There was an open culture of reporting, and learning was shared with staff to make improvements.
  • The trust had made several improvements to the emergency department to provide a better and safer patient experience including improving consultant cover and how effectively the department managed sepsis.
  • Staff understood how to protect patients from abuse and there were effective systems in place to protect people from harm.

Effective

Good

Updated 11 December 2018

Our rating of effective stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Staff followed national professional standards and guidelines to achieve the best possible outcomes for patients receiving care and treatment. There was an effective process and system in place to ensure guidelines and policies were updated and reflected national guidance and improvement in practice. Audits and quality outcomes were conducted at departmental level to monitor the effectiveness of care and treatment.
  • Different groups of staff worked together as a team to benefit patients. Medical staff, nurses, midwives and allied health professionals supported each other and worked collaboratively to deliver effective, patient-centred care. We observed good team working amongst staff of all levels.
  • The service made sure staff were competent for their roles. Staff were encouraged to undertake continuous professional development, so the trust was ensured staff were competent for their roles and were able to provide an effective service.

Caring

Good

Updated 11 December 2018

Our rating of caring stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Patients and their families were treated and cared for with compassion, patience and respect. Feedback from patients about their experience of care was consistently positive.
  • Feedback from patients confirmed that staff treated them with respect and with kindness and our observations of interactions between staff and patients and relatives showed staff were sensitive and respectful.
  • Most patients we spoke with said they felt involved in their care and had the opportunity to ask questions. We observed staff listening to patients and discussing aspects of their care.

Responsive

Good

Updated 11 December 2018

Our rating of responsive stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • Services were planned and provided in a way that met and supported the needs of local people, including those with complex or additional needs. The trust worked closely with the commissioners, clinical networks, patients and other stakeholders to plan the delivery of care and treatment.
  • The service took account of patients’ individual needs. Staff used flags on the electronic patient wards boards to indicate if a patient was at risk of falling, was living with dementia, had a risk of developing pressure ulcers or needed assistance at meal times. This helped improve care by making sure patients got the attention and support they needed.

However:

  • Patients sometimes experienced delays in accessing care and treatment and were not always able to contact the trust to discuss or rearrange outpatient appointments.
  • The trust failed to reach key national performance targets for example the 62-day cancer and four-hour ED targets, where performance also fell below the England average.

Well-led

Good

Updated 11 December 2018

Our rating of well-led stayed the same. We took into account the current ratings of services not inspected this time. We rated it as good because:

  • The trust had an experienced leadership team with the skills, abilities, and commitment to provide high-quality services. Leaders at every level were visible and approachable and demonstrated a clear understanding of the trust’s issues, challenges and priorities.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation. We saw multiple examples of where research was being used to improve care and treatment for patients.
  • The leadership team had a clear vision and strategy and there were action plans in place to achieve this.
  • Staff told us that they were proud to work for the hospital and were well supported by their colleagues. The trust’s exemplar ward accreditation programme focused on improving patient experience, safety and quality and efficiency and was led by frontline staff.
  • There was a positive and friendly culture. We observed good team working amongst staff.

However:

  • BME staff were not well represented in senior positions in the trust. Board members recognised that they had work to do to improve diversity representation across the trust at a senior level.
  • The trust did not have a fully collaborative approach with its NHS mental health partner trust to ensure the best patient pathways for patients living with mental health conditions.