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Provider: Imperial College Healthcare NHS Trust Requires improvement

On 23 July 2019, we published a report on how well Imperial College Healthcare NHS 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

Requires improvement

Updated 23 July 2019

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

  • We rated safe and responsive as requires improvement, effective and caring as good.
  • We rated well-led for the trust overall as good.
  • The rating of well-led improved since our last inspection, but the ratings for each of the other key questions remained the same.
  • The ratings for each of the trust’s acute locations remained the same, except for Queen Charlottes and Chelsea Hospital where the rating had improved.
  • Our decisions on overall ratings consider, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.

St. Mary’s Hospital

  • Our rating of hospital stayed the same. We rated it as requires improvement because safe and responsive required improvement, but effective, caring and well-led were good.

  • The hospital improved its rating of well-led since the last inspection, but the ratings for each of the other key questions remained the same.
  • We inspected Critical Care as part of this inspection to check if improvements had been made. The rating of the service had remained the same. We rated it as good because safe, effective, caring, responsive and well-led was good. The rating for responsive went up, and the ratings for safe, effective, caring and well-led remained the same.
  • We inspected the Maternity service as part of this inspection to follow-up on concerns we had from the previous inspection in October 2017. We found that the service had improved, and the rating of the service went up. We rated it as outstanding, because caring and responsiveness was outstanding, and safe, effective and well-led were good. The rating for safe, caring, responsive and well-led went up and the rating for effective remained the same.
  • We inspected Children’s and young people’s services as part of this inspection to check if improvements had been made. The rating of the service had remained the same. We rated it as good because effective, caring, responsive and well-led was good, however safe required improvement. The ratings for safe, effective, caring, responsive and well-led all remained the same.
  • We inspected Urgent and emergency care in November 2017 to check if improvements had been made. Our rating of the service stayed the same. We rated it as requires improvement because safe, effective, caring, responsive and well-led required improvement. The rating for well-led improved but the ratings for each of the other key questions remained the same.
  • We inspected Surgery in November 2017 to check if improvements had been made. Our rating of the service stayed the same. We rated it as requires improvement because safe and responsive required improvement and effective, caring and well-led were good. The rating for well-led improved but the ratings for each of the other key questions remained the same.
  • We inspected the Medical care (including older people’s care) service in October 2017 because we had concerns about the quality of the service. Our rating of the service stayed the same. We rated it as requires improvement because safe and responsive required improvement, and caring and well-led were good. The ratings for each of the key questions remained the same.
  • We inspected the Maternity service in October 2017 because we had concerns about the quality of the service. Our rating of the service went down. We rated it as requires improvement because safe, responsive and well-led required improvement, and effective and caring were good. The ratings for safe, responsive and well-led went down and the ratings for each of the other key questions remained the same.
  • We inspected the Outpatients and diagnostic imaging service in May 2017 to check if improvements had been made. Our rating of the service significantly improved. We rated it as good because safe, caring and well-led were good and responsive required improvement. We did not rate effective. The rating for responsive improved and the rating for well-led significantly improved. The ratings for each of the other key questions remained the same.

Charing Cross Hospital

  • Our rating of services stayed the same. We rated it them as requires improvement because safe, responsive and well-led required improvement, but effective and caring were good.

  • The hospital ratings for safe, effective, caring, responsive and well-led remained the same.
  • We inspected Critical care as part of this inspection to check if improvements had been made. Our rating of the service went up. We rated it as good because safe, effective, caring, responsive and well-led were good. The ratings for safe, effective, responsive and well-led all went up, the rating for caring stayed the same.
  • We inspected Urgent and emergency care in November 2017 to check if improvements had been made. Our rating of the service went down. We rated it as requires improvement because safe, effective, responsive and well-led required improvement, and caring was good. The rating for safe, responsive and well-led went down, and the ratings for each of the other key questions remained the same.
  • We inspected Surgery during in November 2017 to check if improvements had been made. Our rating of the service stayed the same. We rated it as requires improvement because safe and responsive required improvement, and effective, caring and well-led were good. The rating for well-led improved and the ratings for each of the other key questions remained the same.
  • We inspected the Medical care (including older people’s care) service in October 2017 because we had concerns about the quality of the service. Our rating of the service improved. We rated it as good because safe and responsive required improvement; well-led was good, and caring and effective were outstanding. The ratings for effective, caring and well-led improved and the ratings for each of the other key questions remained the same.
  • We inspected the Outpatients and diagnostic imaging service in May 2017 to check if improvements had been made. Our rating of the service improved. We rated it as requires improvement because safe, responsive and well-led were required improvement, and caring was good. The ratings for responsive and well-led improved; the rating for safe went down. We did not rate effective.

Hammersmith Hospital

  • Our rating of Hammersmith Hospital stayed the same. We rated it as requires improvement because safe, responsive and well-led require improvement and effective and caring were good.

  • The ratings for each of the key questions remained the same since our last inspection.
  • We inspected Children and Young People’s services as part of this inspection to check if improvements had been made. Our rating of the service went up. We rated it as good because safe, effective, caring and responsive was good, and well-led required improvement.
  • We inspected Critical care as part of this inspection to check if improvements had been made. Our rating of the service went up. We rated it as good because safe, effective, caring and responsive was good, and well-led required improvement. The rating for safe, effective and responsive went up and the rating for caring and well-led remained the same. The rating for effective had improved, and the ratings for safe, caring, responsive and well-led remained the same.
  • We inspected Surgery in November 2017 to check if improvements had been made. Our rating of the service improved. We rated it as good because effective, caring, responsive and well-led were good, and safe required improvement. The rating for responsive and well-led improved and the ratings for each of the other key questions remained the same.
  • We inspected the Medical care (including older people’s care) service in October 2017 because we had concerns about the quality of the service. Our rating of the service stayed the same. We rated it as requires improvement because safe and responsive required improvement, and effective, caring and well-led were good, the rating for well-led improved and the ratings for each of the other key questions remained the same.
  • We inspected the Outpatients and diagnostic imaging service in May 2017 to check if improvements had been made. Our rating of the service significantly improved. We rated it as good because safe, caring and well-led were good and responsive required improvement. The ratings for responsive improved and the rating for well-led significantly improved; the rating for safe went down. We did not rate effective.

Queen Charlottes and Chelsea Hospital

  • Our rating of services improved. We rated it them as outstanding because caring and responsive was outstanding and safe, effective and well-led were good.

  • The ratings for safe, caring, responsive and well-led had improved since our last inspection in 2014. The ratings for effective had remained the same.
  • We inspected Maternity services as part of this inspection to check if improvements had been made. We had previously inspected this service as part of the Maternity and Gynaecology services, so this was the first time we rated this service as a standalone Maternity service. We rated the service as outstanding because caring and responsive was outstanding with safe, effective and well-led being good.
  • We inspected Neonatal services as part of this inspection to check if improvements had been made. Our rating of the service had improved. We rated the service as good because caring was outstanding with safe, effective, responsive and well-led being good.

Inspection areas

Safe

Requires improvement

Updated 23 July 2019

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

  • The trust did not always manage infection control risks appropriately, for example in children’s and young people’s services, we found a cross contamination risk when staff did not always wash their hands when moving between different clinical environments.
  • The trust did not always assess risks to the safety of patients in a timely way to support them to stay safe, for example, in critical care venous thromboembolism risk assessments were not always completed for all patients in the acute respiratory unit.
  • The trust did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Some core services did not meet the trust vacancy rate targets.
  • The trust provided mandatory training in key skills to all staff, but rates of completion were variable between the core services.
  • In some areas, the premises and equipment were unsuitable for the service being provided.
  • The trust had improved in its management of patient safety incidents, however learning from these incidents were not always shared appropriately to all staff groups in all core services.

However:

  • Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • The service planned for emergencies and staff understood their roles if one should happen.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Effective

Good

Updated 23 July 2019

Our rating of effective remained the same. We considered the current ratings of services not inspected this time. We rated effective as good because:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff gave patients enough food and drink to meet their needs and improve their health.

Caring

Good

Updated 23 July 2019

Our rating of caring remained the same. We considered the current ratings of services not inspected this time. We rated caring as good because:

  • Services at Queen Charlotte and Chelsea Hospital had improved and were especially focussed on involving the patient in all aspects of their care and treatment. Staff cared for patients with increased compassion and showed sensitivity. The services provided far-reaching emotional support to patients and their families.
  • Feedback from patients across the trust confirmed that staff treated them well and with kindness.
  • Staff across the trust involved patients and those close to them in decisions about their care and treatment.
  • Staff across the trust provided emotional support to patients to minimise their distress.

Responsive

Requires improvement

Updated 23 July 2019

Our rating of responsive remained the same. We considered the current ratings of services not inspected this time. We rated responsive as requires improvement because:

  • Services were not consistently planned and provided in a way that met the needs of local people.
  • People could not be assured of being able to access services in a timely way. Arrangements to assess, admit, treat and discharge patients did not meet national standards.
  • The trust consistently did not meet national targets for waiting times.

However:

  • The trust took account of patients’ individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

Well-led

Good

Updated 23 July 2019

Our rating of well-led improved. We rated it as good because:

  • The leadership, governance and culture of the trust promoted the delivery of high-quality person-centred care.

During this inspection we found the trust had made improvements in leadership, culture, engagement and management of risk, issues and performance. (See the ‘Is this organisation well-led?’ section below for detailed information).

Assessment of the use of resources

Use of resources summary

Good

Updated 23 July 2019

Combined rating