CQC finds support is needed for London NHS trust’s urgent and emergency care

13 Feb 2023 11:40 AM

A London hospital trust has been rated requires improvement by the Care Quality Commission (CQC), following an inspection undertaken in November.

CQC inspected Barking, Havering and Redbridge University Hospitals NHS Trust to follow-up on its system-wide review of urgent and emergency care services in north-east London’s integrated care system, which was carried out in November 2021.

This latest inspection found Barking, Havering and Redbridge University Hospitals NHS Trust’s urgent and emergency care services at Queen's Hospital, Romford, and King George Hospital, Goodmayes, continued to face significant pressure.

Following the inspection, CQC rated the trust, Queen’s Hospital and King George Hospital requires improvement overall. These ratings are unchanged from ratings CQC previously issued.

However, urgent and emergency care at Queen’s Hospital and King George Hospital were rated inadequate following the inspection. These services were previously rated requires improvement.

Medical care at both hospitals was also inspected. No overall rating was issued for these services, as the inspection only assessed them in respect of their role in supporting the hospitals’ urgent and emergency care.    

Diagnostic imaging at King George Hospital was inspected and rated requires improvement.

Following the inspection, CQC reported its findings to the trust so its leaders know what they must address.

Nicola Wise, CQC deputy director of operations in London, said: 

“The trust’s urgent and emergency care continued to face significant pressure.

“People couldn’t always access the service when they needed it, and there was overcrowding and people receiving care on corridors – which undermined people’s safety and dignity.

“We also found oversight of people waiting for assessment was not always adequate, meaning people were at risk of harm if their condition deteriorated while they waited.  

“These issues had become established because there was insufficient space in other services to where people could be transferred. This also meant people remained in urgent and emergency care when it wasn’t the right setting for their needs.

“We previously told the trust and North East London Health and Care Partnership (the integrated care system covering north-east London) that this was an issue.

“While both organisations have begun to foster collaboration to reduce pressure on the trust’s urgent and emergency care, more work must be done – and this should continue at pace.

“However, there were several areas where the trust was providing good care – and where it was taking successful steps to ensure its services are sustainable and resilient.

“This was grounded in its clear vision of what it wanted to achieve for local people, and it generally had enough staff to help it deliver this.

“We also found staff treated people with kindness and compassion – despite, in some instances, while facing significant pressure.    

“We continue to monitor the trust closely, including through future inspections, to ensure people receive the safe and effective treatment they have a right to expect.”

The inspection found:

• The trust faced continued challenges with access and flow into and out of its emergency departments
• People who accessed the emergency pathway did not always receive timely treatment, and they were not always cared for in the best place for their needs
• People could not be moved promptly from the trust’s emergency departments to specialist wards or mental health facilities, due to lack of capacity
• A clinical harm review undertaken by the trust had not identified to what degree people were harmed or impacted by poor management of its patient tracking list
• 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, or initiate actions to reduce their impact, in a timely way
• The trust was improving how staff could access data to understand performance, make decisions and improvements. However, current systems were not well integrated, and the use of paper records meant that people’s records were not completely secure.

However:

• The trust had committed to fostering an open culture where people, their families and staff could raise concerns without fear
• Services had enough nursing staff to care for people, 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, and they were visible and approachable to staff and people using services
• The trust had a vision for what it wanted to achieve, and it was developing a strategy to turn it into action
• The trust promoted equality and diversity, and it was developing opportunities for staff career development
• Senior leaders were reviewing and redesigning governance processes, including to monitor the quality of its services and manage risks to people
• Care was planned to meet local people’s needs, supported by engagement with other healthcare providers
• There was improved engagement from senior staff regarding the trust’s financial challenges
• Staff treated people with compassion and kindness. However, ensuring their 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.

CQC has told the trust it must address several areas to ensure it is meeting its legal obligations, including:

In Queen’s Hospital’s urgent and emergency services:

• Ensuring people’s privacy and dignity, including those receiving care on corridors
• Improving management of people arriving from the urgent treatment centre.

In King George Hospital’s urgent ad emergency services:

• Ensuring people’s records are accessible to relevant staff
• Ensuring safe medicines management.

In King George Hospital medical services:

• Completing all patient records and assessments accurately and in a timely manner – and ensuring action plans are clearly identified.

In King George Hospital’s diagnostic imaging service:

• Providing adequate information and support for all staff
• Completing a clinical harm review as soon as possible regarding the accuracy of patient tracking list (PTL) data.