To receive a summary from Care Quality Commission compliance managers of recent inspections of Queen’s and Whipps Cross Hospitals.
Note: Officers from Barking, Havering and Redbridge University Hospitals NHS Trust and Barts Health NHS Trust will be in attendance to give a response.
Minutes:
Care Quality Commission (CQC) compliance officers explained that the A&E at Queen’s Hospital had been inspected in May 2013 by a team consisting of A&E consultants and Experts by Experience who were trained members of the public. The main concerns identified had been over patient care and welfare and over staffing issues. Similar concerns had been raised in the CQC’s previous inspection in December 2012.
It was accepted that staff now gave more time and attention to people waiting in A&E. Nursing staff levels were acceptable but there were not enough permanent consultants in A&E and this had been the position for the last two years. Patient feedback about A&E staff was now more positive and a recent inspection of five elderly care wards at King George Hospital had found that staff there knew the patients and their needs.
A series of inspections had also recently been carried out across Barts Health looking at areas including A&E, outpatients and maternity. This had found that the Trust was not meeting ten of sixteen essential standards. Poor staff attitudes had been found in Whipps Cross maternity and warning notices had been issued over areas such as baby resuscitation units not being ready for use.
Inspectors had also found that elderly patients were not always getting pain relief and that handover of patients from ambulances at the Whipps Cross A&E and Urgent Care Centre was not good enough. A lack of equipment had been noted on elderly wards and warning notices issued concerning a lack of staff appraisals and supervision.
The Chairman noted that there was now a new maternity unit at Whipps Cross and this had recently been visited by members of the Committee.
Following the Francis Report, the CQC recognised that hospital inspections had to be more in-depth. As such, larger inspections teams were being formed that would be on site at a hospital for 5-7 days. Listening events would be held with the public and the CQC would publish performance ratings for hospitals from April 2014. Failing Trusts could be referred to the Trust Development Authority for the implementation of a failure regime. A new inspection of BHRUT was due to commence on 14 October with a listening event in Ilford scheduled for 15 October.
Response from Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT)
The BHRUT officer was pleased that elderly care at King George had recently received a good assessment from the CQC. It was accepted that ther remained a lot of challenges in the Emergency Department and this was a long-standing issue. Current performance on the four-hour rule at Queen’s A&E was only 88%.
Overall attendance numbers at Queen’s A&E were about the same but cases received had got more serious. There had been an increase of 15% in the number of ambulances coming to A&E and a total of 32 ambulances had been received at Queen’s in a 2 hour period the previous Saturday.
There was a national shortage of A&E doctors and BHRUT had lost four further consultants from A&E in the last three months. Recruitment was currently in progress to a series joint appointments with Barts Health but only 7 of 21 A&E consultants across both sites were filled by permanent staff. Work was also in underway with UCL partners to increase recruitment options.
Plans had been drawn up to improve the A&E department at Queen’s which was now seeing in excess of 130,000 patients per year despite having been built for only 90,000 patients. Seven day working had commenced from September 2013 for the frail elderly, gastroenterology, and chest medicine departments. Care planning and discharge procedures had also improved.
The CQC had raised concerned about staffing on both sites and it was confirmed that the London Clinical Senate had advised against the proposed night closure of A&E at King George. Staffing levels in A&E were reviewed by senior officers on a weekly basis.
Response from Barts Health NHS Trust
Following criticism of cleanliness by the CQC, all senior staff in maternity had received enhanced training on how to inspect cleaning. All midwives and support staff had also received enhanced training in infection control. Maternity equipment was now replaced in a more timely fashion and Whipps Cross now had two brand new maternity operating theatres and new high dependency beds. Two bereavement suites had also recently been opened. Officers agreed that poor staff attitudes reported by the CQC had not been acceptable and action plans had been drawn up to address this.
More doctors and nurses had been recruited to the A&E department at Whipps Cross and a new Acute Assessment Unit had been opened ten days previously. It was also planned to improve the hospital discharge process.
Whipps Cross had received good scores on patient satisfaction and on the friends and family test. Officers felt it was also important to ensure staff felt valued by Barts Health.
A lot of work was being undertaken on the hospital cleaning contract. Work was done in partnership with commissioners, the Trust Development Authority and Healthwatch. This also meant there were regular peer review inspections across the Barts Health sites. A new Care Campaign at Whipps Cross ensured team meetings were in place and appraisal rates had been raised.
Questions and discussion
CQC officers were disappointed that some Members had not received details of the planned listening event and agreed to circulate details of this. Members did feel that some local hospital services e.g. maternity at Queen’s had improved and that there should be more media coverage of positive developments in the NHS.
Members also reported very mixed feedback of other services such as the elderly care wards at Whipps Cross. Issues such as a lack of timely administering of pain relief had been addressed some years previously but were now reoccurring. The CQC representative agreed, having found that patients were not appropriately cared for at the Urgent Care Centre at Queen’s and that, in some cases, patients should have been referred to A&E sooner.
Barts Health officers emphasised that they were not trying to defend bad behaviour on wards. While most staff were good, it was also important to eliminate bad behaviour. The Barts Health merger had created challenges for staff but it was not correct to suggest that Whipps Cross was not a major focus for Barts Health. Members felt that not giving pain relief or taking patients to the toilet was simply bad practice. Barts Health officers accepted that some wards were better organised than others and did take these sort of incidents seriously when they occurred.
Officers accepted Members’ reports of staff attitudes being variable at best. It was also agreed that it was sometimes unclear who was in charge of a ward etc. Staff should introduce themselves and phones should be answered. It was also accepted that delayed discharge was a problem at Whipps Cross, particularly as Waltham Forest was an elderly borough. This was a shared responsibility across partners.
Smoking cessation was a key priority for both staff and patients at Whipps Cross and offices were disappointed at reports that hospital staff were leaving discarded cigarette butts on the path between the bus stops and the main hospital entrance. Officers would confirm whether Barts Health had spoken to TfL re helping patients or relatives from Redbridge to get to Whipps Cross.
A Member suggested that the CQC should publish advice for Councillors on what to look out for when they visit hospitals and the CQC officers agreed to take this back. Information on what the CQC looked for during its inspections was available on the organisation’s website. It was noted that Healthwatch also had the power to undertake enter and view visits to hospitals. It was also suggested that the CQC programme of inspections should be more widely publicised.
The Committee NOTED the presentation and responses.