Improvements still needed after NHS trust inspection

A LONDON NHS trust providing services across Ealing, Brent and Harrow has been told improvements are required by the Care Quality Commission.

Concerns included a lack of basic care standards for children and young people at Central Middlesex Hospital and Northwick Park Hospital’s emergency department, where patients were cared for on trolleys in the corridors.

However, despite these findings, London North West University Healthcare Trust was shown to have made marked improvements since its last inspection.

Following an inspection in July and August, London North West University Healthcare Trust was rated as ‘requires improvement’ for safety, effectiveness, responsiveness and leadership.

It was, however, rated ‘good’ for caring and inspectors found areas of outstanding practice in urgent and emergency services at Northwick Park Hospital.

Developments had also been made to support parents whose children have a fever or suspected infection, and in closer working with the local mental health trust.

England’s Chief Inspector of Hospitals Professor Ted Baker said: “Although the trust remains RI (requires improvement) overall, we found evidence of improvement and a renewed energy and enthusiasm from trust leaders and staff to get things right, though there is still work to do.

“There seemed to be a greater sense of cohesion as a trust rather than people just identifying with the particular location they work in.

“I was disappointed with services for children and young people at Central Middlesex Hospital. There was a lack of clear trust leadership and basic care standards.”

The Trust responded to this by saying: “We are already working to make significant improvements to our processes for children’s outpatient services at Central Middlesex

Hospital. This includes reviewing the pathway for children’s recovery from theatres, to find a dedicated space for our paediatric patients.

“In addition, our children’s board will coordinate the governance of children’s services across all our sites and divisions.”

The Trust also needed to improve delays in discharges, which Mr Baker said was having a negative effect on patient flow.

The inspection also noted the trust did not always control infection risk well.

An example included hand hygiene not consistently being undertaken in maternity, children and young people’s services.

The Rainbow Unit at Central Middlesex Hospital was also found to be untidy and inspectors could not be assured that children’s toys were regularly cleaned.

On infection control, the Trust said: “Our director of infection prevention and control is currently leading a campaign on hand hygiene and appropriate glove usage and we will also be undertaking some targeted work with our teams to improve compliance in this area.”

Due to capacity issues in the emergency department at Northwick Park Hospital, patients were still being cared for on trolleys in the corridor, which meant private conversations could be overheard.

In response to this, the Trust said: “We are the most improved A&E service in London and the third most improved in the country over the last two years for treating patients within four hours.

“However, our emergency department at Northwick Park is also one of the busiest in London, receiving an average of 123 emergency ambulances per day last year.

“On occasion, this does mean that we provide treatment to patients while they are waiting for a cubicle or for a bed.

“Our teams will always prioritise the safety of our patients, but they will go to every effort to maintain their privacy wherever possible. We are always seeking to improve the flow of patients through our emergency department.”

Some medicine storage areas also did not meet national guidance for security for controlled drugs in the Northwick Park surgical service.

The inspection noted patients, families and carers were positive about the care across the service and the CQC observed compassionate and courteous interactions between staff and patients.

A spokeswoman said the Trust was delighted the CQC had recognised improvements across a wide range of its services and the energy and enthusiasm of staff.

She said: “Our two A&E departments at Ealing and Northwick Park Hospitals performed particularly well, receiving ‘good’ ratings for providing safe, caring and well led care.

“We know that there is still much for us to do, but this report clearly shows that we are going in the right direction.”