The NHS’s largest hospital trust in England is being put into special measures after inspectors uncovered an array of serious problems at one of its hospitals, including poor A&E care, a lack of staff, poor morale and a culture of bullying and harassment.
They also found patients facing long waits for treatment, some not receiving painkillers when they needed them, over-stretched employees, an over-reliance on agency staff, substandard treatment of terminally ill patients and too little priority given to patient safety.
Barts Health in London has become the latest trust to face such tough regulatory action after inspectors from the Care Quality Commission (CQC) judged Whipps Cross hospital in east London to be “inadequate” in many key areas.
In one of the most critical reports into a hospital issued by the CQC, it has listed no fewer than 15 areas in which Whipps Cross has been told to make urgent and significant improvements. The trust’s entire leadership recently announced its departure.
Whipps Cross is the 20th hospital trust in England to be placed into “special measures” after a crackdown on quality of care following the publication of Robert Francis QC’s report in February 2013 into the Mid Staffordshire hospital scandal.
Whipps Cross is part of Barts Health, England’s largest NHS hospital trust. Its chief executive, Peter Morris, and chief nurse, Prof Kay Riley, announced their resignations last month soon after the trust reported a £93m deficit. Its hospitals have also been struggling to meet key NHS waiting time targets, including treating A&E patients within four hours and giving patients planned treatment, such as elective surgery, within 18 weeks of being referred by their GP.
The trust’s chair, Sir Stephen O’Brien, announced last Friday that he too was stepping down. Barts Health also runs Barts hospital, the Royal London hospital and Newham General hospital, and the helicopter emergency medical service in the capital.
The NHS Trust Development Authority (TDA), which oversees the more than 90 hospital trusts that have not become semi-independent foundation trusts, decided that Barts Health’s problems were so deep-seated that special measures were required to drive through the necessary changes.
In a scathing assessment, the CQC reported it had found:
- “a culture of bullying and harassment”
- that “morale was low” and that “the decision in 2013 to remove 220 posts across the trust and down band several hundred more nursing staff has had a significant impact on morale and has stretched staffing levels in many areas”
- that “staffing was a key challenge across all services”
- poor implementation of a new IT system “had impacted on patient safety and care” and “patients were struggling to get appointments and be recognised as needing care and treatment”
- in A&E “there were delays in patients being assessed and in handovers taking place for patients who arrived by ambulance” and some patients were seen by the CQC to have received what it called “sub-optimal care”.
In response to the report, Morris said: “Barts Health is committed to ensuring the safety and welfare of every one of its patients. This report describes services that fall a long way short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the trust has a big challenge ahead.”
The 45-strong team of CQC inspectors who spent six days at Whipps Cross last November found that many of the improvements they had recommended after visiting it a year before had not been made. Many of the 400 staff who spoke to the CQC during their recent visit were highly critical about working conditions at the hospital, especially the lack of personnel, and its management and leadership.
“Much has been done but we recognise that more needs to be done. We will take all the necessary steps to raise quality standards at Whipps Cross. The CQC has made clear that this report is in large measure the result of what inspectors were told by our staff,” added Morris.
The special measures regime will involve the trust strengthening its leadership team at Whipps Cross and ensuring rapid improvements to quality of care. It will get its own dedicated managing director, nursing director and medical director to help implement the improvements.
On top of that, Dr Tim Peachey, an associate medical director at the TDA, will start working with Barts Health “to help shape the quality improvement plan for Whipps Cross”. The trust said: “Dr Peachey brings a wealth of clinical experience as a consultant in anaesthesia at the Royal Free London NHS Foundation Trust, and as chief executive officer of Barnet and Chase Farm Hospitals NHS Trust prior to its acquisition by the Royal Free London in July 2014.”