17.03.15
England’s biggest NHS trust placed in special measures
The NHS Trust Development Authority (TDA) has placed Barts Health NHS Trust into special measures following a damning report from the CQC.
Barts Health, England’s biggest hospital trust, was found to have a culture of bullying and low morale among staff at Whipps Cross Hospital, one of its six sites across London.
Inspectors found that urgent and emergency services, medical care, surgery, end of life care, outpatients and services for children and young people were all ‘Inadequate’. The hospital's critical care and maternity and gynaecology services were rated as ‘Requires Improvement’.
The CQC report states that there were not enough nurses or doctors to ensure safe care was provided and that a reorganisation of staffing in 2013 had a damaging impact.
Staff were found to be overstretched and some agency staff had not been trained properly in their roles.
The report also notes that the average bed occupancy was so high that it was affecting the flow of patients through the hospital, with patients admitted to wards that were not appropriate to their needs. Patients were cared for in recovery areas and others were transferred out of critical care beds, despite their clinical needs.
People who were well enough to leave hospital experienced long delays in being discharged because paperwork had not been completed, or because transport was not ready.
Additionally, the hospital was missing waiting time targets, with some patients waiting more than 18 weeks from referral to treatment.
Chief inspector of hospitals, Professor Sir Mike Richards, said: “Our inspection of Whipps Cross University Hospital has highlighted a number of serious concerns surrounding poor leadership, a culture of bullying, and low staffing which has led to risks to patient safety.
"I note that many of the failings which we found on inspection in November 2013 are still not resolved. In some areas there has been little progress - and this has been affecting the quality and safety of patient care.
"I know that Whipps Cross University Hospital has been through a period of considerable upheaval, with the reorganisation and re-grading of nursing posts in 2013 still affecting morale even now. I do appreciate how unsettling this can be. There is a large section of the population in east London who depend on this hospital and they are entitled to services which provide safe, effective, compassionate and high quality care.
"Barts Health NHS Trust has not given sufficient priority to safety. We found frequent staff shortages and a reliance on agency and locum staff that increased the risk to patients. The trust must get a grip on what is happening here and on the low staff morale.”
The CQC recommended to the NHS TDA that Barts Health be put in special measures due to the challenges the trust faces.
NHS TDA director Alwen Williams said: “The additional support the trust will receive as part of special measures will help them to rapidly make the necessary improvements for patients. The chief inspector of hospitals has highlighted the scale of the challenge ahead and this is an opportunity to ensure the trust has the extra support it needs to meet this challenge.”
As part of its immediate response to feedback from the CQC, Barts Health has already announced that it has begun to strengthen management arrangements at Whipps Cross. In addition, Tim Peachey, the TDA’s associate medical director will also work with the trust to take forward the improvements needed in the quality of services at the site.
The trust’s chief executive, Peter 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.”
Royal College of Nursing (RCN) regional director for London, Bernell Bussue, said: “Today’s report shows the extent of the pressures on staff working at Whipps Cross and the worrying knock on effects for patients in East London. Barts Health urgently needs a workable long term plan to turn round services at the site. A historic culture of bullying must be addressed. Nursing staff at Whipps and across Barts Health need to be valued and supported to provide high quality care to the millions of Londoners who rely on the trust for their healthcare needs.
“The RCN has stated repeatedly that the decision by Barts Health two years ago to cut and downband several hundred nursing posts would jeopardise patient care. It is to our great disappointment that this has proved to be the case. Barts also now has both the highest deficit and highest agency nursing bill in England as well as vacancy rates up around 15%. After what has happened at Barts, cutting jobs and wages can never again be seen as a safe or sustainable way to fix funding shortages in the NHS.”
With a turnover of £1.25bn and a workforce of 14,000, Barts Health NHS Trust is the largest NHS trust in the country.
Its hospitals include St Bartholomew's Hospital in the City, The Royal London Hospital in Whitechapel, The London Chest Hospital in Bethnal Green, Newham University Hospital in Plaistow, Mile End Hospital and Whipps Cross University Hospital in Leytonstone.
(Image source: Katie Collins/PA Wire)
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