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England's Chief Inspector of Hospitals has published his first report on the quality of care provided by University College London Hospitals NHS Foundation Trust at University College Hospital.

CQC inspected the hospital, which primarily provides services to people living in Camden, Islington, Barnet, Haringey and Westminster, in November. This inspection focused on services provided by the trust in accident and emergency (A&E), medical care (including older people’s care), surgery, intensive/critical care, maternity, children’s care, end of life care and outpatients. 

Overall, the team of inspectors, including doctors, nurses and specialists, found that services run by University College London Hospitals NHS Foundation Trust were safe, effective, caring, responsive to patients’ needs and well-led. The inspection team saw many examples of good care, and were impressed by the dedication shown by staff and the emphasis at all levels of the trust on putting patients first.

The vast majority of patients were very positive about the care they received, and staff told inspectors that they were proud to work at the trust and proud of the level of care they were able to deliver.

However, the inspection team also noted areas of the hospital where staff were delivering care under pressure and where the environment was not at an appropriate standard.

Following the inspection four compliance actions were issued to the trust, relating to the lack of full completion of the World Health Organisation (WHO) checklist, the safety and suitability of premises in A&E, and recording of care assessments and records management on the acute medical wards.

The WHO checklist, designed to ensure safer surgery, was not always being fully completed. This led to a risk that surgery could be unsafe.

In Accident and Emergency (A&E) staff were delivering safe care in very difficult circumstances. The physical environment was inadequate due to shortage of space, facilities and equipment. Patients were routinely doubled up in cubicles designed for one patient only, which severely compromised their privacy and dignity, and meant that only one patient at a time had access to monitoring equipment. There was a big risk of cross infection due to this practice.

The management of the outpatient clinic was not adequate, resulting in overcrowding and patients being left without seating in busy periods. In addition, the trust was failing to ensure that the paperwork for patients who had been assessed as not requiring resuscitation was always fully completed.

Read the full report on the University College Hospital & Elizabeth Garrett Anderson Wing page.

Areas of good practice identified included:

• The commitment of staff in A&E to good care despite environmental challenges.
• There was a strong consultant presence at all stages of patients’ surgical pathways ensuring decisions on care and treatment were made by the appropriate qualified healthcare professional.
• The outpatients’ clinics for children and young people had procedures in place to check reasons for non-attendance. This safeguarded children who might have missed appointments due to abuse or neglect.
• Areas of good practice in intensive/critical care included good examples of caring, efficient staff showing good multi-disciplinary working; good patient mortality rates and clinical outcomes; daily ward input from microbiologist; psychological support for patients and staff.
• Excellent caring staff on the acute medical wards, including positive caring interactions with patients. Staff provided people with regular information and promoted their involvement in their care. They maintained people’s privacy and dignity and promoted their independence.

Actions that the trust must take to improve included:

• Ensuring full completion in all cases of the WHO surgical checklist to help ensure safe surgery.
• Reviewing the current A&E and children’s A&E provision and assessing what planned improvements can be brought forward or interim measures can be employed to mitigate risks to patient safety.
• In surgery, improving patient flow by alleviating pressure on beds and increasing bed capacity in the operating theatre recovery area.
• Improving the quality, completeness of people’s care assessments, care plans and care delivery records on the acute medical wards to ensure that people do not receive inappropriate or unsafe care, and improving the care and security storage of patient records on acute medical units.
• Ensuring that the paperwork for patients who have been assessed as not requiring resuscitation is always fully completed.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “We found that University College Hospital was generally providing services that were safe, effective, caring, responsive to patients’ needs and well-led. My team saw many examples of good care, and were impressed by the dedication shown by staff, the support provided to staff, and the clear emphasis the trust places on putting patients first.

“The vast majority of patients spoken to were very positive about the care they received, and staff were proud to work at the trust and of the level of care they were able to deliver. The trust has a strong board and clear governance structure which has led to high levels of care being maintained in most areas.

“Despite all the positive things my team found, we also found areas where the trust needed to make improvements.

“We found that the World Health Organisation checklist designed to ensure surgical safety wasn’t always being fully completed. This placed patients at risk of harm.

“We also found that the environment in A&E wasn’t really fit for purpose – despite the staff there working hard to deliver safe care in difficult circumstances – and that improvements were also needed to records management on acute medical wards, and in a number of other areas of care.

“Our judgement is that this is an excellent hospital in many ways – but the failings we identified are preventing it from achieving excellence across the board. The trust has told us it is taking action – and we expect to return in due course to find that the problems have been fixed.”

University College London Hospitals NHS Foundation Trust was one of the first to be inspected under radical changes introduced by the Care Quality Commission which are designed to provide a much more detailed picture of care in hospitals than ever before. As part of the inspection, the team held focus groups with staff and a public listening event.

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit was to develop a plan of action and recommendations based on the inspection team’s findings.

CQC inspectors will continue to monitor University College London Hospitals NHS Foundation Trust and will return in due course to carry out further inspections of all trust services as part of its regulatory programme.

-ENDS-

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143. For general enquiries, call 03000 61 61 61.

Notes to editors

The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike is implementing his new approach to hospital inspection with 18 NHS trusts which represent variation of care across England. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model.

Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.