Care Quality Commission finds 'poor culture' at Northwick Park's Maternity Department amidst multiple allegations of bullying. Emergency Dept more positive but the hospital still requires improvement

From the Care Quality Commission

The Care Quality Commission (CQC) has told London North West University Healthcare NHS Trust that it must make improvements at Northwick Park Hospital, following an inspection of the maternity service and the emergency department.

CQC carried out an unannounced focused inspection of the maternity service in April in response to information of concern received about the care of mothers and babies in the department. Following the inspection, the overall rating for the maternity service went down from requires improvement to inadequate. The ratings for the safe and well-led domains also went down from requires improvement to inadequate. The caring, effective and responsive domains were not rated during this inspection.

Inspectors also carried out an unannounced focused inspection of the emergency department to follow up on concerns regarding the quality and safety of the service and found that significant improvements had been made. At the time of the inspection in April, the department was under adverse pressure due to the COVID-19 pandemic. The emergency department was not rated during this inspection, so the previous rating of requires improvement remains in place.

The overall rating for Northwick Park Hospital remains unchanged and is requires improvement.

Nicola Wise, CQC’s head of hospital inspection, said:

“We were very concerned by our findings at Northwick Park hospital’s maternity department. There was a poor culture overall and there were multiple allegations of bullying amongst the staff. This is completely unacceptable. Nobody should have to work in an environment where they feel intimidated.

“Staff told us about one consultant who refused to help a junior midwife when asked, and other consultants who went home instead of discharging patients. We were also told about staff shouting at each other, and a midwife shouting at a patient because she could not understand English. A member of staff shouted at one of our inspectors, after mistaking them for a colleague.

“Some staff said they had raised concerns about the poor attitude amongst the senior management team, but that leaders did not listen. Other staff said they were frightened to speak out, for fear of repercussions, and some claimed they had been told by management only to say good things when asked. The knock-on effect of working in such an environment, is that when things go wrong, the fear of being blamed prevents people from raising concerns and reporting incidents, so lessons are not learnt and shared amongst the wider team.

“The executive leadership team is aware of the concerns our inspectors highlighted and we are assured that the team is implementing improvements while seeking support from stakeholders in the local healthcare community. We will keep a close eye on progress and will reinspect to ensure that improvements have been made and fully embedded.

“The situation in the emergency department was more positive. In general, it was well run, with enough staff with the right skills, qualifications, training and experience to keep people safe and provide the right care and treatment. However, nursing vacancies remain a challenge, although the leadership team was in the process of recruiting staff in order to improve the situation. We also pointed out a potential risk in the department that senior leaders were not aware of and need to address.”

Inspectors found the following areas of concern in the maternity department:

• The leadership team of the maternity service at Northwick Park Hospital had been recently established and because they had only been in post for a short time, the new team did not yet have a proper governance structure in place, and was therefore unable to provide assurance that they had the skills and abilities to run the service, or to implement meaningful changes that improved the safety of the service
• Not all leaders were aware of challenges to the service. Some did not know what was on the risk register and there were some longstanding issues that had not been addressed. Staff reported that not all leaders were visible, and they felt leaders did not act in a timely way to address the issues in the service
• The trust reported 13 serious incidents between March 2020 and March 2021, which included eight perinatal (baby) deaths over a five-week period, during July and August last year, which is a very high number over such a short period. The trust escalated this to the North West London Integrated Care System (ICS) for an external review and the trust had an improvement plan in place to address issues identified in the ICS report
• Doctors, nurses and other healthcare professionals did not always work well together as a team or support each other to provide good care. Most staff that inspectors spoke to had concerns about staffing levels and the high use of agency staff. Staff often had to miss lunch breaks as a result of insufficient staff cover
• The trust was unable to provide assurance that it had effective systems in place to ensure that medical and midwifery staff had the competence, skills and experience to safely care for, and meet the needs of, women and babies using the service
• Mandatory training did not meet the trust’s target. Although staff understood how to protect women from abuse, safeguarding training compliance was not always meeting the trust target and domestic violence assessments were not always documented
• Staff did not always complete and update risk assessments for each patient and did not always remove or minimise risks
• The service did not always manage patient safety incidents well. Incidents were not always reported in a timely way or lessons learned shared amongst the wider service
• During the inspection, concerns were raised regarding delays in the induction of labour for women and an allegation that some women were waiting more than 72 hours to be induced. The trust had completed an audit of patient records in April which showed that half of the women were induced within 48 hours, but the other half experienced delays.

In the emergency department, inspectors found:

• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service had enough medical staff to ensure safe care was provided at all times
• Staff felt respected, supported and valued and they were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff, could raise concerns without fear
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so
• The service generally controlled infection risk well. Staff wore the right personal protective to keep themselves and others safe from cross infection. Patients had an assessment of their infection risk on arrival at the department and staff allocated them to the correct areas
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service
• Patients could access the service when they needed and were able to access treatment promptly. The trust had significantly improved its patient handover and treatment time performance
• However, senior leaders were not aware of all the risks in the department. Staff were responsible for changing the filters on masks, but the leadership team did not monitor, or have oversight of this. In addition, patient safety checklists were not consistently filled all records that were reviewed.

Brent Council sets up Covid-19 Steering Group and Emergency Fund

Using her powers Carolyn Downs, the CEO of Brent Council, in consultation with the lead member, has set up a steering group framework of voluntary and community organisations to shape Brent's response to the Covid 19 (Coronavirus) crisis. The response includes the setting up of an Emergency Fund.

As can be seen above the  lead organisations in two vital areas have yet to be decided.

The report states:


The intention of our proposals is that these groups would be able to seek support from the CVS and we will fund the CVS accordingly.

1.  That the Chief Exec:
• Approve the establishment of a Steering Group made up of lead voluntary sector providers overseeing implementation of the new approach.
• Approve the setting up of thematic groups for the areas detailed in this report co-ordinated by the CVS.
• Approve the administration of small grants of up to £500 and the mapping/monitoring of the thematic groups activity across the borough by CVS Brent.
• Approve the adoption of a two-phased approach to this work.
• Approve the establishment of emergency funds.
• Agree that the council takes a more flexible approach to how it manages currently grant-funded projects.

On the Mutual Aid Groups that were set up a week ago and now serve most of the wards in Brent the report states:

Many residents have self-organised across the borough to create local groups to help support mutual aid for those communities that have been or are likely to become vulnerable. Whilst these are self-organised groups and the council would not expect to manage their activity the council has created the thematic lead to act as key conduits for sign posting, intelligence gathering and disseminating to support the activities of these self-organised groups.

John Healy of Brent Advicacy Concern commented:

Brent Council have identified 7 key groups and have already found leads for 4 of them. Unfortunately they cannot find anyone to take the lead for 'people with disabilities' or for 'older people'.  

If my charity Brent Advocacy Concerns was still in operation mode, I am sure we would have offered to take the lead for disabled people but after closing down last November, this is no longer possible.

And ironically, we had to close down because we could not afford the rent and now the council are offering to pay the rent for charities and community organisations to remain open in order to meet the challenges that we are all facing.

Also the council have issued an emergency number for vulnerable people to contact them but it is only available Mon-Friday.

The Full Report is below (Click bottom right for full page)

Greens call for 'emergency intervention' on NHS & Social Care ahead of budget

The Green Party is calling for ‘an emergency intervention’ to steer Britain away from the brink of the crisis in the NHS and social care, and to clampdown on air pollution which is estimate to end 40,000 lives prematurely every year.

The Greens are also calling for the Government to protect small firms from the business rate hike, raise tax for the richest, stop corporation tax cuts and reverse a planned tax hike on solar panels.

The five demands from the Green Party are:
1)      An emergency aid package to protect health and social care services
2)      Toughest ever action on air pollution
3)      Protection of small firms from Business Rate hikes
4)      Ensuring the richest people and biggest corporations pay more tax
5)      Reversing the solar tax hike

Jonathan Bartley said:

This budget must be an emergency intervention to steer Britain away from the brink of multiple crises.

After years of privatisation and underinvestment the future of the health service now hangs in the balance, and social care services are at risk of collapsing. If the Government is serious about working on behalf of the majority of people in this country then they will unveil an emergency aid package to protect health and social care services. We know that funding a world class healthcare service will cost more, which is why the Government should reverse their planned cuts to corporation tax and their tax giveaway to high earners. Failing to properly fund health and social care would be a dereliction of duty from this Government – and would leave any claim they had to be standing up for working people in tatters.

Caroline Lucas MP said:

There is an air pollution emergency happening in Britain – and the Government has to act now to tackle it. The Chancellor should immediately raise vehicle excise duty on new diesel cars, to send a signal to the market that this fuel must be phased out. The freeze on the fuel duty escalator should also end – thus freeing up billions of pounds which the Government should plough into public transport, walking and cycling. In recent years the cost of motoring has dropped considerably while the price of catching the bus or train has skyrocketed – if we’re serious about reducing the amount of toxic fumes in our air we’ve got to shift people out of cars and onto affordable public alternatives.

The Chancellor must also use this budget to get a proper grip on Britain’s climate policy. At a very bare minimum that must mean reversing the solar tax hike that’s set to hit community groups and schools – and it must mean more support for onshore wind too.

CHARITY DECLARES STATE OF EMERGENCY AS LONELINESS AMONG BRENT'S OLDER PEOPLE REACHES 50-YEAR HIGH

Guest blog by Contact the Elderly

Contact the Elderly LINK has declared a state-of-emergency as the number of socially isolated older people in Brent reaches breaking point.

Spurred by concern over the speed at which the government is tackling the problem of a million neglected older people in the UK who are off the radar, and the rate at which these numbers are growing, the charity is taking the issue into its own hands as it heads into its 50th year.

Supported by a network of volunteers across England, Scotland and Wales, Contact the Elderly offers a vital lifeline of friendship to those aged 75 and over, who live alone. The charity’s monthly Sunday afternoon tea parties in Brent enable older people to receive much-needed human contact.

Now the charity is calling for more volunteers to get involved to host a tea party in their home once a year or to drive older guests to and from the parties once a month.

A new study conducted by independent research agency Qa Research reveals that almost one in five (19%) of the older people Contact the Elderly supports joined the charity because they rarely saw another person.

With almost 50 years’ experience, Contact the Elderly knows that the solution to loneliness can be as simple as a regular face-to-face chat over a cup of tea. Some 78 per cent of the older people surveyed feel less lonely as a result of the monthly tea parties. A total of 96% said the tea parties give them something to look forward to.

Local group coordinator Elaine Smith from Wembley says, “We offer a vital lifeline of friendship to some of the loneliest people in Brent. By its nature, social isolation often means that the loneliest people are the hardest to reach. By spreading the word we can encourage more local people to give up just two hours a month as a driver, or a few hours a year as a host.”

With the survey identifying key loneliness triggers as marital bereavement (22%) and lack of mobility (51%); 80 per cent of guests said they felt happier after joining one of the charity’s groups.

Contact the Elderly Founder and Chairman, Trevor Lyttleton MBE, says “Loneliness amongst older people has reached a state of emergency and must not be ignored. For almost 50 years we have been focussing on providing a cost-effective solution, yet the demand for our service has never been so high.

“We know our formula of tea and conversation works, but we simply cannot reach out to the people that desperately need our help without increased volunteers and funding.”

If you want to volunteer for Contact the Elderly or join as a guest, please Contact the Elderly’s North London Development Officer , Isabelle Wise, She can be reached on 020 8445 1333.

#POWEROFCONTACT
To support the appeal, text POWR15 and the donation amount to 70070

Central Middx and Northwick Park A&Es overwhelmed

Campaigners lobby Sarah Teather over the closures

The Evening Standard today reports that  Maeve O'Callaghan-Harrington, head of emergency planning at NW London Hospitals Trust, emailed local GPs  last week advising them that the casualty units at Northwick Park and Central Middlesex  were full. 

Northwick Park had 19 patients waiting for beds and patients were also waiting for beds at Central Middlesex. Central Middlesex A&E is already closed overnight and would be closed completely under the 'Shaping a Healthier Future' proposals. Central Middlesex A&E patients will be expected to go to Northwick Park instead and that is also where patients from the Urgent Care Centre would be transferred if the UCC cannot treat them.

The Standard reports Andy Burnham, shadow health secretary as commenting:

As this email shows London A&Es are struggling as it is and it is not at all clear how the Government can close so many without putting lives at risk. The planned closures in northwest London look drastic and the onus is on the NHS and the Government to provide clinical evidence for how they can be justified.

Local NHS campaigners have repeatedly drawn attention to the pressures on Northwick Park even before the closure of Central Middlesex A&E  and the absence of any kind of risk assessment on the possible repercussions for the safety of patients if the closure takes place.

WE DEMAND A BILL FOR PEOPLE AND THE PLANET, NOT FOR POLLUTING PROFITEERS

                     EMERGENCY DEMONSTRATION

Wednesday 19th December 2012
5.30pm-7pm
Parliament Square
   
The Government is trying to sneak its disastrous Energy Bill through Parliament before Christmas with minimal attention.

Don't let them get away with it!

Come to Parliament Square on the day the Bill is debated to MAKE A NOISE for an energy system that serves people and planet.

Bring instruments, bring chants, bring Energy Bill-themed Christmas songs...

Facebook event: https://www.facebook.com/events/515534771803540/

WE DEMAND A BILL FOR PEOPLE AND THE PLANET, NOT FOR POLLUTING PROFITEERS

We are groups and individuals who have come together to highlight the deep flaws in the Energy Bill now going through Parliament. The Bill as written will take us further away from the urgent tasks of cutting down greenhouse gas emissions and helping people to heat and power their homes affordably.

The past year has revealed the dangers of climate change resulting from rising greenhouse gas emissions, caused largely by the burning of fossil fuels. A series of extreme weather events and a melting Arctic point to the future catastrophe we face as a result of a drastically changing climate, caused by the failure to control rising emissions.

Sections of the media and some politicians have framed the Bill as a threat to increase our energy bills to pay for low carbon renewable energy, but this argument is deeply flawed.

The Energy Bill in its current form would lock us into future dependence on fossil fuels - by encouraging a new dash for gas. Our energy bills would continue to shoot up as gas prices increase and we turn to environmentally-destructive fracking. 

The lack of a 2030 electricity decarbonisation target in the Bill makes this future dependence on fossil fuels more probable. This frightening omission only serves to line the pockets of Big Energy, instead of making the planet habitable for future generations. We should be empowering communities and individuals to generate their own renewable energy locally, and investing in energy efficiency and storage, to make energy bills affordable for struggling householders.

We call for an emergency demonstration outside Parliament at the second reading of the Bill, and will work to build a further demonstration and rally outside Parliament at the third reading of the Bill. 

We need an energy system that serves people and the planet, not Cameron and his cronies.

http://www.climatebloc.wordpress.com/