The Care Quality Commission inspected the London NW University Healthcare NHS Trust, which covers Central Middlesex Hospital and Northwick Park Hospital, in the summer. The report has now been published and makes worrying reading.
Of most concern will be the red light 'Inadequate rating' for three areas of Services for Children and Young People at Central Middlesex Hospital.
The Commission said:
· We found a lack of
clarity over where the overall responsibility and accountability of children
and young people services lies within Central Middlesex Hospital. We also found
a lack of clarity for how and where this service feeds into the trust.
· Governance in
children and young people services at Central Middlesex Hospital was weak. The
risk register for the recovery ward was out of date. There was a lack of up to
date policies and associated audits demonstrating that the care being delivered
was compliant [with] national standards and best practice. We were not assured that
the service was guided or supported via a paediatric surgical network.
· There was no clear
evidence that areas from the last inspection for children and young people
services had been addressed or necessary improvements made.
· In medical care,
risks were mitigated and managed but there had been limited action to address
risks directly.
· The senior
leadership team for medical care at Central Middlesex Hospital recognised the sometimes poor relationship between its staff and local authority staff, but
there had been no action to address this
There were many issues regarding safety. The report says:
· Our rating of safe
stayed the same. We rated it as requires improvement because:
· The trust provided
mandatory training in key skills however there was some confusion among
midwifery staff as to the correct length of mandatory training and its content.
Compliance rates for mandatory training and safeguarding training were below
trust targets in the surgical services at Northwick Park Hospital and Central
Middlesex Hospital. Not all clinical staff in children and young people
services at Central Middlesex Hospital caring for children were trained to
safeguarding level three however, plans were in place to ensure all staff
received this training.
· In medical care at
Central Middlesex Hospital, some staff did not always report incidents and, in
particular, near misses.
· The trust did not
always control infection risk well. Hand hygiene was not consistently being
undertaken in maternity services. In children and young people services, the
Rainbow Unit at Central Middlesex Hospital was found to be untidy and we could not
be assured that children’s toys were regularly cleaned.
· 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.
· At our last
inspection we found that the clinical decisions unit (CDU) was being used
inappropriately to treat level two patients. Whilst the service assured us that
this was no longer the case we did find that the area was being used as
overflow for patients requiring inpatient beds and patients within the CDU could
be there for over four hours and sometimes up to three days. In children and
young people services at Central Middlesex Hospital, staff we spoke with in
Recovery Stage One told us that children were cared for in a mixed four bedded
recovery bay with adults.
· Staff at Central
Middlesex Hospital did not use a nationally recognised tool to identify
deteriorating patients, such as Paediatric Early Warning Signs (PEWS) or a
validated acuity score system to assess patients. We were told that not all
medical staff had European Paediatric Life Support (EPLS) or Advanced
Paediatric Life Support (APLS) training. There was no paediatrician available
on-site at Central Middlesex Hospital. Staff had to refer to the consultant of
the day or week, who was based at a different hospital in the trust. Some staff
were not aware of this arrangement.
· Some medicine
storage areas did not meet national guidance for security for controlled drugs
in the Northwick Park surgical service.
However:
•
Mandatory training compliance rates at Northwick Park and Ealing emergency
departments had improved. Staff monitored patients who were at risk of
deteriorating appropriately.
The Commission fournd 'Outstandin Practice' in Urgent and Emergency Care at Northwick Park Hospital:
In Urgent
and emergency care at Northwick Park Hospital-
The department had
developed a patient sepsis video for parents whose children attend the
paediatric emergency department with a fever or suspected infection. The video
was a four minute video aiming to educate parents about the warning signs to
look out for sepsis.
The department had done a rotational shift with
the local mental health trust. The purpose of this was for staff to get an
ideas how the other service was run, learn and share knowledge and
understanding to improve the way they worked together.
FULL REPORT HERE
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