The Care Quality Commission (CQC) has dropped the rating for the trust’s overall leadership from good to requires improvement, and again rated it requires improvement for medical care, following inspections in September and December. The overall rating for the trust remains requires improvement.
The inspection of the trust’s overall leadership was prompted in part by concerns staff raised to the CQC about the organisation’s culture. Inspectors also assessed the trust’s medical care services, because concerns had been raised to CQC about care for elderly people and people with sickle cell disease.
The trust is currently in the process of a proposed merger with the Royal Free London NHS Foundation Trust, and was managing this alongside people’s ongoing care.
Jane Ray, CQC deputy director of operations in London, said:
“When we inspected the trust, we found a leadership team which was skilled and committed but needed to better manage the workload from a proposed merger with the Royal Free London NHS Foundation Trust.
“Leaders were already struggling to complete some work such as responding to complaints and investigating serious incidents in a timely manner. This meant that improvements to people’s care weren’t always carried out as fast as needed.
“Whilst the trust was largely a positive place to work, staff told us issues of bullying and harassment in certain teams have persisted since our last inspection. Leaders must support these teams to urgently address this to ensure staff can work together well to meet people’s needs. Linked to this, formal processes to address HR issues are taking too long to resolve.
“We found the trust’s leaders were honest about the challenges they faced and were taking action. We’ve shared our findings with them so they know where improvements must be made and will continue to monitor the trust closely, including through further inspections to ensure this happens.”
Inspectors also found:
- Some managers of front-line services needed more professional development to enable them to better manage busy services and ensure the staff were supported well
- On the medical wards low staffing for nurses meant people’s needs weren’t always met promptly and safely. For example, four-hourly observations to ensure people were safe were often delayed. While staffing is an issue across the NHS, leaders must ensure this doesn’t impact people’s safety
- Some staff didn’t have up-to-date training in areas such as life support, the Mental Capacity Act, and dementia awareness training
- Staff didn’t always manage people’s medications safely. Inspectors found records showing some people may have missed medication doses, which risks their health.
However:
- Most staff treated people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions
- Staff on medical wards took account of people’s individual needs well. CQC raised the medical care service’s rating for effective from requires improvement to good as a result.
- Most people gave positive feedback on the trust, saying they felt safe
- The trust actively engaged with people using their services and in the local community, and acted on their feedback.
See the full report on the CQC website.