New Care Quality Commission report recognises improvement while overall rating is unchanged at ‘requires improvement’

Imperial College Healthcare NHS Trust is committed to making further improvements in response to the latest CQC report on the Trust, published today, Wednesday 21 February.

‘Service-level’ inspections took place in November 2017 for surgery at Charing Cross, Hammersmith and St Mary’s hospitals and for urgent and emergency services at Charing Cross and St Mary’s hospitals. These services were last inspected in September 2014.

The CQC has introduced a new type of inspection to look at performance against the well-led domain at Trust level. The Trust had its first of these inspections in December 2017.

The latest report incorporates findings and ratings from all of these inspections. England’s chief inspector of hospitals, Professor Ted Baker, said that there has been some improvement in care and the quality of some services is outstanding but that there is still plenty of scope for our ratings to improve.

The overall Trust ratings have remained the same for all CQC ‘domains’ (safe, effective, caring, responsive and well-led). The overall rating for the Trust also remains unchanged, at ‘requires improvement’. Detailed analysis of progress against each of the CQC domains for each of the core services across all of our hospitals does show we are moving in the right direction – since our first inspection in 2014, 17 ratings have improved, 33 ratings have stayed the same and 7 ratings have gone down.

Overall ratings for services at each site that were inspected are as follows:
• Charing Cross Hospital (surgery) – ‘requires improvement’, the same rating as 2014
• Charing Cross Hospital (urgent and emergency services) – ‘requires improvement’, down from ‘good’ in 2014
• Hammersmith Hospital (surgery) –‘good’, an improvement since the 2014 inspection
• St Mary’s Hospital (urgent and emergency services) – ‘requires improvement’, the same rating as 2014
• St Mary’s Hospital (surgery) – ‘requires improvement’, the same rating as 2014.

The Trust was rated ‘requires improvement’ in its first Trust level well-led inspection.

Areas of outstanding practice noted by the CQC include:
• Our role as a leader in developing and using digital technology to improve patient care as a global digital exemplar
• Being part of the ‘Redthread’ youth violence intervention programme, which ensures seven-day support from an onsite youth worker at St Mary’s Hospital
• The major trauma centre within St Mary’s achieving good clinical outcomes for patients, recognised in the Trauma Audit & Research Network (TARN) audit
• Having a dedicated full-time play specialist working in the paediatric A&E at St Mary’s Hospital to support children in the department
• Significant research funding in place to drive forward innovative practice in surgery. This included a recent breath test trial for oesophageal cancer diagnosis
• A surgery team being awarded a British Medical Journal (BMJ) prize in recognition of an innovative ‘prepare for surgery’ project that aimed to reduce the length of hospital stays
• The hepato-biliary service providing a specialised tertiary service for procedures such as ‘Whipples’ surgery for pancreatic cancer. Nurses on the hepato-biliary ward had developed specialist knowledge and skills to care for patients with complex symptoms
• The Northwest London RAPID (rapid access prostate imaging and diagnosis) pathway for prostate cancer where patients can have all their diagnostic imaging and biopsies carried out on the same day, shortening their number of hospital visits and the length of time they wait for a diagnosis
• Providing rapid access to cardiac catheterisation for patients with chest pain.

A number of the areas identified for improvement are well documented challenges that we are continuing to work hard to address – they include meeting the national standards for 4-hour A&E access and 18-week wait for referral to treatment, reducing vacancy levels in key areas and improving the physical state of our facilities. There are also some specific improvements we must make, notably:
• Providing better assurance on how we are monitoring our performance effectively against agreed standards
• Improving the physical standards of some of our operating theatres at St Mary’s Hospital in relation to rust and damage of fixtures
• Ensuring that equipment is regularly serviced, labelled to indicate the next review date, and appropriately stored
• Improving our medicines management
• Increasing uptake for mandatory training.

Commenting on the report, interim chief executive Professor Julian Redhead said:
“We are pleased that we continue to be rated as ‘good’ for both the effectiveness and care of our clinical services. It’s also a boost for Hammersmith Hospital to have its rating for surgery move to ‘good’. This means that the CQC felt that the care, treatment and support we provide to our patients achieves good outcomes, helping them maintain their quality of life, and that our staff treated their patients with compassion, kindness, dignity and respect.

"We are disappointed that our other ratings stayed the same or, in the case of urgent and emergency care at Charing Cross, moved down one ranking. This is despite great efforts by our teams to address the feedback we received in our last inspection, reflected in the many positive findings recorded throughout the report. We are committed to resolving the issues highlighted so that we can get to ‘good’ and beyond, as the CQC indicates.

“Winter is a particularly challenging time for NHS trusts and recent months have seen unprecedented levels of activity, most keenly felt in our A&E departments. We know that there are a number of key areas for improvement at both of our A&E departments, with space and environment constraints exacerbating our capacity pressures.

“The CQC has acknowledged throughout the report the impact of our old estate and lack of space on the care and experience we can provide to patients. Progressing our redevelopment and estates improvement plans is a major priority for us in the coming year.

“The well-led inspection showed that our Trust Board has the right skills, knowledge and experience to lead the organisation in the delivery of its aims. We have been developing our leadership structures and systems over the past two years and will continue to work hard to help all staff feel enabled and empowered to make improvements for the benefit of patient care."

Here you can access the full CQC summary report.