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Barts Health NHS Trust

Largest NHS trust in England rated 'inadequate'

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The largest trust in the country has been rated inadequate by the Care Quality Commission, and has appointed an interim chief executive.

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Barts Health Trust had already been placed in special measures following an inspection of its Whipps Cross Hospital in March.

The CQC has now published a report for the trust after inspecting its two other acute sites, the Royal London Hospital and Newham University Hospital.

Barts

The CQC has given Bart’s Health one of the worst assessents it has given a trust

The trust was found to be “inadequate” for whether services were safe, effective, responsive and well led, and “requires improvement” for caring. This is one of the worst assessments the CQC has given a trust.

Inspectors found the trust lacked a strategy or vision and lacked confidence in its own data. The trust’s chief executive, chair and chief nurse all announced their resignations earlier this year.

They said they met a “caring” and “very committed” workforce who felt “undervalued” by the trust leadership.

Inspectors found that safety was not a “sufficient priority”. Staff did not always recognise concerns and incidents, some were discouraged from raising concerns and there was a “culture of blame”.

The team could not be “confident” that children and adults were appropriately safeguarded and that security needs were consistently met.

The trust was “considerably reliant” on temporary staff, but the processes to support this flexible workforce were not “robust”. There was a low compliance with mandatory training for staff.

However, junior doctors were “incredibly positive” about the support and learning opportunities at the trust and leadership from consultants.

Eight ‘never events’

Early warning systems to alert staff when a patient was deteriorating were “varied” and “inconsistent” across the trust.

There had been eight “never events” for wrong site surgery in the last 14 months.

Despite being responsible for 15,715 births a year, the trust did not have a maternity dashboard to be able to identify the quality of the service provided.

Some patients had their surgery cancelled on “multiple” occasions due to a lack of beds.

Work related stress among staff was the joint highest in the country for an acute trust, with 44 per cent of staff reporting stress according to the 2013 staff survey and only 32 per cent recommending the trust as a place to work. The inspectors found “minimal improvements” in the 2014 survey.

Inspectors said there was a “lack of timely response” to address the “bullying and harassment culture” the team identified at the last inspection in November 2013.

The pain team for adults was well regarded by patients and staff at Whipps Cross. They also said The Royal London is a “pioneer” in trauma care. The survival rate at the hospital is approximately twice the national average.

Falling short

Chief medical officer Steve Ryan said: “These CQC reports describe some services that fall short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Newham and the Royal London hospitals. We know we have a big challenge ahead but we are determined to rise to that challenge.

“We are already making rapid and dramatic improvements in key areas… All our hospitals will be part of the trust’s improvement plan in response to special measures.”

Sir Mike Richards, chief inspector of hospitals, said given Barts Health’s size, “it is all the more disappointing to report the extent and level of our concerns in all three hospitals, particularly in safety and leadership”.   

“It is clear that the leadership issues we found at Whipps Cross were replicated at the other hospitals,” he added.

Interim chief to join Barts

Barts Health Trust has appointed a new interim chief executive to take over from Peter Morris, who resigned in February.

Alwen Williams, who was previously director of delivery and development for London at the NHS Trust Development Authority, will join the trust in June.

Ms Williams spent nine years at the Royal London Hospital and was previously chief executive at Tower Hamlets Primary Care Trust and NHS North East London.

An improvement director has also been appointed. Angela Helleur will support the trust board to develop and deliver its improvement plan.

Ms Helleur trained as a nurse and midwife and she has held several senior management roles within the NHS including deputy director for London in the medical division of NHS England. Most recently, she was the improvement director at Barking, Havering and Redbridge University Hospitals Trust.

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