Care Quality commission tells Kings College Hospital NHS Foundation Trust that it still ‘requires improvement’

Katherine Johnston (12 June, 2019) Health

'Care is not consistently high quality in all services' - NHS England chief inspector

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King’s College Hospital NHS Foundation Trust has been told it ‘requires improvement’, after its latest Care Quality Commission inspection found that – despite examples of outstanding work – ‘in some areas the trust has gone backwards’.

This means the trust’s overall rating is unchanged since its last inspection.

Across the key areas evaluated, it was rated ‘requires improvement’ for being safe, effective, responsive and well-led, while a ‘good’ rating was given for being caring, following visits in January and February of this year.

Sites the trust manages include King’s College Hospital, Princess Royal University Hospital, Orpington Hospital, Queen’ Mary’s Hospital and satellite dialysis units across south London.

It currently has the worst financial deficit of any NHS Trust in the country, with £193 million projected for this financial year.

At King’s College Hospital specifically, inspectors rated services overall as ‘requires improvement’.

They witnessed inconsistency in staff completing mandatory training, equipment checks, patient privacy, infection control, completion of patient risk assessments, waiting times, staff morale, communication between staff and management.

England’s chief inspector of hospitals, Professor Ted Baker, said it was ‘disappointing that there has been no overall improvement’.

“While trust was rated Good overall for caring and there were some examples of outstanding practice, care is not consistently high quality in all services,” he added.

“The trust must take action in response to this report to address this.”

One area where the trust has deteriorated is in urgent care and the emergency department.

Performances at Denmark Hill against national accident and emergency targets and referral to treatment standards are among the worst in the country – with cancer treatment targets deteriorating over the last twelve months.

Between October and December 2018 there were 580 operations cancelled on the day.

For day surgery, the majority of cases involved patients not attending, but for main surgery this was usually down to lack of available beds.

Progress has been made in other areas. The number of complaints received by the hospital has reduced by eight per cent and staff retention has also improved.

Maternity services and end of life care at King’s have both improved from requires improvement to good.

However, one area outlined in the inspector’s evidence was a significant rise in year-on-year cases of Hypoxic Ischemic Encephalopathy (HIE) a type of brain damage in babies caused by lack of blood and oxygen to the brain.

The number of cases between January and December 2018 was nearly three times higher than in the same period in 2017. In 2017, ten babies suffered HIE, but the following year this rose to 27, attributed to the complex cases treated by the hospital.

“King’s College Hospital is a referral centre for women with high-risk pregnancies,” a spokesperson for the trust told the News.

“Nationally, the incidence of Hypoxic Ischemic Encephalopathy (HIE) in babies born at full term is between one and three cases in every 1,000 deliveries.

“We have around 10,000 births across both of our sites each year, so our figure is within the expected range.

“However, we always aspire to have fewer cases, in line with national targets.”

Staff morale and communication between management and staff, which had been a key area of concern in the last inspection, also showed improvement.

But there are worrying pockets of dissatisfaction, especially from administrative staff and those who are from ethnic minority backgrounds.

Twenty-two per cent of staff who identified as BME said they had ‘personally experienced discrimination at work from a manager, team leader, or other colleagues’ in 2017, compared with nine per cent of white staff.

Responding to a request to comment from the News, a spokesperson for the trust said: “The report recognises improvements in maternity, end of life care and for patients with mental health conditions at King’s College Hospital (Denmark Hill).

“However, there are areas that require focused attention in terms of patient care, staff morale and running our hospitals more effectively and efficiently.

“We have already taken immediate action to tackle the issues at the Princess Royal University Hospital Emergency Department, improve our performance, as well as working with staff to improve morale.”

Trust overall

Safe – requires improvement

Effective – requires improvement

Caring – good

Responsive – requires improvement

Well-led – requires improvement

 

King’s College Hospital overall – requires improvement

Urgent and emergency services – requires improvement

Surgery – requires improvement

Maternity – good

End of life care- good

Outpatients – requires improvement

 

Princess Royal University Hospital overall – requires improvement

Urgent and emergency services – inadequate

Surgery – requires improvement

End of life care – requires improvement

Outpatients – requires improvement

 

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