Thursday, 30 October 2014

‘Model’ hospital that survived axe requires improvement, say inspectors

A hospital held up as an example for others in London to follow was today found by inspectors to require improvement.
Chelsea and Westminster, which fought off the closure of its accident and emergency department last year, was marked down across a number of key departments by the Care Quality Commission.
They said increased demand in its A&E had caused delays in assessment and treatment for patients needing to be seen quickly. The hospital also failed to meet the 18-week NHS target for surgery, with longer waits in general surgery, trauma and orthopaedics, urology and plastic surgery.
However is burns unit – which treated the London schoolgirls Katie Gee andKirstie Trup who had acid thrown at them in Zanzibar last year – its HIV and sexual health services, and a female genital mutilation (FGM) service were “outstanding”. Critical care and maternity – it handles 6,000 births a year including many complex deliveries – were rated “good”.
Chelsea and Westminster, which has 430 beds, was one of the winners in the shake-up of emergency and maternity care across west London, with its selection last year as one of five major hospitals leading to closures atCharing Cross, Ealing, Hammersmith and Central MiddlesexStaff told inspectors the reconfiguration had contributed to the extra pressure.
At the time, doctors leading the Shaping a Healthier Future reorganisation said Chelsea and Westminster set standards for others to follow. But
staff told CQC inspectors, who visted in July, that the reconfiguration had contributed to the extra pressure on its A&E.
In its summary of findings, the report states: “There had been an increase in demand for services, and the capacity in some areas of the trust, such as A&E, experienced difficulties in meeting this additional demand. Staff reported that a contributing factor to this increase was due to the local reconfiguration of services across London.”
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said:“When we inspected Chelsea and Westminster Hospital we found that, while staff were caring and compassionate, some of the services we looked at required improvement in some areas.
“Our overall findings highlight the level of variation that can be found within the same organisation. We hope that the trust can quickly build on the good work that we found in most areas to consistently deliver good services across the board.”
Chelsea and Westminster has the highest Caesarean rate in the capital, at 35 per cent of all deliveries. The report said the maternity department’s “leadership and culture needed to improve… to ensure women did not have interventions that might not be needed”.
Staff shortages meant there was reliance on overtime and agency staff, while the acute assessment unit and children’s services “did not always have safe staffing levels”. National medical staffing standards were breached in the A&E department.
The hospital said it had recruited 85 nurses and midwives since July and was spending £10 million on refurbishing and extending its A&E. The work is due to be completed in summer 2016.
It said in a statement: “We have a strong historic A&E performance having been the best performing trust two years in a row. Our A&E performance against the four hour target in October is the best in North West London and so far this year is 96.6%, compared to the national target of 95%.”
Chief executive Tony Bell said: “We are obviously disappointed that we have been rated as requiring improvement and take all of their feedback on board. I believe that the areas in which the CQC have said we must make improvements can be resolved swiftly.”
This is the second CQC report to flag concerns with changes proposed under the Shaping A Healthier Future programme. In August, the CQC warned that maternity services at Northwick Park hospital were under pressure, ahead of the closure next year of Ealing hospital’s maternity unit.
Councillor Julian Bell, leader of Ealing council said: “This is the second report in as many months where the chief inspector of hospitals has highlighted concerns about the remaining A&E services in our area. Since the plans to shut A&Es were announced, I have expressed concerns about the ability of the remaining A&E services to cope with extra demand in patient numbers and this second report confirms my fears.
“We are committed to ensuring that our residents have access to the best possible health services available. I will now be writing to the secretary of state for health to reiterate the very real concerns that this council has about the NHS’s plans for accident and emergency services in this area and ask that he assures us that patient safety is not put in jeopardy by further reconfiguration.”

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