The Care Quality Commission (CQC) will today (11 January) publish its report into Lewisham and Greenwich NHS Trust following the inspection carried out in September 2018.
Ben Travis, Chief Executive for Lewisham and Greenwich NHS Trust, said: “While the Trust’s overall rating from the inspection remains “requires improvement”, the CQC found many improvements since their previous inspection. The CQC also commented on how caring they found our staff, with the Trust’s rating in the caring domain improving to ‘good’.
"While the CQC noted there is more to do, they said that there are positive signs that we are addressing the challenges we face. The report shows that we are moving in the right direction, and I’d like to thank all our staff for their ongoing hard work and commitment to patient care.”
The Trust’s community services weren’t inspected this time and retain their rating of “outstanding”. Key points from the inspection report include:
- The Trust has achieved an overall rating of “good” for caring
- Urgent and emergency care at University Hospital Lewisham (UHL) has improved from “requires improvement” to “good”
- Maternity services at UHL have moved up from “requires improvement” to “good”, with maternity services at Queen Elizabeth Hospital (QEH) retaining their rating of “good”
- End of life care at QEH, which had been rated ‘inadequate’ in the last inspection, has moved up to “requires improvement”. End of life care at UHL has improved to “good” from “requires improvement”
- Overall, across the core services and hospital sites inspected, we have seen an improvement in ratings in 12 service area domains and deterioration in just one area/domain rating (surgery, effectiveness). The CQC ratings are included in editors’ notes.
Dr Elizabeth Aitken, Medical Director for Lewisham and Greenwich NHS Trust, said:
“Our improved rating of ‘good’ for caring is well deserved, and I’m very proud of the compassionate care our staff provide, putting patients at the heart of everything they do, often in challenging circumstances.
“We are extremely pleased that no services were rated as “inadequate”, reflecting improvements since the last inspection. I’m delighted that maternity services at both our hospitals, and urgent and emergency care at UHL, have been rated as ‘good’.
“Of course, we recognise that we have got more to do, but this report gives us confidence as it shows that the work we are doing is having an impact. We are excited about working with our staff to continue our improvement journey.”
Steve Russell, NHS Improvement’s executive regional managing director (London), said:
“Whilst the overall rating of the Trust remains Requires Improvement, the Trust has made good progress in a number of areas, most notably across end of life services at Queen Elizabeth and surgery at both sites.
“This is positive for local residents and reflects a concerted effort of the Trust’s new leadership and members of staff. We will continue to work with Ben and the team to accelerate the delivery of the improvement that is still required.”
Inspectors noted that the appointment of a new chief executive and chief nurse at the Trust last year had resulted in improved communication and engagement. Inspectors could also see that recent changes to strengthen clinical leadership were already having an impact.
They observed staff providing compassionate care and being attentive towards patients, who spoke positively about the staff and the care they received. They said staff were friendly and helpful. Response from the Friends and Family test showed that patients would generally recommend the Trust.
The inspectors saw areas of outstanding practice, for example the excellent education strategy in the emergency department at QEH and the “education trolley bus” in maternity, which senior staff use to discuss key issues and best practice with staff. Another area of outstanding practice was the bereavement service in maternity at UHL, which provides support to women and families who have lost babies at all stages of pregnancy.
There were areas where the Trust needs to improve, including medicines management and staffing. In response, we have provided more training to staff on medicines management and we have increased the number of internal audits we carry out to monitor progress and address any issues. We have been carrying out a major recruitment drive and have succeeded in reducing vacancy rates from 17.5% to 13.9%. We have recently completed an international recruitment drive for nursing staff, offering positions to a further 91 qualified nurses. More international recruitment for key roles is planned in 2019/20.
The inspectors noted that emergency department at QEH was often overcrowded, but acknowledged that the new clinical facility (see below) would provide increased capacity.
Recent developments at the Trust include:
- The opening of a new clinical facility next to A&E at QEH in December 2018. This new building contains two new wards providing 44 short stay beds for patients who come through the emergency department and need further hospital care. The new building also houses the surgical assessment unit and clinical decisions unit. This new development will improve the flow of patients through the hospital, so patients get the right care in the right place sooner.
- The development of a mental health crisis café at University Hospital Lewisham. Known as The Harbour, the cafe offers a sympathetic, supportive and calming environment for people experiencing a mental health crisis. It will be managed by a mental health charity, Certitude, with clinical support from our mental health providers, South London and Maudsley NHS Trust, and other staff. People will be able to stay in the café for as long as they need when they feel they can no longer cope and need some support.
- Reopening of the day care unit at QEH in September 2018, with ring-fenced beds for patients to recover in the right environment after planned surgery.
- A new MRI scanner for UHL in September, giving us increased capacity for inpatients and outpatients.
CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said: “There has been some improvement in the quality of care in some areas at Lewisham and Greenwich NHS Trust.
“The strengthened leadership team needs to drive marked improvement in the trust’s ratings in the future and with that in mind we will continue to monitor the trust’s progress carefully.”
- The CQC rates NHS organisations as “Inadequate”, “Requires Improvement”, “Good” or “Outstanding”. The CQC’s five domains look at whether services are safe, effective, caring, responsive and well-led.
- The 2018 inspection did not inspect the following services, and therefore the ratings have remained as they were in the 2017 report:
UHL: Critical care, services for children and young people, outpatients and diagnostics
QEH: Medical care, services for children and young people, outpatients and diagnostics.
The CQC ratings for the Trust are below: