Significant improvements need to be made in a number of areas at Croydon University Hospital, Care Quality Commission (CQC) inspectors have said.

An inspection team including doctors, nurses, hospital managers and trained members of the public, visited the hospital in September and said in its report published today, that while improvements were necessary staff are working to change the hospital's culture.

Staffing levels in older people's wards, reducing discharges in the evening- especially for older people and improvements to outpatients to reduce waiting times, are among improvements listed in the report that must be made a priority.

Inspectors were concerned about low staffing levels affecting patient care and said the trust must also improve care plans to ensure they involve patients and reflect their needs.

"Serious concerns" were raised about the urgent care centre attached to the hospital, which is run by Virgin Care and sees patients when they first arrive at the hospital.

Patients suffering from certain symptoms such as chest pain, should be sent straight through to A&E. Other patients must be assessed by a care professional within 20 minutes.

Inspectors noted two occasions where the condition of patients who waited more than 20 minutes worsened.

The report said: "We were so concerned about the potential impact of this on patient safety that we ordered an urgent inspection of the Urgent Care Centre.

Although the Croydon University Hospital staff are trying to work in collaboration with the other provider, the provision of care was not safe."

The CQC told the trust it also needs to improve in other areas including staffing cover and the skill mix of staff across a number of services, the quality of care delivered to patients who are not being treated in the correct ward for their condition and monitoring the availability of pain relief.

The Trust has been told to improve the accuracy and storage of patient records, to support food choices for people with dementia and to develop a stronger attention to detail on key practices including infection control.

Inspectors found a number of areas of good practice, including the hospital's Listening into Action programme, improvements in maternity services, the care of people with dementia in A & E and the new Acute Medical Unit.

The report also praised the enthusiasm of staff and their "caring and passionate attitudes."

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: "While most patients praised the care they had received, poor patient experience was still a theme across the trust.

"Long standing staffing problems at the trust are currently being addressed by a large recruitment drive, but there were still significant staffing challenges in A&E and some inpatient wards."

John Goulston, chief executive at Croydon Health Services NHS Trust, said: "This is an extremely encouraging assessment of our progress after many challenges and shows that the hard work of our staff is making a real difference.

"I agree with the CQC that more remains to been done and where that needs to happen. The report will go a long way toward helping us make continued improvements where they matter most to staff and patients."

Summary of CQC inspection findings at Croydon University Hospital

Inspectors from the Care Quality Commission (CQC) visited Croydon University Hospital with five key questions in mind.

As the inspection team of 25 which, included CQC inspectors and analysts, doctors and nurses spoke to staff and patients and looked at records and patient feedback, they asked the following five questions of every service: Are services safe? Are services effective? Are services caring? Are services responsive to people's needs? and Are services well-led?

The results in the report were as follows:

Are services safe?

Inspectors concluded while most services at the hospital were delivered safely, the Accident and Emergency department must be improved, stating it was crowded, badly designed and that staff vacancies are high. Concerns were also raised about staffing levels.

The Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: "We found that while most services were being delivered safely, a number of areas needed to be improved as a matter of priority. There were staffing challenges in a number of areas of the hospital - including A&E and elderly care - despite an ongoing recruitment drive."

Are services effective?

Inspectors found services were largely being delivered effectively with outcomes for patients within expected ranges.

Professor Richards said: "While there was no evidence of concerns about infection rates or mortality rates, lessons learned from incidents and audits wasn’t always fully embedded at ward level.

Are services caring?

Patients gave the inspection team positive feedback about their care and "good" care was observed during the inspection. But inspectors raised concerns about outpatients and the number of discharges-particularly of older people- in the evening.

"This is a trust where patient experience has been problematic in the past, and some recent cases were raised at the public listening event," said Professor Richards.

Are services responsive to people's needs?

The CQC report says the hospital needs to do more to be responsive to people's needs, particularly in A&E.

"The hospital needs to do more to be responsive to people’s needs, especially in A&E where large numbers of people are being discharged just before the four hour target is breached, and in appointments for orthopaedic and eye services.

"The physical environment especially in areas like A&E-which was crowded and badly designed- made the delivery of care difficult," said Professor Richards.

Are services well-led?

Inspectors praised the trust's new senior management team and said they had made "impressive strides" in the past six months.

"Staff were keen to tell us about the impact they’d made. Despite this, more evidence of sustained improvement is needed.

"We found that complaints were not always responded to within an appropriate timetable, and some patients told us that staff were defensive when responding to their concerns."

 

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