Good news and bad news for the Royal London Hospital, that huge blue building in Whitechapel which we all rely on at some time in our lives and sometimes for our lives.
A report by the Care Quality Commission has highlighted some major failings in care but also found room for praise.
The Royal London site is the largest standalone acute hospital building in Europe and is one of five hospitals run by Barts Health NHS Trust, the largest trust in the country. Barts Health NHS Trust has an annual turnover of over £1.5 billion and employs over 14,000 staff.
For the sake of accuracy we have copied and pasted some sections of the report in their entirety below. LW would urge you to download the report here to get all the details and a balanced picture.
Barts Health NHS Trust The Royal London Hospital Quality Report
“This report describes our judgement of the quality of care at this hospital. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations.
We inspected eight core services: Urgent & Emergency Care, Medicine (including older people’s care), Surgery, Critical Care, Maternity & Gynaecology, End of Life Care, Services for Children, and Outpatients & diagnostic services. Overall, we rated this hospital as requires improvement.
The critical care service was rated as good; maternity services as inadequate and the remaining core services as requires improvement.
The good news about the Royal London
- A very strong record of innovation in the hospital’s trauma service and the trust was internationally recognised as an innovator and leader in research in this field.
- The emergency department was the only centre in the country and one of only two in Europe to offer the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) treatment for patients.
- The emergency department had introduced a ‘Code Black’ protocol for patients who had severe head injuries. This was the first of its kind in the country and meant that appropriate patients had care led by neurological surgeon from the first time that they arrived in the department.
- Staff in sexual health and HIV services were highly research active and used findings from in-house research and collaborative partnerships to drive improvements in care and patient outcomes.
- We found the Adult Critical Care Unit delivered outstanding care. The service had also developed a programme of learning to ensure best practice and improve patient care for a frequently changing medical workforce.
The bad news about the Royal London
The main issues that have caught the headlines are the findings in Maternity and Gynaecology which was rated as inadequate.
“There were not enough midwives on wards, day or night. Numbers of clinical midwives were significantly below establishment. This slowed down processes on the delivery suite and the postnatal ward and prevented some women from getting timely care.
Only 92% of women had one to one care in labour, far short of national guidelines.
The level of consultant cover on the delivery suite was 71.5 hours a week which falls far short of the Royal College of Obstetricians and Gynaecologist recommendations.
Processes for ensuring baby security were weak. Not all mothers or babies were wearing name bands and there was no local or central guidance on making appropriate checks when baby labels were missing.
The infant abduction policy had not been effectively circulated to staff. However the policy itself was deficient as it assumed the use of an electronic baby tagging system not in use in the hospital. [LW Emphasis]
- Women had inconsistent experiences, some very poor, of the maternity services, and some women and partners reported a lack of respect from midwives.
- There was unwillingness among some midwives to adopt new processes: the morning safety briefing and the use of a second person to review fetal heart rate patterns at regular intervals were examples.
- Record keeping was not consistent and accurate, particularly of handover of care from the delivery suite to the postnatal ward.
- The maternity service did not demonstrate care for its own staff, rosters were late, approval of annual leave was slow, midwives felt their concerns were not listened to and morale was low. However, improvements had been made in assessing and monitoring the quality of the service.
- Staff planned and managed care in line with current evidence-based guidance, standards and best practice. Additional capacity for midwife led birthing was due to open in autumn 2016, and more space for postnatal women.
- Secure archiving for ultrasound scans was being rolled out and already used in some areas. It would be available throughout maternity and gynaecology service in autumn 2016.Incidents were being investigated and closed in a timely way
- Gynaecology services were well managed and provided a responsive service to women.”
On a personal note we had to send our entire editorial team to A&E at the London the other week and the care was great. As our team walked in they were more than a little impressed to see none other than Dr Gareth “Where’s my helicopter?” Davies, Medical Director of London’s Air Ambulance and Consultant in Emergency Medicine calmly waiting for a psychiatric patient to behave.
Not sure about all the badges on your tunic that day doc, but hey, you the man!
I mean, how many hospitals in the country are you likely to see someone like that? Huh? The NHS rocks.