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Barts in special measures after CQC rates Whipps Cross 'inadequate'


Whipps Cross University Hospital in east London has been rated as inadequate by the Care Quality Commission, which noted “serious concerns” about poor leadership, culture of bullying and low staffing levels.

The majority of the hospital’s services – including urgent and emergency care, care for older people, children and young people, and outpatients – require “significant improvements”, said the regulator in a report published today.

“Barts Health Trust has not given sufficient priority to safety. We found frequent staff shortages and a reliance on agency and locum staff that increased the risk to patients”

Mike Richards

The hospital is run by Barts Health NHS Trust, which confirmed it has been put into special measures, meaning it will receive support from regulators to turn its service around.

It is the largest trust in England – running six hospitals and employing 14,000 staff – but has recently struggled with finances and performance, and now has a planned deficit of £93m. A raft of senior managers, including its chief executive, chair and chief nurse – Professor Kay Riley – recently resigned.

The CQC noted more than 200 posts were cut across the trust in 2013 and several hundred more nursing staff were down-banded, which has had a “significant” impact on morale at the hospital.

However, on a positive note, staff were found to be caring in half of its eight services, and in particular the maternity and gynaecology services were highlighted for committed staff and examples of good practice.

But a high usage of agency nurses in Whipps Cross hospital’s emergency service in particular were noted, with day shifts frequently seeing 66% of nursing cover provided in this way.

A trust merger in 2012 had seen a significant number of experienced nurses leave. They had either not been replaced or their posts had been filled with more junior nurses, which had resulted in a negative culture within the department, said the CQC.

Most of the workers inspectors spoke to in the emergency department said they rarely took a break in a 12-hour shift due to time constraints.

“The trust must get a grip on what is happening here and on the low staff morale”

Mike Richards

The CQC spoke with four patients who had been in the emergency department during at least one mealtime – with some having been there for more than 10 hours –  and said they had not been offered anything to eat or drink, despite there being no medical reason for this.

A lack of skills due to the high use of temporary nurses was also noted by some staff – who reported some agency staff being unable to triage patients or give IVs .

Surgical wards were found to be experiencing similar problems, with three out of six not having a ward manager for up to three months and one had just one band 5 nurse covering 15 beds. Band 2 healthcare assistants were also found to be carrying out complex work, including care of tracheostomies and complex dressings.

Meanwhile, in the children’s service, there was a 40% vacancy rate for qualified nurses and 16% for unqualified nurses. An external review on the neonatal unit was conducted in October 2014, following a whistleblower raising concerns regarding staffing experience, knowledge and skills and action plan has been put in place.

Meanwhile, mandatory training for nurses fell far below the 90% target in many wards, with one having a completion rate of just 33% in infection control and basic life support.

In its assessment of older people’s care, the CQC found there was a high referral rate for patients with dementia to the specialist nurse, however many were not being screened for the condition.

Problems around capacity assessments for these patients – such as long waits for psychological assessments or them not taking place at all – were noted.

Issues with incident reporting were highlighted, with some staff saying they did not have time to report incidents and would not escalate inappropriate skills mix issues, due to fears of repercussions from senior staff.

“This report describes services that fall a long way short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross”

Peter Morris

Professor Sir Mike Richards, CQC chief inspector of hospitals, said: “I note that many of the failings which we found on inspection in November 2013 are still not resolved. In some areas there has been little progress – and this has been affecting the quality and safety of patient care.     

“We found frequent staff shortages and a reliance on agency and locum staff that increased the risk to patients,” he said. “The trust must get a grip on what is happening here and on the low staff morale.”

Barts chief exectuive Peter Morris said the trust had already taken steps to strengthen leadership at Whipps Cross, adding: “Barts Health is committed to ensuring the safety and welfare of every one of its patients.

“This report describes services that fall a long way short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the trust has a big challenge ahead.”

Responding to the decision by the NHS Trust Development Authority to place the trust into special measures, the Royal College of Nursing said organisations must “never again” see cuts to jobs and wages as a “safe or sustainable way to fix funding shortages in the NHS”.

It said the CQC report showed the extent of the pressures on staff working at Whipps Cross and that an “urgent” long term plan was required for the hospital, which should address a “historic culture of bullying”.



Readers' comments (14)

  • Perhaps at some point the government will realise that most health care providers have cut back on staff due to funding available, for the private and public sector, and its gone too far.
    CQC are identifying the same problems everywhere, will someone in power take note??

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  • This is the same story for all hospitals in London so why has Whipps Cross been put into special measures.UCLH uses huge numbers of agency staff plus its own staff to cover other shifts because of staff shortages.I think its extremely unfair to put one hospital Trust into special measures and not treat the others with the same action.

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  • This Trust is far too big. The staff were disenfranchised by downbanding and redundancies a few years ago. This appears to be the result. Short-termism - when will they ever learn??

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  • so some manager decides I know to make me look good and save money I will downband staff and cut nursing posts

    well the nurses left in droves and the agency spend went through the roof..rocket science this is not!

    NHS managers...could not even run a bath!!!

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  • As someone who's mother died through very poor care at Whipps Cross I feel angry, disgusted, and resigned to the fact, that despite my complaint been taken to Kay Riley and underlings, absolutely nothing and I mean nothing was learnt through their mistakes, despite all the promises that where made.I had face to face meetings with these people and remember telling them at the time they took there eye off Whipps Cross because they were too busy with the merger, and the fact so much of what the CQC told them came as a " surprise" smacked to me of very very poor management.

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  • We need staff staff staff, reduction of managers, skip level meetings, working on the coalface; this will change the NHS.
    Training young people, most of the student nurses I see in my department are 30+ some 50, not a long term solution for staffing in the future! Get the nurse training back to basics, learning how to care for people. Pay nurses in training a wage so they can afford living while getting a qualification. This may help recruitment in years to come of the younger generation.
    The NHS will face great problems as many older nurses are facing retirement, none has been trained to fill the gap.
    Managers however seem to progress very quickly through the paygrades no one challanges their lack of experience or value added. to get an upgrade as a nurse you have to sweat blood, write a thousand essays to get paid for the job you're already undertaking.
    Who manages the managers.... managers? Maybe that's why all the eggs go into that cake.

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  • Anon - 18th Mar 12.04pm

    Well said!!!!
    Get the dead weight managers out and get student nurses back to learning the basics and I agree, there has to be a cut off point where age is concerned! This is not me being discriminatory, merely being realistic!!
    It's by no way cost effective to have student nurses in their 40's and 50's undergoing training!

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  • It is right to say that priorities are shot and resources are not being pooled where they should be, but to effectively render student nurses in their 30s, 40s and 50s as redundant, is nonsense! How unfair to judge someone's suitability on their age. Nursing is about being capable of providing empathic and holistic care, and the rest! I do agree that there should be a drive at training people up from an early age, but in maturity comes experience and a more well-rounded attitude to delivering care based on life experience, which a lot of young people don't have, and they often don't have the sense of commitment to go through training. So don't discard trainees based on their age, be inclusive of everyone who have skills and qualities to contribute.

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  • This is not specific to Whipps Cross - if the CQC were to pay unscheduled visits to other Trusts recently graded as failing, they would see the same and they would all end up in special measures. Scheduled visits are all very well and good but do not show Trusts in true colours. It's a travesty that staff are so pressured and that patients cannot be given the care they so rightly deserve. Mergers between Trusts have caused so many problems - the money it costs to implement a merger should be put into services and direct patient care.

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  • As a mature student, I feel that I am capable of making a significant difference to the care of patients and if anything, my life experience places me in an ideal position to deal with patients in a compassionate manner. I have about 30 years of my working life left and so to say that it is a waste of NHS resources to invest in my training is quite offensive. Unfortunately it is attitudes like these that would discourage students from working in areas where these thoughts and values were commonplace, adding to the problem of staff shortages and low morale. Very concerning and disappointing!

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