A major trust dogged by performance and financial problems for more than a decade has moved out of special measures, with regulators commending the hard work of staff and visibility of managers.
Barking, Havering and Redbridge University Hospitals NHS Trust was judged to have made significant enough improvements to be removed from the support regime for struggling providers.
“We found that the senior leadership was visible and involved in clinical activity”
The recommendation was made by the Care Quality Commission and ratified by NHS Improvement today.
The trust, in East London near the Essex border, was originally placed in special measures in December 2013 and remained in the regime after an inspection in March 2015.
But after the latest round of inspections in September and October 2016, staff were seen to have worked hard to improve the quality of care, said the CQC in its new report.
The visit in the autumn focused on the four areas where the organisation had been rated “inadequate” at the previous visit – urgent and emergency services, medical care, services for children and young people, and outpatients and diagnostic imaging.
The trust, which has two main sites at Queen’s Hospital in Romford and King George Hospital in Ilford, had demonstrated the “sustained” improvement necessary, according to the regulator.
“The last three years have been a steep improvement curve”
The inspection team found all four core services had shown significant improvement, with services for children and young people particularly being commended and was now rated “good” overall.
None of the trust’s domains are now rated as “inadequate”, noted the CQC. However, the trust retains its overall “requires improvement” rating, as the targeted visit was of only four services.
Meanwhile, the regulator highlighted that staff seemed positive. Only 53% of staff said they would recommend the trust for care in 2013, but this had risen to 83% last year.
CQC chief inspector of hospitals Professor Sir Mike Richards praised particular areas of outstanding care for dementia patients and the trust’s improved facilities for children with learning disabilities.
For example, the CQC noted that a dedicated paediatric learning disability nurse had introduced extra support for patients, including a children’s hospital passport and visual communication tools.
Sir Mike Richards
The regulator also noted that Matthew Hopkins, a nurse by background, had been appointed as trust chief executive to lead a largely new executive team in April 2014.
Sir Mike said: “We last visited the trust in March 2015, under a new executive team at that time, it was evident that improvements were being made, but more needed to be done.
“I am pleased to say that our latest inspection demonstrated that the trust has continued to make progress; to provide safer, better quality care,” he said.
“We found that the senior leadership was visible and involved in clinical activity,” he said. “The staff were positive about the changes, their environment, and the future direction of the trust and the services.
“The inspection team was impressed by a number of innovative quality improvement and research projects which have taken place to improve the patient experience,” said Sir Mike.
He added: “While further improvements are necessary, we are confident that both leadership and staff know what needs to be done to continue towards achieving an improved rating.”
The trust still has performance and finance issues, including performance against the four-hour accident and emergency target of 87.1% for the third quarter of 2016-17 – some way below the national performance target of 95%, but only very slightly below the London average over this period.
It is on track to achieve a deficit of £13.3m by the end of 2016-17 – only £1.4m off-plan – and recently started reporting elective waiting time performance after losing track of thousands of patient records.
But, with a third quarter performance of 78.3% against the national target for treating patients within 18 weeks of 92%, it is still the fourth worst performing trust in the country on this measure.
“I am delighted that we are taking such a big step forward today”
The CQC’s latest report also said that, although nursing staffing levels had improved since the last inspection, some areas still had “significant vacancy and turnover rates”.
Commenting on the improvements, trust chief executive Mr Hopkins said: “I have always believed in the huge desire and passion of our staff to deliver outstanding care to this community.
“It is evident to me every single day in our hospitals, so I am delighted it was clearly evident to the CQC team too, as this very positive report shows,” he said.
“It captures some of the many sustained improvements our staff, with the help of our patients, partners and key stakeholders, have delivered,” said Mr Hopkins.
“The last three years have been a steep improvement curve. We needed to take significant steps and make some big cultural changes. This has taken time, but firm foundations have been laid,” he said. “We are excited about the future, and continuing our journey towards outstanding.”
Kathryn Halford, the trust’s chief nurse, said: “I am delighted that we are taking such a big step forward today. There are some wonderful things happening in our hospitals, which I am proud to be associated with.
“As well as our local community, I particularly hope this sends out a clear message to people across the health community, that we are a progressive trust moving very much in the right direction, and that this is a great place to work and develop professionally,” she added.
NHS Improvement’s executive regional managing director for London, Steve Russell, said: “Having previously worked at the trust myself, I know first-hand that staff at all levels are 100% committed to delivering superb care for every patient, every time.
“In every corner of the trust, you can find people wanting to share ideas about how to do things better, how to be more effective, how to be more efficient – their pride in doing a good job for their patients and community is almost tangible,” he said in a statement.
He added: “I’m really pleased that their progress so far is evident in today’s announcement, and look forward to seeing their continued progress, which NHS Improvement will continue to support and monitor.”
The trust still has a significant legacy debt, thought to be more than £200m, relating to historic financial deficits after a private finance initiative rebuild.
There are currently 11 hospital trusts still in quality special measures.