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Specialist nurses help large trust out of special measures but bullying concerns remain

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One of the largest NHS trusts in England has been lifted out of special measures after four years under the regime for struggling healthcare providers.

Inspectors from the Care Quality Commission praised Barts Health NHS Trust for its use of expert nurses to improve patient care and staff training. However, they also received complaints from nursing and midwifery staff about bullying.

“Some staff sought us out to complain about cliques, favouritism and passive bullying”

CQC report 

The East London trust was placed into special measures for quality by NHS Improvement in 2015, after the CQC highlighted significant concerns about leadership, governance, patient safety and quality of care.

The CQC returned between September and October 2018 and visited its main sites the Royal London Hospital, Whipps Cross University Hospital and Newham University Hospital.

In a report published today, the watchdog boosted the trust’s ratings for effectiveness, care and leadership to “good”, but safety and responsiveness stayed at “requires improvement”.

“Credit must go to the leadership team at the trust”

Edward Baker 

While the trust’s overall rating remained at “requires improvement”, the CQC found enough had been done to recommend for it to be removed from special measures, which fellow regulator NHS Improvement accepted. However, Barts Health remains in special measures for its finances.

Inspectors commended the trust for having specialist nursing teams in place including in dementia, psychiatric liaison, pain management, critical care outreach, palliative care, and oncology.

They noted that since their last inspection a clinical nurse specialist in palliative medicine had been trained as a non-medical prescriber. 

Barts Health NHS Trust

Damning report on care at major London hospital

Alwen Williams

They also highlighted the appointment of practice development nurses to support staff with education and training.

In addition, the inspectors found that a learning disabilities nurse specialist was helping consultants to communicate with and make reasonable adjustments for patients with learning disabilities.

They praised a nurse on the Cedar Ward at Whipps Cross for showing “outstanding practice” by finding a new way of using a patient assessment tool that had “decreased risk and improved response times”.

However, the CQC found “found pockets of bullying” in the emergency department at Whipps Cross and they urged the trust to “actively work towards eliminating” this.

They said nurses also complained about bullying in the neonatal unit (NNU) and the Rainbow Centre for children and young people at Newham.

“Today is a significant step forward on our improvement journey”

Alwen Williams

“There were some isolated comments from nurses in the Rainbow Centre and NNU about perceived bullying and harassment and not feeling supported or listened to when they raised concerns, but this was not representative of most of the feedback we received from staff,” the report stated.

In addition, the CQC noted reports of bullying in the trust’s maternity services at Newham, which were rated as “inadequate”.

“We received mixed feedback about midwifery leadership and support for staff,” the document said. “Despite some improvements in staff engagement, some staff sought us out on inspection to complain about cliques, favouritism and passive bullying and a perception of unwillingness to listen to staff concerns and investigate them properly.”

The watchdog issued the trust a warning notice following its visit due to issues with care and leadership on its maternity wards.

Ted Baker

edward ted baker

Professor Edward Baker

Inspectors returned in January 2019 to check the trust and found that the requirements of the warning notice had been met but further issues still needed to be addressed. 

Professor Edward Baker, chief inspectors of hospitals at the CQC, said the trust had made “real, consistent progress” and transformed the quality of services in many areas.

“Credit must go to the leadership team at the trust and to the commitment and hard work of all the staff,” he said. ”I congratulate them on what they have achieved.”

However, Professor Baker said there were still areas that required attention such as in maternity services at Newham. 

NHS Improvement

Kathy mc lean

Kathy McLean

The CQC will return later this year to review the trust’s progress.

Alwen Williams, chief executive of Barts Health NHS Trust, said: “Today is a significant step forward on our improvement journey and a tribute to the skill and dedication of our 17,000 hard-working and talented staff.”

She added that the trust would continue to address areas of concern highlighted by the CQC.

Dr Kathy McLean, executive medical director and chief operating officer at NHS Improvement, said: “We will continue to support the trust as it seeks to build on the excellent progress it has made and ensure that further improvements recommended in the CQC report are satisfied and sustained.”

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