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Largest trust in England rated 'inadequate' by CQC

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The largest trust in the country has been rated inadequate by the Care Quality Commission, after a challenging few months of the organisation

Barts Health Trust had already been placed in “special measures” following an inspection of its Whipps Cross Hospital in March.

The CQC has now published a reports for the trust after inspecting its two other acute sites, the Royal London Hospital and Newham University Hospital.

The trust was found to be “inadequate” for whether services were safe, effective, responsive and well led, and “requires improvement” for caring. It is one of the worst assessments the CQC has given a trust.

Inspectors found the trust lacked a strategy or vision. They said they met a “caring” and “very committed” workforce who felt “undervalued” by the trust leadership.

The trust’s chief executive, chair and chief nurse all announced their resignations earlier this year.

Inspectors found that safety was not a “sufficient priority”. Staff did not always recognise concerns and incidents, some were discouraged from raising concerns and there was a “culture of blame”.

The CQC team could not be “confident” that children and adults were appropriately safeguarded and that security needs were consistently met.

The trust was also “considerably reliant” on temporary staff, but the processes to support this flexible workforce were not “robust”. There was a low compliance with mandatory training for staff.

In addition, early warning systems to alert staff when a patient was deteriorating were “varied” and “inconsistent” across the trust.

“We know we have a big challenge ahead but we are determined to rise to that challenge”

Steve Ryan

Despite being responsible for 15,715 births a year, the trust did not have a maternity dashboard to be able to identify the quality of the service provided.

Work related stress among staff was the joint highest in the country for an acute trust, with 44% of staff reporting stress according to the 2013 staff survey and only 32% recommending the trust as a place to work. The inspectors found “minimal improvements” in the 2014 survey.

Inspectors said there was a “lack of timely response” to address the “bullying and harassment culture” the team identified at the last inspection in November 2013.

The pain team for adults was well regarded by patients and staff at Whipps Cross. They also said The Royal London was a “pioneer” in trauma care.

Sir Mike Richards, chief inspector of hospitals, said: “It is clear that the leadership issues we found at Whipps Cross were replicated at the other hospitals.”

Trust chief medical officer Steve Ryan said: “We are very sorry for the failings identified by the CQC in some of our services at Newham and the Royal London hospitals. We know we have a big challenge ahead but we are determined to rise to that challenge.

“We are already making rapid and dramatic improvements in key areas… All our hospitals will be part of the trust’s improvement plan in response to special measures,” he added.

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