Croydon NHS Trust “requires improvement” after a report revealed failures such as faulty theatre equipment and inadequate staff training.
An inspection by the Care Quality Commission (CQC) into Croydon Health Services NHS Trust, which runs Croydon University Hospital and Purley War Memorial Hospital, highlighted 14 areas of “outstanding practice” but flagged up concerns about staffing shortages, cancelled operations and a lack of mandatory training.
The Trust’s urgent and emergency services, maternity and gynaecology wards and services for children and young people were rated as “good”, while its medical care, surgery, critical care, end of life care and outpatient and diagnostic imaging services were rated as “requires improvement.”
Several areas of outstanding practice were outlined in the report, including palliative care, involvement in breast cancer research, the diabetes team for children and young people, the UNICEF-accredited special care baby unit and the maternity service.
The majority of improvement required across all of the areas deemed as requiring improvement was to increase the number of staff receiving mandatory and refresher safeguarding training.
The report comes after the CQC assessed Croydon Health Services as “high risk” earlier this year and prioritised them for immediate assessment, which took place between June 16 and 19, as well as a surprise inspection on June 23.
In a statement to EastLondonLines, Professor Sir Mike Richards, chief hospitals inspector at CQC, said that while the Trust has made “significant improvements” across a number of services, with patients telling the CQC of the “compassionate care” they had received, the Trust “continues to face challenges in many other areas, including community services, surgery and critical care.”
“Operations were sometimes cancelled, the day surgery department experienced difficulty in coping with the increased level of demand and patients were often delayed when being discharged from critical care.”
The report stated that risks, such as faulty theatre equipment or poor theatre environments, were often neither identified nor addressed by staff, and that the Trust was slow to resolve such risks.
The cancellation of operations was put down to unavailable equipment or equipment failures.
Inspectors said there was “low morale” amongst consultant surgeons and a “distrust” of leadership in the surgical department, which was rated as “inadequate”.
“We received concerning reports of consultants being blamed when they raised concerns, which had resulted in a culture of fear,” they said.
In response to the report, the Trust is expected to start work to “completely refurbish” all nine of its surgical theatres in 2016, which are used to perform more than 30,000 operations each year.
It has also reportedly spent more than £1 million on new theatre equipment in the last 15 months, including £130,000 on anaesthetic machines and more than £90,000 on operating tables.
Sir Richards also noted that “vacancies across all staff groups remained an ongoing issue, resulting in the regular use of locum and bank and agency staff to maintain safe staffing levels.”
The inspection showed that the Trust was consistently short of at least 500 full-time staff, particularly nurses and midwives, leading it to rely on nearly 10% more bank and agency staff than the national average in the last year.
This meant that on most shifts, 20% of nurses were from an agency, rather than employed full-time by the Trust.
Concerns were also raised about the level of training undertaken by staff, as the report showed attendance at mandatory training sessions to be below the 90% target.
In a statement on their website, Croydon NHS chief executive John Goulston said the improvements laid out by the CQC in their report “are within our hands” and that he was “extremely proud” that the CQC had recognised the progress the Trust had already made since their last inspection in 2013.
“Where the CQC has rated us ‘good’ we now want to get to ‘outstanding’ and where we ‘require improvement’ we must get to good – if not better,” he said.
As well as improving its surgical theatres, the Trust outlined its plans to invest in new IT systems and expand its staff recruitment campaign.
Mike Bell, Chairman of the Trust, said he was “proud” of the progress it had made since 2013, when CQC inspectors said it required “significant improvement”.
“When I first joined the Trust in 2013, we would repeatedly hear ‘it’s good enough for Croydon.’ Our view since then has been that it is fine to say, as long as it has the prefix: ‘Only the best is good enough for Croydon’,” he said.
“Our CQC inspection two years ago was the single most important advice that we could have been given to focus our attention on what we need to improve,” he said.