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CQC inspection finds Croydon Health Services is making significant progress, but further improvements still required

The Care Quality Commission (CQC) has described Croydon Health Services NHS Trust as making “significant progress” after a routine inspection of its hospital services and care provided throughout the local community.

Overall, the Trust has been rated as “requires improvement” and is determined to make continued progress. 

  • Patients told the CQC that “staff [were] gentle, kind and caring,” and that care at Croydon University Hospital had “improved since their last admission.”
  • One patient quoted in the inspection report said they were “gobsmacked at how much better it is than before.”
  • CQC Chief Inspector of Hospitals, Professor Sir Mike Richards said: “Since our last inspection, Croydon Health Services has made significant improvements across a number of its services.”

Croydon University Hospital was the very first in the country to be visited by the CQC’s Chief Inspector of Hospital’s team in September 2013. It was not given a rating at the time. The CQC held its second planned inspection of services at Croydon University Hospital in June 2015. For the first time, this inspection also included community services run by the Trust in schools, homes and health clinics throughout the borough.

As part of the CQC’s rigorous inspection of health and social care providers across the country, all services are individually rated in five quality domains. This is to assess whether services are safe, effective, caring, responsive and well-led. There are four ratings:Outstanding, Good, Requires Improvement or Inadequate.

The CQC highlighted 13 areas of “outstanding” practice at the Trust, including the special care baby unit at Croydon University Hospital and the specialist palliative care team who, alongside a team of community nurses, provide 24/7 care and support for people in the last days or hours of life.

The Trust was rated as “good” for caring and effective services. The Emergency Department, maternity and gynaecology services, and services for children and young people at Croydon University Hospital and Purley War Memorial Hospital were also rated as “good.”

Overall, Croydon Health Services was rated as “requires improvement,” with improvements needed under the CQC domains of safe, responsive and well-led.  

John Goulston, Chief Executive at Croydon Health Services NHS Trust said:

“The majority of the improvements are within our hands, such as increasing the number of staff who complete mandatory refresher training every year, and further strengthening our governance process throughout the Trust.

“I am extremely proud that the CQC has recognised the considerable achievements of our dedicated and caring staff. Thanks to them we have made several leaps forward, but we know there are aspects of our services where we can, and must, do better.

“There is no doubt that our progress so far has been enabled by Listening into Action – our way of listening to what our staff and patients and local residents say, and helping our staff to take forward their ideas for how we can improve. Listening into Action is our way of developing a culture of continuous improvement, and we have set ourselves tough targets. 

“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.

“We are now more determined than ever to keep improving our care.”

Publishing its findings from the inspection this year, the CQC praised many aspects of the Trust’s services, including its participation in national audits which were largely positive and showed improvements – but the CQC also found a number of areas where the Trust must improve. Notably, the CQC said the Trust must promptly implement plans to refurbish its operating theatres and put in place an equipment replacement programme.

Nine main surgical theatres at Croydon University Hospital will now be completely refurbished. The hospital performs more than 30,000 surgical operations every year, with the vast majority of procedures carried out without an overnight stay. The refurbishment work will begin next year (2016/17), with theatres being renovated two at a time so to not impact on waiting times.

More than £1m has been spent on new theatre equipment over the last 15 months, including £130,000 on new anaesthetic machines, and more than £90,000 on new operating tables.

The CQC also found that some of the Trust’s oversight and governance systems were still evolving and needed to be strengthened. In September 2015, the Trust appointed its first Director of Quality Assurance and Governance. This is a new role to increase the focus on continued quality improvements at Board level.

The Trust is already working to improve in other areas highlighted by the CQC, including: 

  • Investment in new IT systems: The Trust successfully applied for £969,000 from NHS England’s Nurse Technology Fund (Feb 2015) to give community nurses, therapists and midwives better remote access to secure patient records. This will be invested in new portable equipment update patients’ online records in real-time.
  • Recruitment: Like many NHS trusts, Croydon has struggled to recruit more clinicians faced with limited availability and greater competition – especially in London. The Trust’s ‘Could you be a Croydon Nurse’ campaign has helped recruit 160 new nurses since March 2015. This initiative is now being expanded to recruit to vacancies in other areas, including in the Emergency Department and therapies.
  • Cancelled operations: Patients are now contacted by telephone and text so they do not miss planned operation appointments. The Trust is also using a new scheduling system so that more operations now start on time, and the hospital makes more efficient use of its theatres to reduce waiting lists.

Mike Bell, Chairman of the Trust said:

“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.

“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 needed to improve. This relentless focus must now not slip, and we must maintain these improvements.

“All of our staff can be proud of what we have achieved in just two years. We expect to see continued improvements from this point forward.”

The full CQC reports from their inspection of the Trust’s community services, Croydon University Hospital and Purley War Memorial Hospital can we viewed at www.cqc.org.uk/provider/RJ6

All of the actions and recommendations made by the CQC will be taken forward as part of the Trust’s renewed Quality, Experience and Safety Programme (QESP). The Trust’s performance and progress will be monitored through its strengthened governance arrangements, alongside:

  • Weekly ‘Quality Rounds’ led by Matrons across all ward and clinical areas;
  • Monthly ‘Quality Reviews’ led Trust Executives to check and monitor progress;
  • Mini ‘Mock’ inspections and regular peer reviews to benchmark the Trust’s performance through share learning and best practice from across London and throughout the country.

 

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