Archived: Northwick Park Hospital

We carried out this comprehensive inspection because North West London Hospitals NHS Trust had been identified as potentially high risk on the Care Quality Commission’s (CQC) Intelligent Monitoring system. We carried out an announced inspection of Northwick Park Hospital between 20 and 23 May 2014. Northwick Park is the main location of the trust and accommodates the senior management team.

North West London Hospitals NHS Trust is located in the London Boroughs of Brent and Harrow, and cares for more than half a million people living across the two boroughs, as well as patients from all over the country and internationally. The North West London Hospitals NHS Trust manages three main sites registered with the Care Quality Commission: Northwick Park Hospital and St Mark’s Hospitals in Harrow, and Central Middlesex Hospital in Park Royal. St Mark’s Hospital as an internationally-renowned centre for specialist care for bowel diseases. The trust has a sustainable clinical strategy with Ealing Hospital to improve patient pathways, and is underpinned by combined ICT and estate strategies, and a vision to establish Northwick Park Hospital as the major acute hospital of choice for outer North West London.

The hospital has had some issues in the past, particularly around its maternity services. However, the management team has worked hard to address these. We saw a number of areas where improvements had been made to the maternity services, but it still requires further improvements in order to provide a safe, effective, caring and responsive service.

Overwhelmingly across the trust, staff were found to be caring and compassionate towards patients, their family and friends. The management of areas at a local level required some improvement for services to develop and provide good care.

Our key findings were as follows:

• The patient flow through the hospital impacted on patients waiting in the A&E department, in that patients were often 'bedded down' in A&E until a bed became available. 
• Middle grade doctors did not always receive the training and supervision they required.
• Policies and protocols, particularly in surgery and critical care, were not always up to date and reflective of national guidance.
• Pressures on the critical care units were such that some patients were discharged too early and had to be re-admitted on some occasions.
• The pace of change in maternity was slow, leading to potential risks for women using the service.
• In most areas the hospital, while clean, was in need of refurbishment.

We saw an area of outstanding practice:

• The stroke unit was providing a ‘gold standard service’ with seven-day working. It had been the recipient of the prize for the 2013 Clinical Leadership Team at the British Medical Journal awards.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Ensure that there are appropriate numbers of staff to meet the needs of patients in the A&E department, surgical areas and critical care.
• Ensure that there are systems in place to assess and monitor the quality of the service provided in A&E, critical care, surgery and maternity, to ensure that services are safe and benchmarked against national standards.
• Ensure that the environment is safe and suitable in paediatric services.
• Ensure that equipment is available, safe and suitable within the paediatric service.

In addition the trust should:

• Review the coping strategies within A&E during periods of excessive demand for services.
• Empower senior staff to make changes to ensure that patients are safe in A&E and maternity.
• Ensure that planned changes are undertaken in a timely manner in surgery and in maternity.
• Review discharge arrangements in A&E and critical care to avoid re-admission to these areas.
• Encourage a proactive midwifery department.
• Encourage increased multidisciplinary working in areas such as maternity.
• Review the confidentiality of medical records within the outpatients department.
• Review the effectiveness of clinics to prevent overbooking, late running and cancellations.

Professor Sir Mike Richards

Chief Inspector of Hospitals