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18 December 2013, 14:00
The NHS trust running Queen's Hospital Romford is being put in special measures over concerns about patient safety in its accident and emergency (A&E) departments.
Barking, Havering and Redbridge (BHR) University Hospitals NHS Trust has been the subject of intense scrutiny after a series of inspections and reports flagged it as high risk.
The NHS trust development authority - which offers support and governance for trusts - has now put the trust in special measures following recommendations from Professor Sir Mike Richards, chief inspector of hospitals for the Care Quality Commission (CQC).
Eight foundation trusts and five other NHS trusts are currently in special measures.
BHR also runs King George Hospital in Ilford which also has an A&E department.
A CQC inspection report in October found that while the trust was working hard to make improvements in many areas, it still provided "unsafe care" in A&E and "needs to urgently focus" on resolving these issues.
The report said: "The A&E departments are at times unsafe because of the lack of full-time consultant and middle-grade doctors. "There is an over-reliance on locum doctors with long waiting times for patients to be assessed and reassessed.
"Delays in specialist doctors seeing patients in the A&E departments are also impacting on patient safety."
The report said Barking faces "significant difficulties" in recruiting medical staff for A&E, and has done since 2011.
More Consultants Needed
The College of Emergency Medicine recommends that, for the number of patients seen in just one of the trust's A&E departments, it should have 16 consultants to provide cover 16 hours a day, seven days a week.
"The trust has eight consultants in post out of an establishment of 21 to cover both A&E departments at Queen's and King George Hospitals," the report said.
"The heavy reliance on locum staff is putting patients at risk of receiving suboptimal care."
Inspectors also found problems at both hospitals with nursing staff, who were not routinely documenting the care patients required or received.
The report said: "Discharge plans, along with nursing notes, were not up to date.
"Many patients were transferred between Queen's and King George Hospitals with transfer check lists not always completed which meant staff may not be aware of a patient's needs - as in the case of one patient who had diabetes which was not recorded."
Maternity Services Improving
The CQC did find examples of good practice, including impressive care provided to patients who had suffered a stroke.
Prof Richards said: "This trust has demonstrated that it is capable of making significant changes to the quality of services.
"Maternity services have shown sustained improvement over time - and although the findings of last week's maternity survey suggest there may still be more to do, there has been progress.
"It is very disappointing that this good work has not been replicated throughout the trust. The long-standing issues in the two A&E departments are clearly affecting patients - and all attempts to address these problems over the last few years have had insufficient impact.
"While we understand that this trust serves a large and diverse population, and that the leadership team is trying to resolve the issues, it's clear to us the trust is unable to do so without help.
"That's why I've recommended that the trust should be placed in special measures in order to give it the support it needs to tackle the issues it faces."
The trust will now be forced to publish an improvement plan on action it will take to improve its services.
An improvement director is also being appointed to provide oversight while a comprehensive leadership review will also take place.
Three Important Factors
NHS trust development authority director, Alwen Williams, said: "This is a disappointing report both for the trust and the patients it serves. Our priority is making sure the trust is able to rapidly improve the care it provides."
Barking, Havering and Redbridge University Hospitals NHS Trust Chief Executive Averil Dongworth said: "There are three very important factors which we must not lose sight of today.
"First, the Care Quality Commission has recognised the good quality of patient care provided by our staff and sustained improvements to our services.
"Secondly, our patients need to know that it is business as usual. They can rest assured that our hospitals are performing well in many areas, services are continuing to improve and we are clear on where more effort must go.
"Thirdly, today's decision provides the opportunity for the whole health system to come together to give our hospitals the level of support that we have been asking for. We must now all work together to address the long-term issues that we have been facing once and for all."