Britain’s biggest NHS trust was today shamed as “inadequate” as it received some of the worst criticism ever levelled by the NHS watchdog.
Barts Health, which runs five east London hospitals including the £650 million Royal London in Whitechapel, was ordered to make an unprecedented 65 immediate improvements by the Care Quality Commission.
It was castigated for having “not enough doctors and midwives to deliver safe care” to women in labour, “significant risks” due to a lack of paediatric nurses, and security failings that created a risk of newborn babies being abducted.
A shortage of beds at the Royal London – the biggest stand-alone hospital in Europe, with 671 beds on 31 wards – meant operations were repeatedly cancelled and patients were shuffled between wards for non-medical reasons.
A “them and us” culture exists between a “very committed” workforce and the trust board, while a “culture of blame” and bullying meant some staff were afraid to speak to CQC inspectors.
The trust, which posted a £79.6 million debt in the last financial year, was placed in special measures by the Trust Development Authority in March after the CQC found Whipps Cross hospital, in Leytonstone, to be inadequate.
The CQC’s concerns led it to investigate the flagship Royal London – rebuilt under a controversial private finance initiative (PFI) deal three years ago – and Newham.
It found these too to be inadequate, with only the major trauma unit at the Royal London – which saves twice as many patients as the national average – and the trust’s stroke services among the few services attracting praise.
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said “too little attention was paid to safety” across the trust. There were nine “never events” – medical blunders so bad they should never occur – in 14 months, including eight cases of surgery in the wrong area and 1,253 serious incidents.
Sir Mike said: “Barts Health NHS Trust is the largest NHS trust in England, serving a population of well over two million people, and home to some world-renowned specialities. So it is all the more disappointing to report the extent and level of our concerns in all three hospitals, particularly in safety and leadership.
“It is clear that the leadership issues we found at Whipps Cross were replicated at the other hospitals. It is three years since the merger which formed the trust – but there is still a lack of engagement with the staff, low morale, high levels of stress, even confusion among the workforce about who is in charge.”
The report, based on inspections in January followed by unannounced visits, could increase pressure to break up the trust. Its chief executive, chairman, chief nurse and finance director have all quit in the past months.
One patient told the CQC that it was so difficult to contact staff at Whipps Cross that he had to visit the hospital in person after making 79 phone calls without success.
Another patient had their surgery cancelled five times – but the head of surgery, head of cancer, hospital director and head matron were all unaware.
Security tags had not been fitted to the ankles of newborn babies for six months because of a series of false alarms, despite the high number of unknown visitors to the Royal London’s maternity unit. Two of the floors at the Royal London remain mothballed because of a lack of cash, but there are plans to use one floor for private patients to reduce the trust’s deficit.
Royal College of Nursing London Operational Manager Sue Tarr said: “Barts Health has faced a series of problems over recent years, driven in part by an unsustainable PFI debt. However the decision in 2013 to try to save money by cutting and down banding hundreds of nursing posts has proved disastrous. Barts now has the biggest deficit and the biggest agency nursing bill of any trust in England.
“The CQC suggests that staffing shortages went further than those reported at board level. The trust urgently needs a realistic and sustainable plan to get enough nursing staff in post to safely deliver the care needed by the millions of East Londoners who rely on Barts for their healthcare needs.”
Steve Ryan, the Barts Health NHS Trust Chief Medical Officer, said: “These CQC reports describe some services that fall short of what we aspire to. 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. We welcome the targeted help the special measures regime provides. We firmly believe in Barts Health as an organisation and we recognise the need for improvement.”