One of the country’s biggest trusts, it employs more than 10,000 people, Royal Free was rated Good for being effective, caring and well-led. It was rated Requires Improvement for being safe and responsive, following the inspection in December 2018 and January 2019.
Royal Free London has three main hospital sites: The Royal Free Hospital; Barnet Hospital and Chase Farm Hospital.
Some of the issues identified during the previous inspection, which impacted on the safety and responsiveness of services, had not been addressed.
Mandatory training for staff in key skills, including safeguarding, fell below the trust’s target for compliance.
Staff did not consistently follow best practice when prescribing, giving, recording, storing and disposing of medicines. Services did not always have sufficient numbers of staff, with the right mix of qualifications and skills, to keep patients safe and provide the right care and treatment.
Whilst the majority of staff felt the culture of the organisation had improved and described the leadership team as accessible and supportive, there remained a culture of bullying within the operating theatres.
There were long waits in A&E and waiting times from referral to treatment and decisions to admit patients were not always in accordance with best practice recommendations.
However, inspectors found that staff worked together as a team to deliver effective, patient centred care and improve patient outcomes. Patients were treated with kindness, dignity and respect, and feedback from patients about their experience of care was consistently positive. Most staff felt well supported by managers and they said that management encouraged effective team working.
There was also evidence that patient safety incidents were managed effectively, and that infection risk was generally controlled well. Overall, the trust was committed to improving services by learning, promoting training, research and innovation.
Areas the trust must now improve include:
- Ensuring staff in maternity services at The Royal Free Hospital follow the trust medication policy and procedures in the safe storage of medicines and safe disposal of expired medicines.
- In Urgent and Emergency at Chase Farm Hospital the trust must ensure that staff follow the trust’s record management policies concerning safe storage and security of patient and staff records
There were though some areas of outstanding practice. In medical services at The Royal Free Hospital the trust dementia lead had worked with the volunteer-led radio station to implement daily ‘sundown’ sessions for patients as part of dementia action week in 2018. This was an evidence-based project to address the clinical phenomenon of ‘sundowning’, which refers to increased confusion patients with dementia or delirium typically experience in late afternoon.
In response to feedback from family members, staff on ward 12S had designed and launched a care plan specifically for carers. The team recognised patients on the ward were often admitted for substantial periods of time, which their carers often spent with them. The care plan helped staff to get to know carers, understand their needs and develop strategies to support them during the patient’s admission.
In medical care at Barnet Hospital on the concourse on the third floor a pop-up café with tables and chairs brought together patients from care of the elderly wards. Staff brought patients from wards, in their beds and wheel chairs as well as patients who could mobilise for a social afternoon with music tea and cake which was ran by hospital volunteers and staff. During inspection in the afternoon, inspectors observed the café was supported by local school children who came to sing Christmas carols.
In medical care services at Chase Farm Hospital each patient undergoing a procedure in endoscopy was allocated an individual pod with en-suite bathroom facilities which they used before the procedure and to recover afterwards. This ensured patients had sufficient privacy throughout the course of their endoscopy procedure.
“Although The Royal Free London NHS Foundation Trust’s rating has fallen from Good to Requires Improvement, there is much still to be proud of at the trust, including some outstanding practice.
The trust was rated Good in three of the main categories that we rate, though it was let down in the safe and responsive areas. We want to see improvements quickly and CQC will monitor the areas where the trust is not doing so well.”
CQC has also published the trust’s Use of Resources (UoR) report, which is based on an assessment undertaken by NHS Improvement. The trust has been rated as Requires Improvement for using its resources productively. Its combined UoR and Quality rating is Requires Improvement.
You can read the inspection report in full on the CQC’s website