The trust was rated Requires Improvement for being safe, effective and responsive. It was rated Good for being caring and well-led, following the inspection in July and August 2019.
CQC last undertook a comprehensive inspection at the trust in May 2018 when it was also rated Requires Improvement overall. At this inspection CQC inspected urgent and emergency services, medical care and services for children and young people.
Inspectors found some Outstanding practice at the trust. The trust sees a significant number of patients from Female Genital Mutilation (FGM) practising countries. The trust’s Iris Clinic provided specialist care for people affected by FGM, including an all-female team, an interpreting service, social support, FGM reversal surgery, and other health advice including gynaecological, contraceptive, and sexual health advice. In addition to direct patient care, the Iris Clinic team also carried out community engagement, health promotion and education work.
The London boroughs of Enfield and Haringey, which are served by the trust, had some of the highest levels of serious youth violence in the capital, and more than 20 knife and gun fatalities involving teenagers and young people under 30 in 2018. Following a Knife Crime Roundtable convened by the trust’s CEO in October 2018 with local MPs, councillors, police, youth workers, and anti-knife campaigners, the trust provided a programme of outreach sessions in local schools, delivered jointly by ED consultants, local mentors, police and the voluntary sector. There were also embedded workers in the trust ED, working with victims and perpetrators of serious youth and gang-affiliated violence.
The trust, in partnership with a local further education college, was supporting internships to 12 local people with learning disabilities, as part of Project SEARCH. The programme was based at NMUH where all practical work-based training and classroom learning would take place.
The trust has established a partnership with a local college to provide many apprentice opportunities. During 2018/19, the trust recruited more than 100 apprentices, bringing their apprenticeship workforce to 186, working in roles ranging from health and care, IT, business administration and pharmacy. The clear majority of these new staff are from the local communities the trust serves.
However, there are areas where the trust must now improve. These include in urgent and emergency services:
Ensuring there are systems and processes in place to safely prescribe, store, administer and record medications.
Ensuring that staff carry out regular physical health checks of patients after they receive medication by rapid tranquilisation for their mental state.
In medical care:
Ensuring an oversight over Deprivation of Liberties Safeguards authorisations (DOLS) process within the hospital. Where the DOLS authorisation is extended more than once this must be done in accordance with legislation.
Ensuring mental capacity assessments are completed by the clinician as part of the best interest process.
In services for children and young people:
Ensuring governance systems for updating evidence-based practice guidelines and governance systems at ward level to ensure stock management of medicines is appropriately completed. This includes risk assessing all patients appropriately to obtain assurance that no patients came to harm with the discharge summaries backlog.
“I am pleased that North Middlesex University Hospital NHS Trust now appears to be moving in the right direction. Although the overall rating remains Requires Improvement, it now has two Good ratings for being caring and well-led.
Since our last inspection the trust had established, a substantive, experienced and capable leadership team with the skills, abilities, and commitment to provide high-quality services. The trust had made significant improvements to its serious incidents reporting and learning systems.
We found a strong organisational culture of collaboration, team-working and support and a common focus on improving the quality and sustainability of care and people’s experiences. Staff were proud of the trust as a place to work and spoke highly of the culture and of the leadership team.
In the future I want to see all the trust’s ratings improve and CQC will be working with the leadership team to help ensure that happens.”
You can read the inspection report on the CQC website.