CQC report on Imperial NHS Trust: "Requires improvement" 21st Feb 2018

In November and December 2017 the CQC inspected the three major hospitals in the Imperial group (St Mary's, Charing Cross and Hammersmith). Their report has been published on 21st February 2018 and is available here.


In the Evening Standard, Ross Lydall reported:

One of London’s biggest NHS trusts was today criticised for treating A&E patients on trolleys in corridors.

Imperial College Healthcare, which had problems with soaring patient demand highlighted in an acclaimed BBC documentary last year, was rated by the Care Quality Commission as “requires improvement”.

But it was praised for “outstanding practice” at Hammersmith Hospital in pioneering a keyhole method of replacing damaged aortic valves, avoiding the need for open-heart surgery.

A new system at Charing Cross Hospital for diagnosing prostate cancer meant MRI scans and biopsies were done on the same day, resulting in “significantly fewer” men having to undergo painful tissue-sampling tests.

But today’s report shows the trust, which has one of the largest building maintenance backlogs in the NHS, had largely failed to improve in the three years since it was last inspected.

The rating for emergency services at Charing Cross fell from “good” to “requires improvement”. The layout and lack of capacity was “challenging”. Five resuscitation bays “were frequently used for seven to eight patients”.

The report said the lack of emergency capacity affected the “privacy and dignity” of patients. This was despite a refurbishment at St Mary’s, which is a major trauma centre. A £3.5 million upgrade of the emergency department at Charing Cross is planned.

Nine “black breaches” were declared in 12 months, eight of them at Charing Cross, because patients arriving by ambulance waited more than an hour to be handed over to hospital staff.

Bosses did not have a full understanding at times of extreme pressures as front line staff were too busy looking after patients to tell them

The trust was ordered to improve urgently the state of seven operating theatres at St Mary’s and implement “deep cleaning” schedules.

Professor Ted Baker, England’s chief inspector of hospitals, said: “There has been some improvement in care at Imperial College Healthcare NHS Trust and the quality of some services are outstanding. However, there is still plenty of scope for the ratings of the trust to improve.”

Imperial’s interim chief executive, Professor Julian Redhead, said: “In addition to the challenge of increasing demand for our services, we have a problem with an aging estate and shortage of space, especially at St Mary’s. 

“Despite our constraints, and thanks to our very skilled and dedicated staff, we continue to be rated ‘good’…  We’re determined to make further progress on the issues highlighted so that we can provide the very highest standard of care all round.” 

NHS faces £1bn deficit and widespread shortages of staff

By Laura Donelly - The Daily Telegraph  21st February 2018


HS hospitals are facing a financial black hole almost twice as bad as was predicted, new figures show.

Experts said the updates made “grim reading” for the NHS, with trusts struggling to cope with widespread staff shortages and rising demand.

The quarterly report from NHS Improvement predicts that hospitals will reach a deficit of £930m by the end of this financial  year - £435m worse than planned.

Meanwhile, the NHS reported almost 100,000 vacancies, with thinktank the Nuffield Trust raising fears that the situation is set to “spiral out of control”.

One in eleven jobs is now vacant, with even higher rates of shortages among nurses, the figures show.

Watchdogs said NHS staff were doing their best in the face of rising demand.

NHS leaders said the health service was “pushed to the limit”.

Why is the NHS under so much pressure?

  • An ageing population. There are one million more people over the age of 65 than five years ago. This has caused a surge in demand for medical care

  • Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years. This has caused record levels of “bedblocking”; people with no medical need to be in hospital are stuck there because they can’t be supported at home

  • Staff shortages. While hospital doctor and nurse numbers have risen over the last decade, they have not kept pace with the rise in demand. Meanwhile 2016 saw record numbers of GP practices close, displacing patients on to A&E departments as they seek medical advice

  • Lifestyle factors. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Growing numbers of overweight children show this problem is currently set to continue


Saffron Cordery, NHS Providers’ director of policy and strategy, said: “Despite working at full stretch with around 100,000 vacancies and a real risk of staff burnout, and despite treating 6 per cent more emergency patients year on year in December, trusts cannot close the gap between what they are being asked to deliver and the funding available.”

NHS Improvement said that the deficit is still not as high as it was in 2015/16 when it stood at £2.47 billion, officials said that the deficit had been reduced through a series of measures including cutting down on expensive agency staff, efficiency measures and "smarter" procurement.

The regulator said that the majority of the financial decline against plan in the current year comes from a small number of trusts with larger than expected deficits.

The ten worst trusts for A&E waiting times in January


Percentage in 4 hours or less (type 1)

The Hillingdon Hospitals NHS Foundation Trust


Blackpool Teaching Hospitals NHS Foundation Trust


University Hospitals Of North Midlands NHS Trust


Royal Cornwall Hospitals NHS Trust


Shrewsbury And Telford Hospital NHS Trust


West Hertfordshire Hospitals NHS Trust


East Lancashire Hospitals NHS Trust


Worcestershire Acute Hospitals NHS Trust


Norfolk And Norwich University Hospitals NHS Foundation Trust


London North West Healthcare NHS Trust



[Target is 95% within 4 hours]     [my bold - London NW Healthcare NHS Trust includes Northwick Park and Ealing Hospitals]

Meanwhile it said that NHS providers had maintained A&E performance, with 89.5 per cent of patients being seen within four hours, a similar rate to last year.

NHS Improvement chief executive Ian Dalton said: "Some providers appear to have managed the financial pressures better than others.

"We are working closely with those providers whose financial position has deteriorated seriously to ensure that they grip their problems while delivering the best possible care for their patients."

A Department of Health and Social Care spokesman said: "Despite the challenging winter months, the NHS has cared for record numbers of patients and fewer NHS trusts are expected to be in deficit at the end of this financial year.

"Whilst the NHS was prioritised in the recent Budget with an extra £2.8billion for the next two years, NHS trusts must now tighten their grip on finances.

"There are currently record numbers of staff working in the NHS and the vast majority of vacancies are filled by bank and agency staff so patient care is not compromised. We are supporting staff to improve work/life balance by working more flexibly and have announced the biggest ever expansion of training places for both doctors and nurses."

Consultancy firms make hospitals worse

By Chris Smith - The Times 21st February 2018

The hundreds of millions of pounds the NHS spends on management consultants actually make it less efficient, the first study of its kind has concluded.

Not only are hospitals wasting their money but the consultants appear to make finances marginally worse.

Researchers said that “inefficiency is the norm” in NHS consulting projects.

Health unions reacted furiously to the “scandalous” findings, urging ministers to divert money from management consultants to doctors and nurses. Hospitals and consultants insisted that external advice was needed, but conceded that the results underlined the need for clear measures of value for taxpayers’ money.

Andrew Sturdy, professor in management at Bristol University, who carried out the study, said: “Our research has clearly shown that management consultants are not only failing to improve efficiency in the NHS but, in most cases, making the situation worse . . . this is money which, many argue, could be better spent on medical services or internal management expertise.”

Despite consistent political criticism of management spending from both main parties, the cost to the NHS has increased under both, reaching £640 million in 2014 before falling to £263 million in 2016-17.

Professor Sturdy gathered data on 120 NHS hospitals over four years, comparing spending on consultancy with an efficiency measure recording how much it cost them to carry out standard procedures. Each £100,000 spent on management consultants led to extra costs of £880, he concluded in the journal Policy & Politics.

The average trust spent £1.2 million a year on management consultants and afterwards became less efficient by about £10,600 a year. Professor Sturdy said: “The big question is what that money could have been spent on instead.”

Read more ...

HCT march prompts Trump tweet - and international coverage for NHS underfunding

On Saturday 3rd February veteran "professional" campaigners, families, OAPs, NHS professionals, trade unionists and people from every part of England and Wales joined in a march of about 60,000 from outside University College Hospital in Gower Street to Whitehall. This was a repeat of the much bigger march on 4th March 2017 along almost the exactly same route.

Amazingly 2 days later it has become an international news story - at last the severe underfunding and repeated wrongheaded reorganisations which protesters reject have hit the international news headlines following a comment by Nigel Farage on Fox News and a response by President Trump - which was based on his complete misunderstanding of our NHS.

In this news piece the BBC effectively advertised: "The US health system is crap".

If you google "Fox news NHS march" you find that the march is covered in major outlets:

(1) Fox News: http://www.foxbusiness.com/markets/2018/02/03/thousands-march-to-demand-more-money-for-uk-health-service.html

(2) The  Washington Post: https://www.washingtonpost.com/news/worldviews/wp/2018/02/05/trump-thought-the-british-were-protesting-against-their-health-service-they-werent/?utm_term=.cc2fb6ef5130

(3) Huffpost  (UK edition):  http://www.huffingtonpost.co.uk/entry/donald-trump-attacks-the-nhs-after-nigel-farage-appears-on-fox-news_uk_5a784a57e4b01ce33eb5225c

(4) Sky News: https://news.sky.com/story/donald-trump-says-nhs-is-going-broke-and-thousands-are-marching-11237776

(5) The Times:  https://www.thetimes.co.uk/article/jeremy-hunt-hits-back-at-donald-trump-over-broke-nhs-jibe-g556wxsr9

  Save Our Hospitals demonstrators as part of the Health Campaigns Together and People's Assembly and NHS campaigners in general (ALL the groups) -  have broken through onto an international stage.

Thank you, Mr Farage, for banging on about your favourite topic of immigration and blaming that, wrongly, for the pressure on the NHS.

Thank you, Mr Trump, for misunderstanding Nigel Farage's comments.

Thank you, Mr Hunt, for saying that 28M Americans don't have health cover and that [in the UK] "all get care no matter the size of their bank balance"....

Two wrongs did make a right: I am referring to proper coverage of the HCT/PA march, of course.