They described the commitment to nurse training at Imperial College Healthcare NHS Trust as “outstanding practice”, following their latest visit in February this year.
“I’m delighted that inspectors have recognised the real progress we have made”
The Care Quality Commission inspected four of the nine core services provided by the trust across four of its hospitals in London.
In a report published today, the watchdog rated maternity services at the trust as “outstanding” and all of its children and young people’s, neonatal and critical care services as “good”.
As a result, the overall rating of Queen Charlotte’s and Chelsea Hospital has been raised from “good” to “outstanding” – making it the first hospital run by the trust to receive the top mark.
The trust – which employs around 11,000 staff – also improved its overall ‘well-led’ rating from “requirements improvement” to “good” following a separate inspection in April 2019.
Despite the positive results, the CQC is unable to change the trust’s overall rating from “requires improvement” until further services are inspected.
In its latest report the CQC highlighted a number of areas of outstanding practice across the services inspected at Charing Cross, Hammersmith, Queen Charlotte’s & Chelsea and St Mary’s hospitals.
This included the training and mentorship opportunities on offer for nursing staff and students working in its intensive care service.
“The critical care service provided extensive opportunities for learning and professional development for nursing staff,” the report said.
“There were dedicated clinical nurse educators responsible for coordinating the education, training and continuing professional development for the nursing staff and pre-registration nursing students.”
The nurse educators also conducted one-to-one clinical coaching with nurses new to the unit, highlighted the CQC document.
In addition, all band 5 and 6 nurses were part of a team led by a band 7 nurse who acted as their mentor and was responsible for overseeing the ongoing review of critical care competencies.
“The service was especially caring and responsive to parents who had suffered a loss”
Also listed as an example of outstanding practice was the introduction of a “what matters” boards onto the cardiac intensive care unit.
The boards are placed on bed headboards for relatives and nurses to write the patient’s likes, dislikes, hobbies and other things that were important to them to “improve their emotional wellbeing during admission”.
Another area of outstanding practice highlighted by the CQC was the “compassionate individualised care” provided by staff in the trust’s maternity service.
“Staff provided extensive support to patients and their relatives and worked hard to meet the holistic needs of their patients through emotional and practical measures,” the report said.
“The service was especially caring and responsive to parents who had suffered a loss, such as miscarriage, stillbirth or neonatal death.”
In addition, the regulator noted that the trust’s bereavement midwife had developed a UK-wide bereavement midwifery group engaging with external parties such as MPs, NHS England and charities.
However, the CQC was not meeting certain legal requirements around its premises and equipment and ordered it to take action to address this.
The regulator also found other safety concerns. Issues were found with the trust’s infection control measures with staff spotted moving between different clinical environments without washing their hands.
The trust did not always assess risks to the safety of patients in a timely way, said the report, noting how some patients in the acute respiratory unit were not checked properly for venous thromboembolism.
Meanwhile, staffing was found to be an issue in some areas of the trust.
“We have found numerous improvements at the trust, including examples of outstanding care”
“The trust did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment,” said the report.
It noted that those on one critical care ward at Hammersmith Hospital “were not benchmarking themselves against intensive care staffing standards and were unaware whether they fell short of this”.
Overall, Imperial is now rated “requirements improvement” for being safe and responsive, and “good” for being effective, caring and well-led.
NHS Improvement has also rated the trust ‘good’ overall for its use of resources.
Professor Ted Baker, England’s chief inspector of hospitals at the CQC, said: “Although Imperial College Healthcare NHS Trust remains at an overall rating of ‘requires improvement’, we have found numerous improvements at the trust, including examples of outstanding care.
“The trust is now rated ‘good’ for being well-led which is a reflection of the progress made by the executive and management team – before it was ‘requires Improvement’.”
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Imperial chief executive Professor Tim Orchard said: “I’m delighted that inspectors have recognised the real progress we have made, both in terms of the quality of care we offer as well as the way our organisation is led.
“We have much more we want and need to do but this is fantastic news for our staff, partners and patients and reflects a huge amount of hard work and commitment.”
He added that the trust would be using the CQC’s findings to build a case for major redevelopment of its estate.