The chief executive of a hospital trust threatened the Care Quality Commission with legal action if it capped the number of accident and emergency patients it could admit, HSJ can reveal.

In February the CQC announced its intention to limit the number of admissions at Barking, Havering and Redbridge University Hospitals Trust in east London following prolonged poor A&E performance.

Correspondence obtained using the Freedom of Information Act reveals trust chief executive Averil Dongworth wrote to the CQC urging it to reconsider its plan or face “a very public debate before an appeal tribunal from which all will be losers except the lawyers”. She also wrote that “the CQC considers the [cap] unnecessary but wishes to be seen to have done something/anything”.

If implemented the A&E cap would have been the first of its kind in England.

The letters were submitted by the trust and the CQC’s London office as part of the commission’s appeals process. This culminated in Sue Howard − the CQC’s central west region head of regional compliance, who was appointed to rule on the appeal - deciding the cap should not be imposed, it emerged in April.

The commission’s London regional director Matthew Trainer had previously written a letter saying the cap was required due to the “level of risk” in the trust’s A&E improvement plan.

“Nothing I have heard from the trust or other parties suggests the level of concern we have should be any lower,” he wrote.

“In our view there are serious challenges ahead in [the trust’s] plans for recruitment (particularly of emergency department consultants, we know of other trusts across London that are struggling to recruit to these posts) and a range of factors affecting demand that are outside the trust’s direct control (working with local primary care and London Ambulance Service).

“These external factors are in addition to the trust’s aim of implementing significant cultural change in the department and across the hospital, as well as making and embedding structural changes that are already underway in the emergency department.”

Ms Dongworth’s letter also mentions the affect capping admissions at the trust’s Queen’s Hospital might have on other emergency departments and the ambulance service. She predicted the latter would have seen an increase in “black breaches”, in which ambulances wait more than an hour to transfer a patient to a hospital.

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