• Croydon Health Services Trust has integrated with its CCG
  • CQC says trust was “rightly focussed” on integration, but felt more management capacity was required

A south London trust has seen quality and safety deteriorate in some areas as its leadership focussed on major strategic changes, according to a Care Quality Commission report.

Croydon Health Services Trust is integrating with health and care providers and commissioners in the London borough of Croydon, including the clinical commissioning group to develop “an integrated health and care system”.

This has involved appointing trust executives to joint posts at the top of the trust and CCG, however, the CQC felt “more capacity was required to support them to undertake this cross-sector role whilst focusing on the challenges within the trust itself”.

The CQC said: “It was anticipated that the strategic changes would bring long-term benefits for patients and staff”. The trust was “rightly focussed” on them but said, “during this time there had been a clear deterioration in some areas of quality and safety”. It said actions to address ongoing issues should have been taken earlier.

The trust’s overall rating remains at “requires improvement”. Its rating for caring was reduced from “good” to “requires improvement” with this inspection.

The trust and CCG are now closely aligned though they remain separate organisations. They appointed a joint chief nurse in May 2019 and a “place-based leader” for the trust and CCG in July. This saw Matthew Kershaw made substantive chief executive of the trust and fill a role akin to a managing director at the commissioner.

Sarah Blow has remained as the accountable officer at the CCG, as well as the other five commissioners in south west London. The six CCGs will merge in April 2020 when Ms Blow will run the unified CCG within which Mr Kershaw will continue to lead on Croydon work.

The trust said the CCG merger “means we will have full delegation to ensure decisions about Croydon are made in Croydon whilst benefiting from the governance and oversight from the South West London CCG”.

The joint chief nurse was supported by a deputy director of nursing and the CQC was “concerned that this was insufficient given the post covered two organisations and nursing leadership and patient experience in the trust needed further development”.

The trust said it was going to appoint two deputy chief nurses after the inspection. Inspectors also raised concerns about a lack of senior nursing capacity with the chief executive and chair and were told “this would not be reviewed until April 2020” when the six south west London CCGs are due to merge into a single commissioner.

The trust told HSJ it “hasn’t waited for the CQC to tell us this”. A spokesman said it had “strengthened our leadership team,” including appointing a deputy chief nursing officer, a director of nursing, a director of allied health professionals and community services, and a director of quality. The additional “gives us more capacity, freeing up clinical leaders”.

The spokesman also said the trust recognised “there are some areas where we have fallen short of the standards that the CQC and local people should expect of us”. It has “taken immediate action to tighten our governance processes within some services, including in areas mentioned in the report, such as diagnostic imaging”.

“The Trust also has measures in place for identifying and responding to risks, including a weekly executive review group, where any concerns, risks and incidents are reviewed, assurance is sought on actions taken and ensure lessons learned are shared.”

Update: this post was updated at 09.50 on 11 February to include a response from the trust.