Daily Insight: Front-door friction

A chief executive has highlighted the problems caused by his trust not owning its own “front door” after its accident and emergency departments were rated “inadequate” by inspectors.

The Care Quality Commission has downgraded urgent and emergency care services at Barking, Havering and Redbridge University Hospitals Trust’s two hospitals sites following an inspection.

While this may not come as a surprise to some, the “front door” interaction between its emergency department and a provider-run urgent treatment centre run has come under increasing scrutiny.

BHRUT chief executive Matthew Trainer told HSJ the arrangement was “difficult”, and that it formed part of a “series of frustrations” about how local systems were designed.

The UTCs at King George and Queen’s hospitals are run by the Partnership of East London Co-operatives, with both and two others run by them recently being placed in special measures by the CQC.

Inspectors were critical of BHRUT, including of how patients are moved to the emergency pathway and around capacity, but also called on the North East London integrated care system to better support the trust.

North East London ICS chief executive Zina Etheridge told HSJ “immediate action” had been taken following the CQC’s visit and a plan has been developed.

Still alarming

It is more than a decade since the tragic death of a 19-year-old failed by every NHS service she came into contact with – and five since her case prompted a report to urgently fix provision.

Yet the Parliamentary health service ombudsman Rob Behrens has now warned that failures which led to Averil Hart’s death are “depressingly familiar” to those in 19 cases identified by HSJ since his December 2017 report Ignoring the Alarms. At least 15 of these were deemed avoidable, and resulted in formal warnings being issued to mental health chiefs.

Treatment delays, shortages of specialist beds and a lack of risk assessments and adequate monitoring were among the failures raised by coroners. Mr Behrens told HSJ the number of deaths since then is “very distressing”, although he also highlighted that there are “no easy answers” to major structural issues facing mental health services.

Meanwhile, Ashish Kumar, vice-chair of the Royal College of Psychiatrists’ eating disorder faculty, said a “massive gap” remains between child and adult services.

Campaigners said “too little” has been done over the last five years to address the concerns raised in Mr Behrens’ report and that failures identified since amount to a “national crisis”.