The newly formed Lewisham and Greenwich Trust has been told to improve by Care Quality Commission inspectors just seven months after it was set up.
The trust formed in October last year following the dissolution of the South London Healthcare Trust.
The inspection team visited the trust in February to examine whether it was safe, effective, caring, responsive, well led. It received a ‘requires improvement’ rating across the board.
The accident and emergency department at Queen Elizabeth Hospital was found to be “not fit for purpose” with poor patient flow between A&E and the ward, a heavy reliance on agency staff and insufficient space for the number of people using the service.
The team also found that patients experienced delays in access to specialist opinions after they were admitted via the A&E.
Doctors rarely used hand hygiene facilities available to them, clinical waste was stored in unlocked areas which was considered to be “a risk to safety of patients and public”, and ambulance staff were frequently delayed or unable to hand over patients to the clinical team.
However, there were also examples of good practice including increased clinical involvement in the leadership of the trust and the inspectors concluded that the staff were “committed to high quality care”.
The trust was found to be under-staffed and some patients on wards told the inspectors that their call bells were not answered for 30 minutes. There was also a concern that an “e-rostering system” could generate “unworkable” shift patterns for example by rostering too many long days in succession.
The Patients Association looked at the way the trust handles complaints and found that although staff had a positive approach “significant” work needed to be done to improve complaints response times and follow-up actions.
The CQC’s chief inspector of hospitals, professor Sir Mike Richards, said: “While we would acknowledge that this is a relatively new trust, we identified issues in both hospitals which we require it to take action to improve.
“The biggest problem here is in the A&E at Queen Elizabeth Hospital, which we have rated as Inadequate. Waiting times there regularly exceed the four hour target, there isn’t enough space for the number of people using the service, and the patient pathway from A&E to the ward doesn’t work as well as it should.
“Most patients we spoke to across both sites praised the caring nature of the staff looking after them, and told us that they were treated with respect and dignity. We saw this for ourselves – although the trust still has some work to do for this feedback to be universally positive.
“We’ve rated this trust as requires improvement overall. The trust has told us it will take action – and we’ll return in due course to make sure that it has done so.”
A spokesman for the trust said that as a new organisation the inspection was “welcomed”.
He added: “It [the CQC] complemented quality assessments we had been carrying out ourselves to ensure we have a good understanding of how our services are performing and to identify areas where we need to improve.
“The report focuses in particular on Queen Elizabeth Hospital’s A&E. The Trust had already identified a number of these issues, and has been working with partners to reduce patient waits and improve the flow of patients through the department. We are also developing plans to improve the facilities so patients are treated in the right environment.
“While much progress has already been made, we have lots to do and over the next month we will be developing an action plan in response to all the issues highlighted by the CQC. We are pleased to have the full support of our partners and look forward to working with them to deliver significant improvements for local people.”