CQC carried out a focused inspection in May to follow up on information of concern received about the safety and quality of the diagnostic imaging services provided by the trust. The diagnostic imaging services had not previously been inspected and rated as a standalone service. As this focused inspection only looked at the safe and well led domains, the overall service was not rated during this inspection.
Nicola Wise, CQC’s head of hospital inspection, said:
“We had several serious concerns when we inspected the diagnostic imaging services at Barts Health NHS Trust.
“At The Royal London Hospital, we found rooms containing hazardous clinical equipment that were not securely locked. This meant that anyone could enter the room and risk exposure to radiation or powerful magnets, which would be extremely dangerous. We also found a mobile X-ray machine which had been left unsupervised in a publicly accessible corridor. It was connected to mains power with the key left in place, so it could be operated by a patient, visitor or an unauthorised member of staff, putting them at risk of exposure to ionising radiation.
“Staff told us there was conflict within the department which created a hostile working environment. This is an indication of wider cultural issues which leaders need to address as a matter of priority. As a result of this, staff didn’t consistently recognise and report incidents, which meant the trust was unable to respond to incidents and share learning with staff.
“At Whipps Cross Hospital, we found that ageing equipment did not always work, resulting in a delay to patient care. In some cases, new equipment had been purchased but could not be used, as it had not been integrated into the software systems. We found rooms containing specialist equipment were not always locked, posing a risk to staff, patients and visitors.
"Some staff said that, although there was a system in place to raise concerns, they did not want to use it in case they were treated unfavourably, reflecting the fragmented culture of the department.
“In both hospitals, we were informed of allegations of bullying, harassment, racism and sexism that had had apparently been escalated to the human resources department but staff felt had not been resolved. It was also deeply concerning that, at both hospitals, staff were concerned about using mechanisms for raising concerns or reporting incidents because they were afraid they may be treated unfavourably by managers for doing so.
“We told the trust that it must ensure that the governance and risk management structures for completing and monitoring risk assessments are improved and that it must manage the staff rota more effectively. I am pleased to report that the trust has already taken urgent steps to address our concerns. We will keep a close eye on the situation and return to inspect to ensure that improvements are made and fully embedded.”
In the diagnostic imaging departments at both hospitals, inspectors found:
- Leadership of the service was not stable or fully embedded. Many of the leadership team were either interim, or relatively new in post.
- Conflict in the team was impacting on staff morale and the difficult working environment was having a negative impact on the delivery of the service. Staff did not know how to access support if they needed to raise concerns and they said there was a lack of support and consideration regarding staff welfare.
- The division did not have an overall training programme in place for specialist training and staff said they were often made aware of training dates too late for them to attend. The service was not meeting the trust target of 85% for completion of mandatory training, with only 75% achieved in some areas, including risk management and information governance.
- Managers could not always calculate the number of staff needed for each shift and were not able to accurately monitor staff hours. In some cases, the lack of clarity regarding staff availability had resulted in a poor experience for patients.
- Systems to manage performance and escalate risks to reduce their impact were not always effective. Managers investigated incidents, but there was no evidence of learnings being shared with the wider team.
- When things went wrong, staff apologised and gave patients honest information and suitable support.
- The service controlled and monitored infection risk well. Staff followed infection control principles, including the correct use of personal protective equipment and effective hand hygiene.
At The Royal London Hospital inspectors found:
- Trust senior leaders were not fully aware of the extent of the challenges faced by the department.
- Staff stated that the leadership team was not visible in the department and some had not even met the service leaders. Although this was partly due to the COVID-19 pandemic, staff felt that the lack of visibility of leaders meant that they were inaccessible.
- There was no process in place to test and assess the reliability of ageing equipment and to check the quality of images produced. These had been raised as a concern during previous inspections. When equipment needed repairing, if the issue was reported, records were not always kept, or were filed inconsistently, and there were often no follow up checks to see what action had been taken.
- Some office areas containing patient and staff records were left unlocked and accessible to unauthorised personnel.
At Whipps Cross hospital, the inspection team reported:
- The divisional leadership did not have oversight of environmental or equipment risks. Premises and equipment were not maintained properly to keep people safe. Equipment fault logs and records were poorly maintained. Superintendent radiographers did not always have time, or permission, to keep up-to-date records of systems that were indicating faults, although new systems were being developed.
The reports will be published on the website on Friday 30 July:
Notes to editor
The overall rating for Barts Health NHS Trust is requires improvement. The trust is also rated requires improvement for being safe and responsive. It is rated good for being effective, caring and well-led.
The Royal London Hospital is rated good overall and good for being safe, effective, caring and well-led. It is rated requires improvement for its responsiveness to people’s needs.
Whipps Cross University Hospital is rated requires improvement overall and for being safe, responsive to people’s needs and well-led. It is rated good for being effective and caring.
Throughout the COVID-19 pandemic, the CQC’s regulatory role has not changed. CQC’s core purpose of keeping people safe is always driving decisions about when and where we inspect. As the risks from the pandemic change, we are evolving how we regulate services to reflect what we have learnt during this time. You can read more about our current approach.
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About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. We make sure health and social care services provide people with safe, effective, caring, well-led and responsive care, and we encourage care services to improve. We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.
- Click to download and view an embargoed copy of the inspection report for The Royal London Hospital Click to download and view an embargoed copy of the inspection report for The Royal London Hospital
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