Kingston Hospital 'must improve' safety and effectiveness, CQC says, but 'caring' staff are praised

The Care Quality Commission came down particularly hard on Kingston’s emergency department in a report published today.

It said reporting of safety incidents was “not fully embedded”, that clinical equipment should be better cleaned and that a string of authorities, including Kingston CCG, the regulator Monitor, NHS England and patients’ forums had raised concerns about it.

The CQC’s report, released six months after January’s three-day inspection, said: “A lack of service planning and a lack of robust capacity and demand modelling had resulted in the emergency department not being in a position to consistently meet the needs of the local people.

“There was a high number of new and inexperienced nursing staff in the emergency department and not enough permanent shift leaders or doctors to cover the rota.”

Ambulance handover targets and the goal of seeing 95 per cent of patients within four hours were not always met.

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Nursing director Duncan Burton said the hospital’s deficit of nurses had halved since this time last year.

He added that more were due to start work in the coming months and that “we have a number of ongoing mechanisms in place to recruit and retain nurses, which include international recruitment, more career development programmes to attract and retain our nurses, and later this year we will be increasing the number of student nurse placements in the hospital”.

The CQC said the hospital had to improve in four of five main areas—safety, effectiveness, responsiveness and management.

Separately, however, surgery, critical care, maternity and gynaecology, services for children and young people, and end of life care were rated as ‘good’ overall.

Urgent and emergency services, medical care, outpatients and diagnostic imaging required improvement. The safe storage of medicines was a concern in a number of departments.

Workers were highly praised for their caring approach, as was the hospital’s dementia strategy.

Claims: Politicians have repeatedly promised safety and stability for the hospital

The chief inspector of hospitals, Prof Sir Mike Richards, said: “Staff demonstrated an impressive understanding of their role in addressing the needs of people at the end of life and of providing sensitive and compassionate care.”

The report added that feedback from patients and families was “almost entirely positive”.

Inspectors said: “Patients reported receiving care and treatment from staff who were compassionate, kind and attentive.

“A relative of a patient we spoke with described the care as ‘world class’. Patients described how they could ask any health professional any questions associated with their care and treatment needs.”

Austerity imposed by successive governments slashed the hospital’s budget and increased its costs, forcing previous chief executive Kate Grimes to run a financial deficit in order to maintain the quality of services.

Before last year’s election, former Prime Minister David Cameron promised safety for the hospital for a second time, but failed to say why, after five years of his government, it was several million pounds in the red.

Bosses expect to be back in the black by the end of 2016-17.

New chief executive Ann Radmore was officially installed in April following a period of ‘acting’ cover for Ms Grimes, having left the London Ambulance Service during a crisis of poor emergency response times.

She said A&E performance was much improved since January.

She added: “We are a very busy hospital. In January the A&E leadership was very new.

“We hover around the 95 per cent mark and we often hit it on weekdays.

“I know we have some work to do. Five of our departments were rated ‘good’ but overall we require improvement.

“It is an odd system. We are at the top of a very broad spectrum and on the cusp of ‘good’.”

Asked whether the hospital would achieve a better grade if it was reinspected tomorrow, Ms Radmore said: “The answer to that is I do not know. There are definitely some areas we need to improve in.

“There were a lots of ‘goods’ in our inspection but obviously we want to be outstanding and we are working hard towards that.” 

The problems highlighted by the CQC were already known to hospital leaders, she added.

She said: “Progress in A&E, medicine and outpatients and diagnostics is very much down to the whole hospital working together. We will also be extending our work with partners outside the hospital.”

The hospital has promised to work particularly on recording risks in A&E and taking “timely action” to manage them.

Kingston and Surbiton MP James Berry described the report as “disappointing”.

He said: “Residents are entitled to expect that our hospital achieves a ‘good’, if not ‘outstanding’, rating from the CQC, so this report is disappointing.

“From what I have seen on regular visits to the Kingston Hospital, however, this rating bears no reflection on the hard work and dedication of the staff.

“Indeed, the report highlights the kind and compassionate care they offer.

“I have already spoken with the chief executive of the hospital who has reassured me that a robust plan is being put together to address the areas in which the hospital was found wanting.”

The way hospitals are inspected has now changed, and the CQC will no longer take three days to inspect every department every few years.

Instead, one hospital department will undergo an unannounced inspection every year.