Wexham Park trust placed in special measures for care failings

The Care Quality Commission (CQC) has recommended that Heatherwood and Wexham Park Hospitals NHS Foundation Trust should be placed in special measures due to unsafe staffing levels. 

Following an inspection in February, the regulator rated the Trust as “inadequate” with inspectors finding unsafe staffing levels consistently throughout the trust. It identified a major shortfall in doctors, nurses and other healthcare professionals, and a heavy reliance on agency staff that were often unfamiliar with the wards where they were working. 

Overall, the inspectors concluded that the quality of care provided by Wexham Park Hospital at Slough was inadequate, although the children's department and critical care unit were both providing a good service. Heatherwood Hospital at Ascot was also rated as good.  

However, Wexham Park Hospital was also failing to consistently meet national targets to admit, transfer or discharge patients from the A&E department within four hours.  

Patient discharges were often delayed while they waited days for X-rays or other assessments, taking up beds which should have been used for patients having surgery. Outpatients also faced long delays for appointments. 

Professor Sir Mike Richards, the chief inspector of Hospitals at CQC, said: “We know that Wexham Park Hospital has had a long history of problems - and the legacy of these problems is all too apparent in the safety culture, the staffing levels, and the overflowing wards. 

“There are some positives - notably in critical care and in the children's department - and the trust has responded to recent inspections by making some improvement in some areas, such as cleanliness for instance which we note is much improved recently.  

“But there is a lot more to do, and the staff can't go on firefighting, reacting to the latest pressures, without a clear vision about the hospital's future direction.     

Following the investigation, the CQC has identified 18 areas for improvement, including:

• The trust must improve staff engagement across clinical and managerial disciplines to promote a learning and safety culture where patient experience is paramount.
• Patients must be properly risk-assessed particularly for falls and pressure ulcers - including patients who are in the A&E department for a prolonged period.
• Patient flow must be addressed as a priority to improve the poor waiting times in A&E, the high number of surgical cancellations and delayed discharges from the critical care unit.
• The hospital property must be fit for purpose, with repairs and maintenance planned and dealt with in a timely manner.
• A robust system must be introduced to assess the numbers and skill mix of medical and nursing staff for all wards, with establishment numbers increased to reflect this.
• Workforce recruitment and retention plans must be addressed to reduce the dependency on locum and agency staff.
• Where agency and locum staff are employed, relevant background and competency checks must be undertaken, with local induction before they start work.
• The trust must encourage and support an incident reporting culture at all levels, which is seen as a mechanism to learn rather than attribute blame.
• The radiology service must be able to meet the needs of patients in a timely way.
• The trust must improve the booking and appointments system, waiting times and the cancellation of clinics to prevent delays and to improve access to treatment.
• All staff must be able to respond to the needs of vulnerable groups such as people with dementia or a learning disability. 

Grant MacDonald, the acting chief executive at Heatherwood and Wexham Park, said: “We fully accept the findings of this CQC review and welcome the help and support that we will now receive as a result of being placed in special measures.  

“We sincerely apologise to all of our patients and local communities for failing to provide the level of service they deserve. We are committed to tackling all the issues in today’s report with a structured and planned approach that will embed good practice and consistently deliver high quality care. 

“Since the last CQC report four months ago, we have done a great deal to tackle the issues raised and clearly we must now do more.” 

(Image c. Kirsty Wigglesworth/PA Wire) 

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