North Middlesex University Hospital

⚠ Further work was needed to improve the culture of the trust with associated improved results in the NHS staff survey. Whilst the trust was largely a positive place to work, there were still services where staff interactions were not appropriate and where additional support was needed to achieve sustained cultural …

⚠ Whilst the trust had a leadership development programme, further work was needed to ensure staff managing front line services had received the development and support needed to perform their role to a high standard. There were a number of staff, performing these roles who had recently been promoted and did …

⚠ The investigations as part of formal processes to address HR issues, such as cases of bullying and harassment, were often taking too long and causing stress and anxiety to the individuals concerned. This was monitored but further work was needed to ensure sustained improvements.

⚠ Although work had taken place to review the capability and capacity of the executive leadership team, an ongoing review will be needed to ensure senior leaders have the capacity to manage the changes needed as part of the ongoing work to merge with the Royal Free London group.

⚠ The trust needed to improve the timeliness of its complaint investigation work, incident investigations and mortality review work. This was important for patients, families and staff who are waiting to hear the outcomes of these processes. It was also needed to ensure any lessons learnt were shared to improve services …

⚠ Staff did not always follow systems and processes when safely prescribing, administering, recording, and storing medicines. We found that some patients may not have received their medication. Three people had several missed or omitted doses of medicines. On one occasion, it was documented that the medicines were not available out …

⚠ The service did not always have enough staff to care for patients and keep them safe. This affected staff's ability to perform key tasks. For example, four-hourly observations were not always taken on time, patients who required repositioning to manage pressure ulcers were repositioned less frequently than advised by their …

⚠ Not all staff had up to date training in life support. The trust did not confirm staff had training in the Mental Capacity Act, dementia awareness, and Deprivation of Liberty Safeguards. Only 38% of staff at the trust level received dementia awareness training. The trust did not provide information for …

⚠ Not all staff had up to date training in life support. Training records also indicated not all required staff received adequate life support training with training rates declining between May and October 2023. The department failed to ensure that at least 85% of staff had up to date life support …

⚠ The service had delays in reviewing safety incidents and identifying learning lessons from them. The service did not operate an effective process for prompt identification of learning from deaths, they had many outstanding death reviews. The service explained delays in responding to complaints, they were frequently unable to meet the …

⚠ Staff did not always plan discharges in advance to allow patients to plan ahead, to ensure all appropriate arrangements were ready when required, and to manage bed capacity effectively. Occasionally patients were transferred at night on short stay medical wards. Discharge planning required improvement as the trust reported, in their …