West Middlesex University Hospital NHS Trust

⚠ We found insufficient suitably qualified, skilled and experienced staff employed throughout the midwifery and gynaecology service. The service had relied on staff working overtime, often unpaid, and on bank (staff who work overtime in the trust) and agency staff to support day-to-day operations. Even so, we found insufficient experienced midwives …

⚠ The trust did not meet the CEM recommendation that an A&E department should have enough consultants to provide cover 16 hours-a-day, 7 days-a-week. This compromises senior clinical decision-making, which could negatively impact the patient’s care pathway care. Nurse staffing levels did not meet the Royal College of Nursing (RCN) Baseline …

⚠ The trust did not have a robust document and policy management process. We found several examples of out of date policies in use on the wards.

⚠ There was insufficient consultants support in palliative care and the trust overall had not given sufficient focus on end of life care. The specialist palliative care services at West Middlesex University Hospital NHS Trust were considerably smaller than most hospitals of an equivalent size.

⚠ A majority of the ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) forms we viewed had been completed in full and appropriately. However documentation of mental capacity assessments was inconsistent. DNACPR forms were inconsistently completed.

⚠ The hospital has a limited acute oncology service. This means that cancer patients are always referred to other hospitals for treatment. This can have an impact on the quality of patient outcomes.

⚠ Consultants only undertook ward rounds on 3 out of every 7 days.

⚠ A WHO checklist audit carried out in September 2014 showed checklist sign in had been fully completed in 80% of instances meaning that one in five were not. Compliance in individual sections of the checklist under timeout and sign out varied with none at 100%.

⚠ The majority of surgeons had opted to have their discharge letters sent unverified to avoid delays. This meant that 43% of discharge letters were not verified and staff were not clear about arrangements to monitor the error level in unverified letters.

⚠ There were concerns about the leadership in the Special Care Baby Unit (SBCU) and this had an adverse effect on the performance overall of services to children and young people. Changes and a lack of effective leadership on the SCBU had impacted on staff and the mechanisms to monitor the …

⚠ On Marble Hill 2 ward we found that patients or family regularly had to return to the ward the next day to collect their discharge prescription. Nurses and patients mentioned delays in dispensing take-home medicines. Some patients had to collect these after discharge.