9, 10 and 11 February 2022
During a routine inspection
Northwick Park hospital serves an ethnically diverse population mainly concentrated in the London Borough of Harrow. Northwick Park Hospital provides the following services:
•Urgent and emergency care
•Medical care (including older peoples care)
•Surgery
•Maternity and gynaecology
•Outpatients and diagnostics
•Critical care
•End of life care
•Children’s and young people services.
We inspected medical care and surgery core services at our inspection on 9, 10 and 11 February 2022.
Medical care at Northwick Park Hospital was last inspected in August 2018 when it was rated requires improvement for safe, effective, responsive and well led and good for caring. Medical care was rated as requires improvement overall.
At this inspection our overall rating of medical care stayed the same. We rated the service overall requires improvement. We rated safe, and responsive as requires improvement and good for effective, caring and well led.
Medical services involve assessment, diagnosis and treatment of adults by means of medical interventions rather than surgery. Medical care at Northwick Park Hospital provided care and treatment in the following disciplines: regional rehab unit; stroke; care of the elderly; cardiology; dermatology; genitourinary medicine (GUM) and sexual health; infectious disease; respiratory; rheumatology; endocrinology and diabetes; neurology and gastroenterology.
During this inspection we visited Fielding, Dryden, Crick, Darwin, Haldane, Hardy, Gaskell, Jenner and Fletcher wards. We also visited the discharge lounge and endoscopy. We spoke with 25 staff members and viewed 24 patient records. We also spoke with six patients.
We rated medical care at Northwick Park Hospital requires improvement overall because:
- Indications of patients having venous thromboembolism (VTE) prophylaxis were not always specified on the prescription charts we viewed. This meant staff reading the prescription may not have information on patients VTE status.
- Records were not always stored securely. We saw records cupboards were not locked when not in use on Darwin ward. This meant unauthorised people may have been able to access patients’ confidential information.
- All staff did not consistently receive feedback from incidents. One member of staff on Darwin ward told us they were not aware of an incident that had happened on the ward.
- We saw a ‘do not attempt cardiovascular resuscitation’ (DNAR) form on Herrick ward where it was unclear whether the patient’s DNAR had been cancelled. Staff were unable to tell us the reasons for the cancellation.
- We saw a sharps bin in the discharge lounge stacked on top of another sharps bin. The sharps bin was open and had not been signed or dated. There was a risk of the sharps bin being knocked over and potentially causing harm to patients or staff.
- We saw a wheelchair with broken foot straps on the discharge lounge. There was a risk that staff may have used the wheelchair, even though staff had reported the wheelchair to the medical engineering department.
- The hospital was not meeting national standards in some areas of the myocardial ischaemia audit.
However:
- The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risks well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
- Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
Surgery at Northwick Park Hospital was last inspected in November 2019 when it was rated good in safe, effective, caring and well led and requires improvement in responsive. Surgery was rated as good overall.
At this inspection our overall rating of surgery stayed the same. We rated the service overall as good. We rated safe, effective, caring, and well led as good and responsive as requires improvement.
We visited the following areas during our inspection: Gray ward, Eliot ward, Kingsley ward, surgical assessment units (SAU) on levels two, three, and four, the theatre assessment unit, the west London vascular and interventional service, the post anaesthetic care unit (PACU), the theatre recovery unit, the main theatre suite, and the discharge lounge. The service had 13 theatres, of which 11 were in use. One theatre was being refurbished and one theatre was being converted into a paediatric recovery.
To manage staffing and capacity during the COVID-19 pandemic, the trust had restructured surgical services and treatment pathways. Northwick Park Hospital provided non-elective surgery and patients underwent pre-assessment care at Central Middlesex Hospital. As part of our inspection of surgical care at Ealing Hospital and Northwick Park Hospital, we visited Central Middlesex Hospital to understand the pre-assessment pathway and the post-treatment therapy provided by allied health professionals. We have included the findings in our surgery report for Ealing Hospital.
We rated surgery at Northwick Park Hospital good overall because:
- The service managed staffing well and maintained consistent levels of training and appraisals despite pressures on the service caused by COVID-19.
- Services were demonstrably multidisciplinary, and staff had established a wide range of new working opportunities to support patient outcomes.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
- Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
However:
- Pharmacy cover on wards was limited due to short staffing. This meant pharmacists could not always join ward rounds and could not always review prescriptions daily.
- The service did not have a coherent, overarching vision for what it wanted to achieve. Individual departments and divisions developed their own strategies in the absence of a trust-level approach.