Homerton Healthcare NHS Foundation Trust

Updated 10 August 2018

Homerton University Hospital NHS Foundation trust is an integrated care trust in Hackney, East London. The trust provides general health services at hospital and in the community. The trust operates acute services from a single site: Homerton University Hospital, which opened in 1986. The trust provides a full range of adult, older people’s and children’s services across medical and surgical specialties. The hospital has almost 500 beds spread across 11 wards, a nine bed intensive care unit and maternity, paediatric and neonatal wards. Community services are provided by staff working out of 75 partner sites in Hackney and the City of London. The trust has a separate registration to provide continuing health care at the Mary Seacole Nursing Home which in Hoxton, East London, approximately two miles from the hospital.

The trust provides some highly specialised tertiary services, including bariatric surgery and the Regional Neurological Rehabilitation Unit. It is one of London’s designated perinatal centres and provides a range of highly specialised obstetric and neonatal intensive care services. The trust has 40 neonatal intensive care cots. During 2017/2018 the trust provided care for 5,588 births.

The trust serves a diverse and changing local population from Hackney, the City of London and surrounding boroughs in East London. Hackney was the 11th most deprived local authority overall in England in the 2015 Index of Multiple Deprivation. The City of London has a growing population and was judged as the 262nd most deprived local authority out of 326. Hackney’s population is estimated at more than 263,000 people. Hackney has a relatively young population, with 25% of residents under 20 years old. The proportion of residents between 20 and 29 has grown in the last ten years and now stands at 21%. People aged over 55 make up 18% of the population.

The trust is managed by a board of directors comprising six executive and seven non-executive directors. The board is advised and supported by a council of governors comprised of 14 members of the public, six trust staff and seven people representing interested parties such as the London Borough of Hackney. Responsibility for clinical management and leadership is delegated to the trust management board, comprising the executive directors and associate medical directors. Clinical care is the responsibility of clinical teams divided into three clinical directorates of:

• Surgery, women's and sexual health services
• Children's services, diagnostics and outpatients
• Integrated medical and rehabilitation services.

Over the twelve-month period of January to December 2017 the trust reported activity figures of 29,000 non-elective spells and 23,500 elective spells. During the same period there were 270,000 outpatient attendances and 120,000 attendances through the Accident and Emergency (A&E) department.

The CQC last undertook a comprehensive inspection of the trust in February 2014 when it was rated as ‘good’ overall, including a rating of ‘outstanding’ for the hospital emergency department. Since then, we conducted two inspections of the trust’s maternity services in March and October 2015 and a comprehensive inspection of the trust’s community services in February 2017.

Updated 10 August 2018

Our rating of the trust stayed the same. We rated it as good because:

• Overall, we rated Homerton University Hospital as ‘good’.
• We took into account the current ratings of the four core services that were not inspected at this time and aggregated the ratings with the four core services we did inspect at Homerton University Hospital.
• We rated urgent and emergency services as ‘outstanding’ overall, with an ‘outstanding’ rating applied to the caring, responsive and well-led domains. We also rated medical care (including care of the older person) as ‘outstanding’ overall, with an ‘outstanding’ rating applied to responsive and well-led domains.
• All other services at Homerton University Hospital we rated ‘good’. However, we rated the well-led domain in maternity services as ‘requires improvement’.
• We carried out a well-led review of the trust and gave an overall rating of ‘good’ for this domain and considered this when aggregating the overall trust rating.
• We inspected community health services in 2017. Both adult community health services and community health services for children, young people and families were rated ‘good’ across all domains and this was considered when aggregating the combined overall rating for the trust.
• We also inspected the Mary Seacole Nursing Home in 2017 and rated this as ‘good’.

Updated 10 August 2018

Updated 10 August 2018

Updated 26 May 2017

We found that community health services for adults at Homerton University Hospital NHS Foundation Trust were 'good' in terms of safety, effectiveness, caring, responsiveness and well-led. This was because:

• There was a good overall safety performance across community adults services and effective processes for identifying and managing risks. There were very low levels of reported serious incidents and incidents resulting in harm. Staffing levels, infection prevention and control, medications and completion of mandatory training were overall well managed.
• Practitioners across services demonstrated effective evidence based care and treatment in accordance with national guidelines and good practice. Services measured outcomes using objective and patient reported measures. Staff had good access to training and development. There was good multi-disciplinary working between staff and with external partners.
• Patients reported positive feedback about the care and treatment they received. Staff treated patients in a kind and compassionate manner. Patients and their relatives were encouraged to be partners in their care planning and were enabled to participate in care activities.
• Community adults services had a model of integrated community teams across health and social care to ensure patients received joined up working. Staff were responsive to the needs of different communities and vulnerable patients. Community adults services demonstrated learning from complaints.
• There were appropriate plans in place to develop the community adults service. There were effective governance and reporting structures in place for the escalation of performance and risk information. Senior leaders had a clear understanding of their services, local risks and challenges and realistic plans to develop their services. Staff told us managers were accessible and supportive. Patients were involved in service development. There were some areas of innovation including the introduction of extended scope practitioners.

However:

• Overall compliance with completion of mandatory safeguarding level 2 training (and Mental Capacity Act and Deprivation of Liberty Safeguards training which was incorporated in the same module) needed to improve to meet the trust's local target. The trust was aware of this and had put in place actions to improve training completion.

• The trust’s new online appraisal reporting system did not provide sufficiently accurate data to present a complete record of completed staff appraisals. The trust was aware of this and was working to identify those staff who needed to have their appraisal.
• There were separate electronic record systems used in the hospital and community teams. Staff told us this could sometimes lead to problems with effective transfer of information from acute to community practitioners.
• Some of the trust's staff and partners identified a need for greater out of hours community nursing input, which was not provided by the trust.

Updated 26 May 2017

Overall rating for this core service is good because:

• The community health services for children, young people and families (CYP) service had systems for identifying, reporting, and managing safeguarding risks. The child safeguarding team provided good support to staff across CYP services through supervision, training and monitoring of incidents.

• Professionals from different teams in the service worked well with each other and those from external organisations to make sure each child had the best possible care. Health centres housed a variety of services, which meant CYP was able to work closely with partners such as GPs. CYP staff provided competent care in line with best practice and national guidance.

• The trust health centres and children centres we inspected were clean, tidy, and clutter free. Waiting rooms and clinic rooms were child friendly with toys, books and other resources appropriate for different ages. CYP services completed regular infection control audits across locations and most staff demonstrated good hygiene and infection control procedures.

• Staff supported the patients and families they worked with, and provided patient-centred support in clinics and in homes. Staff planned and delivered services in line with local needs including for vulnerable patients and those who spoke limited English.

• Staff told us they could find policies easily on the trust intranet. Staff who worked in the CYP service followed the trust’s lone working policy. Staff we spoke with had good awareness of lone working arrangements.

• Patients we spoke with told us they were very happy with the care and treatment provided and had good access to translation services.

• Staff told us they valued working for the trust and said the trust had involved staff in different ways such as through focus groups. Staff told us that service leaders were supportive, accessible and approachable.

However:

• The CYP service completion rate for infection prevention and control level two was 61 % against the trust’s mandatory training target of 90%. Similarly, the service's completion rate for paediatric basic life support (PBLS) was below the trust target and averaged at 51%.

• Staff did not always recognise the terminology of ‘duty of candour’ although they had an honest approach and were open with patients when things went wrong.

• The trust-wide response rate for the NHS Friends and Family Test was 2% for September and October 2016, which is lower than the national response rate at 3.5%. Most patients told us that staff did not encourage them to give feedback on the care they received or provide any information on how to make a complaint if needed.