2nd Floor, Alderney Building Bancroft Road E1 4DG 22 May 2015

Dear Colleagues

Re: Publication of Care Quality Commission inspection reports for Barts Health NHS Trust, The and Newham University Hospital

Today, following inspections earlier this year, the Care Quality Commission (CQC) has published inspection reports on The Royal London Hospital, Newham University Hospital and the Barts Health NHS Trust (Barts Health).

In each report the CQC gives a rating of: outstanding, good, requires improvement or inadequate and then an overall rating. Overall, Barts Health NHS Trust was rated as inadequate.

Although patient outcomes at both were generally found to be at, or better, than the national average across most medical and surgical specialties and the CQC inspection team discovered many instances of staff being both committed and caring, the reports highlight a number of areas where improvements are required, and have rated both The Royal London and Newham University hospitals as being inadequate.

The Royal London Hospital

The CQC found that generally patients and relatives felt they received a good standard of care. The CQC noted that The Royal London Hospital is a pioneer in trauma care. Twenty-five percent of patients attending the trauma service had penetrative wounds which is significantly higher than any other UK trauma centre. However, unlike other comparable centres the survival rate for patients needing the expertise offered at the centre is approximately twice the national average.

The emergency service was similarly praised. Overall pain relief was found to be well managed. Stroke care was assessed to be outstanding - with the Royal College of Physicians' audit rating the hospital's patient experience scores the best in London.

However the CQC noted ongoing operational challenges at the hospital have impacted on waiting times, delays in discharges, and cancelled operations.

Key areas for improvement highlighted by the CQC include: • Ensuring sufficient numbers of staff and reducing reliance on bank, agency and locum staff • Addressing governance, risk management and data issues • Addressing a perceived culture of bullying and harassment amongst staff.

Newham University Hospital

The CQC found that that staff at Newham University Hospital delivered care with compassion, privacy and dignity. The CQC noted that despite ongoing challenges across the NHS around emergency care, Newham University Hospital provided ‘good’ A&E services. Key areas for improvement highlighted by the CQC include: • Embedding robust governance processes throughout the hospital • Improvements in a range of core services and end of life care

• Addressing the shortage of medical and nursing staff

Response and next steps

We are disappointed in the CQC’s overall ratings of The Royal London and Newham University Hospital. However, since the inspection Barts Health has been working hard with the guidance of the Trust Development Authority (TDA) special measures improvement regime to appoint senior clinical and managerial leaders who will strengthen clinical and operational leadership and take forward the vital work of improving areas of concern. These positive changes are welcome and will provide the support and expertise to ensure a consistent approach to the delivery of high quality care across the Trust.

NHS Tower Hamlets CCG has been working hard with The Royal London and across the Barts Health Trust to make sure patients are receiving safe, high quality care. Patient safety is the CCG's number one priority. We have been listening to what local people say and we have been monitoring the work of Barts Health through monthly clinical quality review meetings and quality assurance visits. We also welcome the appointment of Alwen Williams CBE to the role of interim chief executive of Barts Health from 1 June 2015. Alwen has tremendous experience of the NHS and the local communities in east London.

We will continue, with Barts Health and with other local partners, to ensure that the recommendations for improvements outlined by the CQC are implemented to improve safety and quality. And whilst we will support Barts Health Trust to make the improvements outlined by the CQC, we will also hold them to account if we do not see in a timely manner the change that is needed.

We recognise that Barts Health, like many NHS Trusts, is working within a challenged environment financially. The Trust operates across three boroughs that have experienced some of the largest population growth across country, with many of its communities facing widespread deprivation. To address these challenges in the longer term we are working with our partners to develop a strategy for east London that will transform the way we care for patients; preventing ill health, supporting people to live healthier lives and tackling inefficiencies so that we can invest in coordinated, high-quality sustainable services.

The Royal London Hospital is at the heart of our community. This is a time for all those who care about the NHS and local services in Tower Hamlets to work together to improve the lives of all those who live, work or visit the borough. We recognise that whilst there are examples of poor care there are also examples of good quality care provided by staff across the Trust. Local people rate services well with 95% of patients who completed the ‘Friends and Family’ test in Dec 2014 saying they would ‘recommend the Trust to their friends and family’. We also note that CQC patient-led assessment rates Barts Health above the national average for cleanliness; privacy, dignity and wellbeing; and facilities.

We are keen to hear your views. If you would like to discuss any aspect of the CQC report or the next steps please contact us at [email protected] or call 020 3688 2500.

Yours sincerely,

Dr Sam Everington Jane Milligan Chair Chief Officer