• Operating theatres 'not fit for purpose' 
  • Water leaks and risk of water contamination
  • Inadequate rating for safety and leadership across the trust
  • Inadequate community end-of-life care and inpatient services

St George’s University Hospitals NHS Trust has been rated ‘inadequate’ and recommended for special measures.

The report by the Care Quality Commission (CQC) has given the trust its lowest score for being safe and well-led, and ‘requires improvement’ for being effective and responsive.

Although the trust was rated ‘good’ for being caring, it was given an overall rating of inadequate in the report, based on an inspection in June 2016 and published today (November 1).

The trust's hospitals St George’s in Tooting and Queen Mary’s in Roehampton were rated as requires improvement.

The last CQC report in 2014 had rated the trust as 'good' overall. 

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Queen Mary's Hospital

This time, the CQC raised concerns with the trust, describing several areas of St George’s Hospital as being in a ‘state of disrepair’. This included operating theatres that were unable to meet demand and ‘not fit for purpose’, with 16 of the 51 theatres in need of complete refurbishment, as well as water leaks across the hospital and poor fire detection systems.

The report also criticised staff for not flushing out low water use outlets (for example, taps and showerheads) frequently enough, leading to a risk of water contamination. It raised specific concerns about the risk of legionellosis at the trust – a respiratory disease caused by bacteria which can sometimes lead to Legionnaires’ disease.

Community health inpatient services were rated inadequate, with changes at the Gwynne Holford Ward in Queen Mary’s criticised for being made ‘without due regard for the impact on people’s safety’ as well as a critical shortage of staff.

Community end-of-life care services were also rated as ‘inadequate’ and criticised for having no strategy or overall vision. Although patients were treated with dignity, kindness and compassion, the CQC found a shortage of experienced staff and inconsistent training, and reported that ‘community end of life care was not consistently provided in accordance with national guidelines’.

Community health services for children, young people and families were rated as ‘required improvement’, with drug cupboards left unlocked and a lack of feedback from managers. Despite level-three safeguarding training being a requirement for all staff working with children, the report found 53 per cent of medical staff working with children and young people had not completed the training.

The CQC also criticised the leadership of the trust, arguing that ‘there existed no credible vision or strategy for the organisation’ as well as low accountability for risks.

Poor standards in race equality were also reported, with white staff twice as likely to be offered jobs after shortlisting than black or minority ethnicity (BME) staff, while BME staff were almost two and a half times more likely to enter formal disciplinary processes.

The report says: ‘Patients’ privacy and dignity was not always being maintained; some staff were not always respectful of colleagues; staff were not always challenging the poor behaviour of others and the organisation was failing to fully learn from its mistakes.

‘Our assessment of the organisation at the time of the inspection was that St George’s University Hospitals NHS Foundation Trust lacked an aligned identity or purpose.

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St George's Hospital

‘Divisional managers were setting ambitious and unrealistic strategies which were neither cost-effective or achievable when considering the financial and operational position of the trust.’

Other criticisms included long waiting times in the emergency department, ineffective IT systems and not responding to complaints in a timely manner.

However, the trust was commended for the caring nature of its staff, as well as the standard of its maternity and neonatal teams and the renal unit.

Interim chairman at St George’s, Sir David Henshaw, said: “We have a new leadership team in place, and real progress has been made since June. However, as we’ve always said, there will be no quick fix to the problems we face.

“Many of these challenges are due to very poor board and senior management decisions in the past, and a failure to tackle the big challenges head on.

“We owe it to our staff and patients to make St George’s better again, and the CQC’s report is a key part of this improvement journey.”

Chief executive of St George’s, Professor Simon Mackenzie, said: "St George’s has many great and caring staff. It is thanks to them that the trust does so much that benefits patients, and I am pleased the CQC has recognised this.

"Our staff could do even more if we could make their working lives easier. This is why we are improving the buildings they work out of, and the systems they use every day – which will ultimately benefit patients as well."

In a statement, the trust added that it has re-started its estates maintenance programme, refurbished two operating theatres, introduced a preventative flushing regime to reduce the risk of water contamination, increased safeguarding training, invested £1.3 million in new computers and IT equipment and appointed new leadership staff.

Responding to the CQC's findings, Tooting MP Rosena Allin-Khan said: "What we see here in Tooting is a hospital and trust being stripped back to the bone. The buildings are in a poor state, leaking roofs, inadequate IT facilities and the A&E department has too few doctors. Had the Government given the hospital the resources it needed we wouldn’t be faced with the situation we have today.

"I've worked in the A&E department here, I know just how hard all the staff work throughout the hospital. Let's not forget the report pays tribute to the staff who do a fantastic job under really difficult circumstances.

"I think the board here understands the issues they face. Good leadership can help to improve the situation but we also need a government willing to give them the resources they need to do their jobs."

To read the full report, click here.