Hillingdon Hospitals NHS Foundation Trust provides services from both Hillingdon Hospital and Mount Vernon Hospital. The trust has a turnover of around £222 million and employs over 3,300 staff. They deliver healthcare to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire, giving them a total catchment population of over 350,000 people.
Hillingdon Hospital is an acute and specialist services provider in North West London, close to Heathrow Airport for which it is the nearest hospital for those receiving emergency treatment. Providing the majority of services from the trust, Hillingdon Hospital is the only acute hospital in Hillingdon with a busy Accident and Emergency, inpatients, day surgery, and outpatient clinics. The trust also provides some services at Mount Vernon Hospital, in co-operation with a neighbouring NHS Trust.
The trust has 443 beds including:
• 265 medical care beds; -
• 67 surgery beds (including gynaecology beds ); -
• 62 maternity beds;
• 22 paediatric beds;
• 18 neonate beds;
• and 9 ITU beds
On 2 July 2020 a COVID-19 outbreak was declared by the Hillingdon Hospitals NHS Foundation Trust affecting staff in a single clinical area at Hillingdon Hospital, which resulted in a number of staff from that area and outside it having to self-isolate. On 30 June 2020, a staff study day had been held in the trust Education Centre lecture theatre which had been attended by some of the affected staff. Concerns were raised about alleged lack of social distancing maintained at this event both in the lecture theatre and adjacent social area where food was consumed during the lunch break. During the time of the outbreak Hillingdon Hospital was closed to emergency admissions with ambulances diverted to other NHS trusts in the sector. The trust re-opened to emergency admissions on 16 July 2020.
Following this incident, we undertook a focused inspection on 4 and 5 August 2020 at Hillingdon Hospital, specifically looking at infection prevention and control (IPC) generally and in relation to COVID-19. The inspection focused on the safe and well-led domains in the following areas: urgent and emergency care; Bevan Ward and the acute medical unit.
We visited the Education Centre on site at Hillingdon Hospital following the recent study day held there which had resulted in a number of staff self-isolating. We also viewed the hospital’s arrangements to ensure social distancing in relation to general areas of the hospital.
Following this inspection, we took immediate action and issued the trust with a Notice of Decision under Section 31 of the Health and Social Care Act 2008 requiring the trust to provide us with assurances to implement an effective system to assess, monitor, identify, mitigate and manage any risks relating to the health and safety of people using the service, staff and others.
We inspected the trust again on 29 and 30 September 2020 to follow up on the issues we had identified in the August inspection.
At our inspection of 4 and 5 August, we observed that it was difficult for staff and patients to maintain adequate social distancing in the general areas, entrances and corridors of the hospital. At the September inspection we noted that the trust had installed a two-way system for staff and patients to follow throughout the common areas and corridors of the trust. This was clearly marked using lines and markings on the floor.
During the August inspection, two retail outlets were open directly opposite each other in a narrow corridor leading to and from the main entrance of the hospital. This posed a risk of cross-infection as people would not be able to maintain social distancing. In response to our concerns, the trust had immediately closed the second outlet. During the September inspection there was only one retail outlet open.
During our August inspection, there were no signs in lifts (patient or staff) indicating the maximum number of persons allowed due to COVID-19. On our inspection on 29 September these signs were in place.
During the August inspection, there was a general lack of signage referring to COVID-19 awareness in the areas that we visited and in the corridors. During the September inspection, we noted an increase in COVID-19 awareness signs.
During our August inspection, we saw patients congregating in the main hospital entrance area from their wards without adequate social distancing and inadequate policing. We saw patients standing in the corridor outside the urgent treatment centre, waiting to be assessed, and not social distancing. There was no challenge from staff or signage to maintain social distancing. During our September inspection, we did not see patients congregating as before and we observed staff to be vigilant in policing this.
Because the Education Centre and general areas did not fall under either the urgent and emergency care or medical departments we have included our observations in relation to them here.
At around the time of the outbreak a study day had taken place in the main lecture theatre of the Education Centre. The seating capacity of the lecture theatre was one hundred people in a tiered cinema formation. The room was accessed at the back, with a double fire exit at the front of the room. Also, on the ground floor of the Education Centre was a library, a small reception area and associated administrative offices, and a seating area with a small kitchen. Upstairs there were two seminar/ training rooms of a small to medium size, used for small groups. There was also a clinical skills laboratory on the first floor.
During our August inspection, we learned that the Education Centre could be booked by a wide variety of staff members for various functions both educational, for example study days; and social, for example retirement celebrations. When we checked again during our September inspection, the Education Centre bookings had been limited to education events only.
Previously there had been no prior policing or checking of the nature of bookings. Different members of Education Centre staff took bookings according to the groups of people wishing to book. During our September inspection, we found that there was a single booking system.
We also found during our September inspection, that there was only one permitted access to the Education Centre where previously there had been several access points. Access was supervised by one member of staff who ensured that all visitors signed in clearly indicating the event or room booked, and also ensured hand sanitisation. However, we noted that while people were requested to sign in, there was no signing out procedure. We were told that people were counted in and out but this depended on individual memory. In the event of a fire or other emergency, staff, we felt, would not be able confirm by record to the emergency services who was still in or out of the building.
The trust subsequently explained to us that there was a sign-in request at the entrance to the Education Centre which was solely for the purpose of identifying who makes use of the Education Centre each day. This enabled a COVID-19 track/trace facility should there be any need to follow up members of staff who have used the centre. The sign-in and sign-out sheets were not used to establish who was in the building at a given time which was in line with trust and national fire safety guidance (HTM-05) and the Regulatory Reform (Fire Safety) Order 2005 whereby sweep and search is the preferred recommended method to establish that the building is empty. However, the trust recognised that this process was not clearly understood by senior managers and some front line staff and the trust was addressing this concern by potential additional and frequent training to staff.
At the beginning of each lecture a member of education centre staff now explained the latest COVID-19 regulations as they applied to the facility. Members of education centre staff were encouraged to challenge anyone they could not account for or who was not following the wearing of masks or not adhering to other COVID-19 precautions.
The receptionist also checked rooms and lecture theatre for cleanliness and ensured surfaces were wiped clean following use, conducting a daily audit of rooms. There were wipes available in all of the education centre rooms.
The study day which had occurred at the time of the original outbreak had in excess of 40 people attending. Now the maximum number of people allowed to attend was eight. We saw the lecture theatre clearly showing seats cordoned off. We observed a lecture in progress and this was being conducted with social distancing and also via electronic video. During the August inspection, we were informed that food had been consumed on the study day. However, during the September inspection, we were informed that this practice had now stopped. An exception to this was made for education staff who had their own kitchen and were able to prepare and eat food within those confines.
During the August inspection. we noted that there had been several risk assessments undertaken for the Education Centre, finally arriving at a maximum of eight occupancy in the lecture theatre. During the September inspection, we noted that there was a risk assessment for every room in the Education Centre.
During the September inspection, we observed all staff and visitors to the Education Centre were wearing face masks and observing social distancing.
Following the September inspection, we took regulatory enforcement action as a result of our findings in emergency care and in medical care services. We issued a Warning Notice under section 29A of the Health and Social Care Act 2008. This means that we asked the trust to make significant improvements in the quality of healthcare it provides.
For more information, see the ‘Areas for Improvement’ sections of this report.