Archived: Barnet Hospital

At our last inspection of the hospital in May 2013 we had found that the very long delays experienced by a significant number of patients in A&E meant that the planning and delivery of care and treatment did not always meet their needs and ensure their welfare and safety. During the current inspection on 27 January 2014 we found that significant improvement had been made. Although a few patients had spent long periods in the department action was being taken to mitigate the risks to their health and well-being and ensure their stay was as comfortable as possible.

During the inspection we spoke with more than 60 patients and relatives about their experiences of care and treatment in the hospital. The majority of patients and relatives were pleased with the standards of care provided. For example, a patient on Beech ward told us that from the moment they had come arrived at A&E they had been 'entirely satisfied and impressed' by the care and treatment they had received. Staff on the wards were said to have 'gone out of their way to be helpful and considerate.' Physiotherapists were described as 'very good, they know how to speak to people' and 'really excellent.' A patient who had just undergone a surgical procedure told us, 'I left very reassured as they (staff) made sure I knew what was happening and who was who.' Parents of children we spoke with in paediatric A&E were very positive about their experience describing staff as 'fabulous' and having the 'patience of saints.'

Patients had mixed views about the quality of meals provided on the in-patient wards but the majority were positive. For example, one patient told us 'the food is really very good; there is a good menu choice.' Another patient said, 'the menu is fantastic, I'm amazed at the amount of choice, including healthy options.' A few patients considered the meals were 'just OK' or not to their liking.

The trust was well-led and responsive to people's needs. Systems were in place to assess and monitor the quality of service that patients received and ensure care was provided safely and effectively. Systems in place for managing complaints about care and treatment were improving. Action plans were in place to address a backlog of complaints and the quality of responses to complaints had improved. Medicines were managed appropriately. They were stored securely and patients received the medicines they needed at the right time.

However, we identified some shortfalls in record keeping in different areas of the hospital. Some of these related to incomplete records of checks of key equipment used in the care and treatment of patients. In addition, some patient records were not accurately maintained in respect of checks carried out during and after surgery to ensure surgical procedures were conducted safely.

The service had been significantly reconfigured and expanded in size the week before our inspection, following the closure of in-patient maternity services at another local hospital. We noted that the Trust had prepared effectively for the reorganisation of the service and arrival of numbers of new members of staff so as to ensure that the quality of service provided to women and babies was maintained and the service was safe.

The women and partners we spoke with were positive about the care and treatment they had received. They told us they had been treated with respect by staff. All the women had received one to one care from a midwife once they were in established labour and many praised individual midwives. For example, one woman said, 'all the midwives were great, I was given lots of time and didn't feel rushed' and another woman told us the midwife had been 'compassionate throughout.' Women and partners were pleased with the quality of information they had received before, during and after the birth of their baby.

We found all areas of the maternity unit to be clean and well-maintained and infection prevention and control policies and procedures were implemented by staff. Midwives received appropriate training and support to enable them to provide the care and treatment that women needed. Multi-disciplinary training sessions enabled staff to work together effectively for the benefit of women and their babies. Systems were in place to assess and monitor the quality of service that women received and ensure care and treatment was provided safely and effectively.

Staff worked in cooperation with other health professionals and shared information with them appropriately. There were sufficient staff available in A&E to care for and treat patients. The Trust assessed and monitored the service to make sure that risks to patients were minimised and an appropriate standard of care and treatment provided. However, significant delays were experienced by a number of patients and several spent more than 16 hours in A&E before being admitted to a ward. This meant that care and treatment was not always delivered in a way that met patients' needs or ensured their welfare and safety.