27 September, 5-6 December 2023
During a routine inspection
The North Middlesex University Hospital NHS Trust is a medium-sized acute trust with 633 beds, and employing just under 4000 staff (over half living in the local community); serving a population of around 640,000 people living across Enfield and Haringey. The trusts turnover in 2022/23 was £442.5m.
The trust’s services are provided at the North Middlesex University Hospital (NMUH) main site as well as a range of other hospital and community sites in the boroughs of Enfield and Haringey. They deliver services in collaboration with a range of partners, including local GPs, acute and mental health providers, and other community health service providers across North Central London.
The trust is part of North Central London integrated care system which brings together the NHS organisations and local authorities to meet the health and care needs of people in Camden, Islington, Barnet, Enfield, and Haringey. The community served by the trust is one of the most diverse in London and has high levels of deprivation. The trust is working with system partners to reduce health inequalities.
NMUH is a training unit for medical students from University College London and St George’s University Grenada (West Indies), and for nursing and midwifery students from the Middlesex University and many others.
The trust provides a full range of adult, elderly, and children's services across medical and surgical disciplines. It has some specialist services such as HIV, cardiology, blood disorders, diabetes, fertility, sickle cell and thalassaemia. In April 2023 the trust had taken on the provision of community health services in Enfield such as district nursing, with 600 staff joining the trust.
The majority of clinical activity happens at the main North Middlesex Hospital site. The trust also has an outpatient clinic at St Ann’s hospital, for sickle cell and thalassaemia, in Tottenham. The most recent addition is a step-down ward at Chase Farm (nursing led care with input from GPs). The trust offers integrated sexual health services in Enfield in partnership with the London borough of Enfield. The clinics offer free and confidential sexual health screening and/or treatment and general advice to all patients regardless of their age, sexuality or where the patients live.
This inspection covered the medical care core service provided by the trust and also looked at whether the trust was well led.
The trust has over 421 medical inpatient beds across 20 wards, mostly located at North Middlesex University Hospital. The trust has two wards located at the Chase Farm Hospital.
Medical specialities providing inpatient care are:
- Acute medicine with ambulatory care
- Cardiology with catheter laboratory and outpatient service for heart failure and arrythmia, rapid access chest pain and full range of cardiology technical services
- Respiratory medicine, which includes a full range of diagnostic services including bronchoscopy and endobronchial bronchoscopy, a large tuberculosis cohort and cancer care
- Gastroenterology services include hepatology and endoscopy, including consultant rota 24 hours a day seven days per week
- Care of the elderly - day hospital and community and care home services
- Diabetes and endocrine including outpatients and diagnostics
- Haematology and anticoagulation - large tertiary cohort of haemoglobinopathy patients
- Stroke unit with transient ischemic attack (TIA) clinic
- Oncology services.
Admissions for the top three medical specialties were: general medicine (43%), gastroenterology 30%, clinical oncology (27%).
How we carried out this inspection
We carried out the medical care (including older people's care) core service inspection unannounced on 27 September and the well-led trust overall inspection announced on 5 and 6 December 2023. We inspected medical care because it is the trusts largest service and there had been concerns about sickle cell and elderly care raised with CQC. We also undertook a well led inspection because concerns had been raised with CQC by a number of staff members about the overall trust culture.
We visited areas relevant to the core service inspected and spoke with several patients, staff, and patient representatives. We spoke with staff at all levels of the organisation including healthcare assistants, nurses, junior doctors, pharmacy staff, consultants and administrative staff.
We also looked at a wide range of documents including policies, standard operating procedures, meeting minutes, action plans, risk assessments, training records and audit results. We attended staff handovers and safety huddles.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.