Archived: Heatherwood and Wexham Park Hospitals NHS Foundation Trust

Heatherwood and Wexham Park Hospitals NHS Foundation Trust has six sites. The two main sites are Wexham Park Hospital and Heatherwood Hospital. They also provide outpatient services at King Edward VII Hospital in Windsor, St Mark’s Hospital in Maidenhead, Chalfont’s and Gerrards Cross Hospital and Fitzwilliam House in Bracknell.

The trust provides services to a large and diverse population of more than 465,000. The area it covers includes Ascot, Bracknell, Maidenhead, Slough, South Buckinghamshire and Windsor. The trust has approximately 3,600 staff and a total number of 650 beds. The trust has recently increased the bed capacity at Wexham Park to meet increased demand following an increase in their catchment area for A&E, paediatrics and wards, and had plans to open more capacity later in 2014.

The trust’s catchment area population includes a significant proportion of ethnic minority groups and 30 languages are spoken in the area covered by the trust. The most common (excluding English) include Hindi, Polish, Urdu, Somali, Romanian and Punjabi.

The trust became a foundation trust in 2007. At the time of the inspection, the executive team (based at Wexham Park Hospital) comprised members who were either interim appointments or relatively new in post, with only one member of the executive team in post for over three years. The chief executive had been in post for two years and four months (but had formally resigned, with a leaving date in March 2014).

We inspected this trust as part of our in-depth hospital inspection programme because it represented a variation in hospital care according to our new intelligent monitoring model. This looks at a wide range of data, including patient and staff surveys, hospital performance information and the views of the public and local partner organisations. Using this model, Heatherwood and Wexham Park Hospitals NHS Foundation Trust was considered to be a high-risk service.

At the time of the inspection, Wexham Park Hospital was in breach of a number of regulations and, in many instances, it has been providing care below the essential standards, as found during two previous CQC inspections in May and October 2013. In May 2013, there were particular concerns about the care provided to patients in Accident & Emergency (A&E) and the impact this had on the ability of inpatient wards to provide the essential standards of care. At the inspection in October 2013, improvements in A&E were noted to have been made. However, we found that Wexham park Hospital was in breach of eight regulations. As a result we served compliance actions for breaches of two of the regulations (15 and 16) and warning notices for breaches of six regulations (9, 10, 12, 17, 20, and 22).

We gained views from partner organisations who expressed their concerns about the care provided at Wexham Park Hospital and the future sustainability of the trust.

Heatherwood and Wexham Park Hospitals NHS Foundation Trust provides the following regulated activities, which formed part of our inspection; diagnostic and screening procedures, management and supply of blood and blood derived products, maternity and midwifery services, surgical procedures, termination of pregnancies and treatment of disease, disorder or injury.

We carried out an announced inspection visit on 12 and 13 February. We held focus groups and drop-in sessions for staff. We talked with patients and staff from many areas of the hospital. We observed how people were being cared for, talked with carers and/or family members, and reviewed patients’ records of personal care and treatment. We held two listening events when patients and members of the public shared their views and experiences of Heatherwood and Wexham Park Hospitals NHS Foundation Trust. Patients who were unable to attend the listening events shared their experiences via email or telephone. We carried out three unannounced visits, when we looked at how the hospital ran at night, the levels and type of staff available, how patients were cared for, and patient flow through the hospital.

The trust had a long history of problems. Financial shortfall and high turnover of senior leadership had resulted in poor outcomes in recent CQC inspections and expressions of increasing concern from multiple stakeholders. The trust we found was one that had a significant legacy from a history of financial challenges and the hospital had a culture which was not open with learning at its heart. Trust wide improvements were commencing with support from external agencies, however these were at very early stages and the trust remained challenged. The future sustainability of the trust was clearly a concern. Although efforts had recently been made in response to these concerns they were still very much in their infancy.

The culture was one of learned helplessness and accusations of bullying and harassment were heard throughout the organisation. Although the chief executive was reported to have high visibility and communicated regularly with the frontline, she had recently resigned and was due to leave in March 2014.

The trust was clean and wards that were heavily criticised in previous CQC reports showed evidence of improvement. However, staffing levels were still low in many areas and there was heavy reliance on agency staff to sustain both the medical and nursing workforce.