Hospital leaders at the trust running St Helier and Epsom hospitals have been told they must improve after inspectors found they had been too slow to act on known safety problems in maternity, surgery and accident and emergency care.
The Care Quality Commission (CQC) has rated the leadership of Epsom and St Helier University Hospitals NHS Trust as “requires improvement” following an inspection in May. The watchdog said there was “limited evidence” that leaders had acted quickly enough to reduce the potential for avoidable harm, despite the problems having already been flagged by previous inspections and by the trust’s own incident data.
Antoinette Smith, the CQC’s deputy director of hospitals in London, said: “During our inspection of Epsom and St Helier University Hospitals NHS Trust, we found shortfalls in safety management and ensuring a consistent standard of care and strategic focus across its sites.”
She said the trust had set up a model for how its sites and services should be managed, but its main hospitals had different organisational structures, which affected the ability of leaders to identify problems and respond to them.
“Although the trust had established defined management roles and frameworks to monitor services, there were shortfalls in how consistently some safety risks were being managed,” she said. “Our previous inspections, and the trust’s incident data, had highlighted issues in maternity, surgery, and urgent and emergency care, but there was limited evidence that leaders had taken timely action to reduce the potential for avoidable harm.”
Inspectors also found that more needed to be done to tackle bullying and harassment at the trust, particularly where it involved disabled staff and those with long-term health conditions, and that disparities within the workforce had worsened rather than narrowed.
What a “requires improvement” leadership rating means
The CQC judges NHS trusts across five areas, asking whether services are safe, effective, caring, responsive and well-led. This rating covers the “well-led” question — how the trust is run — and sits in the second-lowest of the watchdog’s four grades, below “good” and “outstanding” but above “inadequate”.
In practice, a trust rated as requiring improvement is expected to draw up an action plan setting out how it will fix the problems inspectors found, and to show measurable progress when the CQC returns. The watchdog can re-inspect at any time, take enforcement action if standards slip further, and place a trust into special measures in the most serious cases. The findings also matter because leadership ratings feed into how regulators judge the overall health of a trust — and they shape the confidence patients can have in the people running their local hospital.
The verdict is not the same everywhere in London’s health system. While leadership at Epsom and St Helier has been told to improve, a CQC inspection at Cygnet Hospital in Beckton recently rated that service good — a reminder that the watchdog’s findings vary sharply from one provider to the next.
A trust serving south London and Surrey
Epsom and St Helier University Hospitals NHS Trust provides hospital and community services to around 490,000 people across south London and Surrey. Its two main hospital sites are Epsom Hospital and St Helier Hospital, and it also runs Queen Mary’s Hospital for Children.
St Helier, in Carshalton, is the hospital most Londoners in this story will know. It serves patients across the boroughs of Sutton and Merton, and people from parts of Croydon and Wandsworth also use its services, while Epsom Hospital serves the Surrey side of the patch. For hundreds of thousands of people, these are the A&E departments, maternity units and surgical wards closest to home.
The trust has also operated for years under the shadow of a long-running debate about the future of its ageing estate. St Helier’s main buildings date back to the 1930s, and there have been repeated plans over the years to build a new specialist emergency care hospital in Sutton and upgrade the existing sites at St Helier and Epsom. Ageing buildings are a familiar headache across the capital’s hospitals — Queen’s Hospital in Romford is in line for a £42m rebuild of its A&E department — but the CQC’s criticism here is aimed squarely at leadership and management, not bricks and mortar.
The workforce findings add to a difficult picture for staff relations across the capital’s NHS, with staff at Guy’s and St Thomas’ having been in dispute over pay this month. At Epsom and St Helier, the inspectors’ message is that the trust knows what its problems are. The question now is whether its leaders can show, quickly and consistently, that they are fixing them.
