Health inspectors have downgraded four outsourced NHS urgent treatment centres in east London to 'inadequate'.
Partnership of East London Co-operatives, known as PELC, runs urgent treatment centres (UTCs) at Queen’s Hospital in Romford, King George Hospital in Goodmayes, Barking Community Hospital and Harold Wood Walk-in Centre.
Two of the centres are attached to hospital emergency departments and treat the majority of patients that arrive with minor injuries and illnesses.
During an inspection in November, health inspectors found PELC’s centres were short-staffed, had unsafe assessment waiting times and that leaders had failed to improve when “things had gone wrong”.
At King George Hospital in Goodmayes and Queen’s Hospital in Romford, patients were waiting two or more hours for an initial assessment due to staff shortages of “at least” 10 per cent for doctors and 20pc for nurses.
Care Quality Commission’s (CQC) director for London Jane Ray said that, although there are national shortages of health staff, PELC failed to prioritise initial assessments within 15 minutes as required by NHS England.
Ms Ray added: “Behind this was the failure of the service’s leaders to effectively monitor issues the services faced, including waiting times, to inform their strategies to meet people’s needs.
“They also failed to capture learning when things had gone wrong to drive improvement.
“However, despite the pressure they were under, staff in each service treated people with kindness, respect and compassion.”
CQC rated each centre as 'good' for being caring but 'inadequate' when it came to being safe, responsive to people’s needs and well-led.
The overall 'inadequate' ratings are a downgrade of PELC’s four centres from 'requires improvement', following a system-wide CQC review of east London’s urgent and emergency care in November 2021.
At King George, inspectors saw patients with chest pain being put at “serious risk of harm” because they were not “streamed” to the hospital’s emergency department for up to five hours.
Delays such as these should have been recorded as “significant incidents” for future learning but were either overdue for investigation or not logged at all, inspectors wrote.
At both Harold Wood and Barking Community Hospital, staff reported “very long” queues of patients waiting to be assessed, potentially delaying transfers to the hospitals’ more serious A&E departments.
At Queen’s and King George, CQC inspectors found the computer systems used by the hospitals and PELC were incompatible, creating further delays when transferring patient records.
The performance of PELC’s senior leadership was another key concern for CQC due to their “unclear” strategic plan and track record of collecting “insufficient” information to compare their performance to other NHS services.
This was despite a report by an external consultant in August 2022, which found that PELC’s organisational objectives were “not clear” and there were “cross-purposed” committees.
The inspectors noted PELC had an “unclear” management of long-term risks and, amongst more junior staff, was failing to manage poor performance or “instances of bullying and harassment”.
Although on-the-ground leaders were visible, staff were “unclear” on who the most senior staff were and “did not see them at work”.
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CQC has now issued PELC with a formal enforcement notice that gives inspectors the power to cancel or vary its registration if it has not improved in six months’ time.
Despite running part of the emergency department services at Barking, Havering and Redbridge University Hospitals NHS Trust, PELC is contracted by NHS North East London (NHS NEL) - a new regional health body formed in July last year.
Zina Etheridge, chief executive of NHS NEL, issued a statement on behalf of PELC and other “health and care partners” in north-east London saying they took “immediate action” to address the inspectors’ concerns.
She added: “Ensuring initial clinical assessments are carried out within agreed, safe timelines and that patients are more closely monitored while they wait to be seen are key issues addressed in a coordinated plan agreed by all health and care partners locally.
“Together with improvements to the way the organisation is managed and a new plan for managing capacity and demand, our plans will help us tackle the long waits and mean we provide better safer care for patients.”
However, NHS NEL declined to comment on whether PELC should stop running the hospital urgent treatment centres.
In their inspection reports, CQC has also recognised that PELC’s own issues have been complicated by “wider challenges within the health and social care system”.
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