Royal Free London NHS Foundation Trust

Updated 10 May 2019

The Royal Free London is one of the UK’s biggest trusts, and became a Foundation Trust in 2012. It employs over 10,000 staff to deliver care and treatment to more than 1.6 million patients each year across its three main hospitals. The trust supports delivery of approximately 8,000 babies a year and has over 200,000 A&E attendances a year.

The trust has 1,770 beds across three sites: Barnet Hospital (440 beds), Chase Farm Hospital (74 beds) and the Royal Free Hospital (830 beds), and in total over 30 locations where services are provided by the trust (11 locations registered with CQC).

We last inspected the trust in February 2016 and rated the trust good overall.

Updated 10 May 2019

Our rating of the trust went down. We rated it as requires improvement because:

• We rated effective and caring as good and safe and responsive as requires improvement.
• We rated well-led for the trust overall as good.
• We rated six of the 12 services inspected this time as requires improvement. In rating the trust, we also took into account the current ratings of the services not inspected this time.
• Some of the issues identified during the previous inspection, which impacted on the safety and responsiveness of services, had not been yet been addressed by the trust.
• Mandatory training for staff in key skills, including safeguarding, fell below the trust’s target for compliance.
• Staff did not consistently follow best practice when prescribing, giving, recording, storing and disposing of medicines.
• Services did not always have sufficient numbers of staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.
• We were not assured that there were effective systems and processes in place to prevent avoidable patient safety incidents from reoccurring.
• People did not always have prompt access to services when they needed it.
• Best practice guidelines for the care and treatment of patients with additional support needs were not always consistently followed.
• Whilst the trust had effective systems for identifying risks and planning to reduce them, risks were not always being dealt with in a timely way.
• Whilst the majority of staff felt the culture of the organisation had improved and described the leadership team as accessible and supportive, there remained a culture of bullying within the operating theatres.

However:

• The service managed patient safety incidents well.
• The hospital generally controlled infection risk well.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes.
• Staff treated patients with kindness, dignity and respect.
• Most staff felt well supported by managers and told us that they encouraged effective team working across the hospital.
• The trust was committed to improving services by learning, promoting training, research and innovation.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RAL/reports.

Updated 10 May 2019

Updated 10 May 2019

Updated 15 August 2016

Overall we rated mental health services for children and young people as requires improvement because;

The general CAMHS tier two service was part of the wider children’s directorate. At the time of the inspection the team didn't have a service manager and staff felt this was unusual for such a large service. However, the clinical director had recently made a proposal to get a specific service line lead for CAMHS which was a clinical leadership role for the whole of CAMHS.

The site environment was small and staff had problems in accessing space to conduct sessions. We did not find evidence of alarms fitted in therapy rooms for use in an emergency.  The rooms did not provide adequate sound proofing and discussions could be heard outside of rooms.

The CAMHS services did not have a formal caseload management system and did not have a system for regularly monitoring non urgent young people on the waiting list to detect an increase in the level of risk. 

Transition from CAMHS to adult services was poor and staff agreed that there was a lack of joint care planning and working. However, the operational service manager was actively negotiating with commissioners to improve the transition for young people to adult services. The service did not collect information for waiting times from assessment to treatment.

Parents/carers of young people were not aware of how to access an advocate and felt facilities could be improved.

However;

Staff had a good understanding of risk and reported all incidents. Staff discussed feedback and learning at team meetings. Staff completed assessments in a timely manner and were responsive to young people’s physical health needs. Clinicians used a range of outcome measures to rate outcomes and the severity of illness for young people using the service.

Staff greeted patients in a friendly and supportive manner and young people and parents/carers said staff behaved with respect and were polite. Staff made themselves available and communicated with young people and parents/carers regularly. Staff involved the families and carers of young people and invited them to appointments.

Young people and parents/carers could give feedback on the service in surveys. Young people and parents/carers felt that staff were flexible with appointment times. Parents/carers said they were fully informed by staff and received information about the service. Parents/carers of young people said they knew how to complain and that staff provided feedback.

Staff were experienced and qualified to provide therapeutic interventions to young people. Staff had good access to specialist training and had strong links to external agencies. Staff were aware of and had understanding of Gillick competency and Fraser guidelines.

The team provided young people and their parents/carers with information about how to keep safe and gave them contact information for an out of hours response.

The team had rapid access to a psychiatrist for urgent referrals. Care plans were holistic and recovery focused but there was difficulty in accessing patients records and knowing where to find key documents.