CQC: Epsom St Helier Leadership Requires Improvement

• The CQC rated the leadership of Epsom and St Helier University Hospitals NHS Trust as 'requires improvement' following a May inspection.
• Shortfalls were identified in safety management, consistent care standards, and strategic focus across the trust's multiple sites.
• The inspection revealed unaddressed bullying and harassment, particularly affecting disabled staff, and worsening workforce disparities.
• Recruitment processes designed to remove bias were not consistently followed, leading to under-representation of Black and ethnic minority staff in senior roles.
• Despite challenges, the trust showed good collaboration with partners and open information sharing, resulting in reduced waiting times and hospital admissions.

The inspection highlighted significant concerns regarding staff experience, including unaddressed bullying and harassment, particularly affecting disabled staff and those with long-term conditions, alongside worsening workforce disparities.

The Care Quality Commission (CQC) has issued a 'requires improvement' rating for the leadership of Epsom and St Helier University Hospitals NHS Trust following an inspection conducted in May. This assessment covers the trust's governance and strategic direction across its extensive network, which delivers hospital and community services to approximately 490,000 individuals across London and Surrey. The trust operates two primary hospital sites, Epsom Hospital and St Helier Hospital, which includes Queen Mary’s Hospital for Children, in addition to eight other CQC-registered facilities such as Frimley Park Hospital Renal Unit and Sutton Hospital.

The CQC's initial review of the trust's front-line services was prompted by specific concerns regarding the quality of care provided, alongside its standard monitoring procedures. The inspection identified several critical shortfalls, particularly in the areas of safety management and the consistent application of care standards and strategic focus across the various sites. Antoinette Smith, the CQC's deputy director of hospitals in London, highlighted that while a management model was in place, the differing organizational structures at the main hospitals hindered leaders' capacity to effectively identify and address issues, although the trust was already aware of this discrepancy and had plans to rectify it.

Despite the presence of defined management roles and frameworks designed for service oversight, the CQC inspection revealed inconsistencies in how certain safety risks were managed. Previous inspections and the trust's own incident data had already pointed to problems within maternity, surgery, and urgent and emergency care. However, the CQC found insufficient evidence that leadership had taken prompt and effective measures to reduce the potential for avoidable harm in these critical areas, indicating a gap in the CQC inspection safety management NHS protocols.

Significant concerns were also raised regarding staff experience, an issue that had been flagged in prior inspections and remained unresolved. The CQC noted that leaders still needed to address prevalent bullying and harassment, particularly impacting staff with disabilities or long-term conditions. Furthermore, workforce disparities had worsened, and the trust's recruitment processes, intended to eliminate bias, were not being consistently applied. Data specifically indicated that Black staff and those from ethnic minority groups faced a lower likelihood of being hired and were under-represented in senior management positions, highlighting issues with NHS trust recruitment bias CQC oversight.

Amidst these challenges, the inspection did acknowledge positive aspects of the trust's operations. There was clear evidence of successful collaboration with partner organizations to enhance services for local communities and a commendable openness in information sharing. These efforts had tangible benefits, including reduced waiting times for patients and a decreased necessity for hospital admissions.

This 'requires improvement' rating for CQC Epsom St Helier leadership requires improvement falls under the CQC's updated methodology, which assigns a single trust-level rating focused on leadership and culture. This new approach, which replaces all other ratings at that level, was developed following extensive consultation and feedback to ensure its suitability for the innovative, complex, and integrated models of care emerging within the NHS. The CQC's assessment of the NHS trust well-led rating is therefore a comprehensive evaluation of the trust's overall strategic direction and operational oversight.

The CQC has communicated its findings and concerns directly to the trust's leadership, who have acknowledged the necessary improvements. The regulatory body has affirmed its commitment to closely monitor the trust's progress in implementing these changes, ensuring that patient safety remains paramount throughout the improvement process. This ongoing scrutiny underscores the importance of robust governance and responsive leadership within all NHS trusts.

Compliance officers and legal advisors for other NHS Trusts should review their internal governance, safety management systems, and HR policies, especially concerning staff experience, bullying, and recruitment equity, to proactively address potential CQC scrutiny and avoid similar 'requires improvement' ratings for leadership.

Source: Reporting based on CQC's recent inspection findings.