Royal Free Hospital: Chief exec wishes hospital had ‘done better’ after CQC tells trust it requires improvement
PUBLISHED: 15:44 17 May 2019
The Royal Free’s chief executive says the trust is going on a “journey” after a Care Quality Commission (CQC) report downgraded it to “requires improvement” and criticised bullying and its finances at the trust.
Speaking to the Ham&High, Caroline Clarke apologised to suppliers who hadn't been paid on time, and said steps were already being taken to address bullying at the Royal Free, in Pond Street.
Ms Clarke, who was confirmed as Sir David Sloman's replacement in February, said she was "disappointed" but that she wasn't surprised by the report, which was published last week.
The report criticised safety, responsiveness and the trust's finances. It replaced the previous "good" rating the Royal Free gained three years ago.
Surgery, urgent and emergency services and medical care were all downgraded to "requires improvement".
The trust, which also runs hospitals at Chase Farm and Barnet, is also not meeting waiting time targets for referrals to treatment, cancer treatment, and accident and emergency.
Ms Clarke said the trust now had to go on a "improvement journey" to restore its rating.
"We're disappointed," she admitted. "I'm really keen to praise our staff where they have done well.
"There are some areas that I wish we had done better in, but we are meeting the majority of criteria.
In the report, which was published on Friday morning, surgery in Hampstead came in for particular criticism.
It said half of the trust's "never events" - the most severe errors and failings - took place during surgery at the Royal Free.
Inspectors attributed these to "poor behaviours among a few consultant surgeons in the trust". After the events had happened, the CQC wasn't satisfied with evidence that they had been learnt from.
It also said it was concerned about a culture of bullying within operating theatres.
Ms Clarke, who previously served as deputy chief executive from 2012 to 2019, said the issue was being tackled, and indicated some staff responsible had moved on. She also wanted to allay concerns about any impact on safety.
"There is no link between bullying and safety. Where we have found it, we have taken action. If there is anything cultural, we will deal with it."
She pointed to new "speaking up" champions, educational videos on bullying and giving staff more opportunity to feed back.
She said: "We report more and encourage more reporting. We want to help staff if they have an issue outside the regular processes, and that's where our new measures come in."
"We survey staff more frequently than the annual staff survey, and we report that to our board as we want it to be in the public domain as much as possible.
"We want this to galvanise us to keep going. There is always more to do."
There was bad news for the trust's balance sheet, too.
Inspectors found it is due to overshoot its planned deficit by £36million, and there isn't an effective action plan to tackle the hole in the finances.
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The report says the Royal Free was expected to receive £70m from a land sale this year in Chase Farm, but this won't take place in time. The Queen Mary's nurses home in East Heath Road has been controversially earmarked for sale amid a row about key worker housing.
Inspectors go on to say the trust is "reliant" on short-term loans to keep it in the black. It is forecast to borrow £57m in 2018/2019, with the overall total reaching £170m.
Ms Clarke said the trust had "worked hard" to be more efficient, and the lack of short-term cash was common in about 80 per cent of hospitals.
She also apologised to businesses who had not been paid on time, but disputed the CQC's findings that staff had also not been paid.
"We have to be to be able to pay them on time," she said of businesses, "and we are trying to get better in the future to pay them as quickly as we can."
She continued: "The national picture is to take money out of London, as a formula that funds the CCGs. So we have less money."
She also said the sale of Queen Mary's House was "a long, complex process" but the cash was needed to improve facilities, including cardiac services, at the Royal Free.
Despite the CQC reporting that there wasn't an "effective action plan" to tackle the deficit and financial position, the chief executive backed the trust's financial strategy.
She was the Royal Free's chief finance officer for seven years until 2018.
"The strategy is the right thing to do," she said. "We have reduced the deficit from £120m to £70m. The rest of the NHS is going through something quite similar. We are disappointed, in that we want it to be better."
The trust was praised as a sector leader in the report. Bosses were given credit for "doing the right thing, even when this had a negative financial impact".
Mortality rates at its hospitals are among the lowest in the country.
Caroline said: "I'm proud of the compassionate care that patients recieve, that the CQC picked up on. It's what you would want for your relatives or what you would want if you were in hospital. That is like gold dust.
"2019-2020 has always been a year where we wanted to consolidate what we are doing and how to do it better.
"We want to make sure staff feel good about coming into work and provide good patient experience."
The chair of Camden Council's health scrutiny committee, Alison Kelly, also struck an upbeat note despite the downgrading.
She said: "I'm not as concerned as others may be. The Royal Free has been through a difficult period. Running a hospital is one of the most difficult things to do, especially one as large as the Royal Free, but Caroline has been a breath of fresh air and has an innovative approach.
"She is surrounding herself with really good people, and if it wasn't like that I would be worried."
Frances Hasler, director of Healthwatch Camden said: "[We are] concerned that the Royal Free London NHS Trust has been rated as needing improvement, but the CQC report shines an important light on both what is good and what needs to improve at the Royal Free.
"Of particular interest is that Camden is a diverse borough with some significant health inequalities and a high level of mental health needs.
"So it is vital that our local hospitals can meet diverse needs and that includes the Royal Free."
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