Healthwatch Croydon, the recently established independent health and social care watchdog in the borough, is pressing for an urgent meeting with the Virgin Care subsidiary which runs the Urgent Care Centre at Mayday Hospital, following serious concerns expressed over its performance in the Care Quality Commission’s report published today.
Other observers suggest that the CQC’s Croydon report is the first to demonstrate that this government’s privatisation of the NHS is failing patients.
Dr Eoin Clarke, the outspoken NHS campaigner, described the CQC’s report overall as “grim, and sad, reading”.
Clarke told Inside Croydon: “There are very serious concerns in the report about the way having two separate providers between Urgent Care and Accident and Emergency works.
“People have long argued that fragmentation of the NHS is dangerous, but this is the first time I have read the CQC agreeing – and providing evidence – of this point.”
The CQC report into Mayday (aka “Croydon University Hospital”) was published overnight and followed the first batch of urgent inspections into some of the worst performing hospitals in England and Wales.
The report made several recommendations, many of which centred on serious under-staffing, and the problems the hospital has had in recruiting properly trained doctors and nurses, particularly in the A&E department, which is run by the NHS Trust.
But the CQC inspectors repeatedly referred to a disconnect between the hospital’s A&E department and the privatised Urgent Care Centre, and a failure to provide consistently “safe care”: “We had serious concerns about A&E and the way in which patients move between the Urgent Care Centre (UCC), which sees people when they first arrive, and the hospital,” the report states on its first page.
“The UCC is run by another provider, who we have inspected separately to address our concerns. The commissioners of this service must ensure that what they commission meets the needs of local people.”
The UCC is supposed to assess patients on arrival at the hospital. “Minor injuries and illnesses are then treated within the UCC,” the Virgin-run unit’s own website states. “Patients with serious and life-threatening conditions are sent straight through to the Emergency Department.”
But the CQC report states, “The A&E unit is not consistently providing safe care, mainly because of relationships with the UCC run by another provider.”
Because the UCC has been privatised, it was not due to be part of the main CQC inspection. But when the panel saw what was happening between UCC and Mayday’s A&E, they ordered an immediate inspection of the Urgent Care Centre: “We saw a summary of two serious incidents where patients waiting more than 20 minutes may have contributed to their deterioration,” the CQC report states, worryingly.
“Most of the staff we talked to said that this provision of care for adults is not safe.
“If patients are not assessed in 20 minutes, some patients who require rapid tests and interventions to prevent their condition from deteriorating may not receive them promptly. Staff also told us that some people were wrongly sent to the UCC instead of A&E.”
The Department of Health’s national target for A&E is that 95 per cent of people should be seen and treated within four hours. “The trust had largely been achieving this target from May 2013 and through the summer – but not in the previous five months,” the CQC inspectors found.
When the CQC inspection panel visited in September this year, “In the three weeks before the inspection the 95 per cent target had not been achieved on four days out of 21, in respect of all admissions (including the UCC). For admissions just to the major A&E department (in other words, excluding the UCC’s minor injuries and illnesses), the target was missed on 11 days out of 21.”
A subsidiary of the Virgin Care private healthcare company started a £6 million, three-year contract in Croydon in April 2012. Within months, Mayday Hospital was given two formal warnings from the CQC for its standard of care for patients. At that time, Virgin denied that these warnings were as a consequence of the way it was running the UCC.
The crying shame in all this, as the NHS is dismantled piecemeal for the benefit of private profit and political dogma, is that when Virgin Care took over the running of urgent care in Croydon, the service was performing better than at any time before, meeting most major A&E targets, including the 95 per cent emergency benchmark.
In a report on Mayday published in October 2012, issues that are familiar with other outsourced public services – of understaffing, and of an over-reliance on temporary staff – were observed under Virgin Care, the CQC reporting then that eight posts were unfilled in the Croydon’s Urgent Care Centre.
Virgin – a brand more usually associated with broadband, planes, trains and record shops – was subject to a C4 Dispatches investigation 12 months ago which portrayed the company as bidding with aggressively low quotes to win contracts, under-cutting bid prices for NHS services, but then struggling to meet previous standards of service. At the time, Virgin Care responded by claiming the television programme was “misleading and defamatory” and said that they had “improved the NHS services it delivers and saved millions of pounds for the NHS”.
Today’s latest, in-depth CQC report into services at Mayday will have done nothing to re-assure the public that the break-up of NHS services is working at their local hospital.
Mark Justice, the chair of the recently established watchdog Healthwatch Croydon, said, “It causes us concern that more and more people are voting with their feet not to use Croydon University Hospital but to go elsewhere.
“Healthwatch Croydon strongly believes that there is a need for a high quality hospital in Croydon. It needs a focus, it needs modernisation and we will be here to be that critical friend to the management team in CUH and others in the health and social care in that needed journey.”
Responding to the CQC report, Justice says that many of the short-comings of Mayday’s A&E and Urgent Care Centre may be the result of the demographics of the area around the hospital, and that much improved GP services would deal with many of the patients who currently present at the UCC.
“Croydon is at the bottom 10 per cent of the ability to see a GP when you want,” Justice said. “The funding levels to meet demand are way out of kilter, and we have a growing young and older population – the demands of these populations are what cause the biggest drain on NHS services.”
Justice notes that there are 176 care homes in Croydon – the highest density in London. As a result, Justice says, Croydon “is an importer of older people”.
“The hospital has always had one hand tied behind its back,” Justice said. Under-funding and systemic budget problems at Mayday have deterred staff from taking jobs at the hospital, leading to the staffing issues referred to throughout the CQC report. “Other hospitals in the area have become specialist hospitals, for strokes, cancer, etc. CUH is not a specialist in anything just a hospital that is in truth a very large ‘cottage type hospital’.
“We believe that you cannot look at one area without looking at the wider remit. Work obviously needs to be done around the issues raised within the CQC report, but also why are an increasing number of people not registered with a GP? Why are we using the expensive A&E services, rather than pharmacy services? When will the GP services in Croydon be no longer in the bottom 10 per cent of the ability to see them?
“It does concern Healthwatch Croydon that there is poor communication between the A&E services and the Urgent Care Centre. Healthwatch Croydon is pressing for an urgent meeting to discuss this further.”
- Under-staffed Mayday remains accident waiting to happen
- COMMENTARY: CQC report tells us nothing we did not know
Coming to Croydon
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- Comedy in Music show: Dec 1
- The Lives of Stanley Halls community entertainment: Dec 4
- Steve Knightly at Stanley Halls: Feb 5
- Inside Croydon: Croydon’s only independent news source, based in the heart of the borough – 262,183 page views (Jan-Jun 2013)
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