CQC: St George’s Cardiac Surgery Unit 'Must Improve'

Nicky Broyd

December 06, 2018

Care Quality Commission (CQC) inspectors have found weak leadership and a culture of mistrust at St George’s University Hospitals NHS Trust in Tooting, London.

The hospital made headlines in the summer after an independent review, commissioned by the Trust, found a 'toxic atmosphere' within the cardiac surgery unit. As a result, complex planned and emergency cardiac operations were suspended.

Inspection Findings

The CQC inspectors visited the hospital on August 23rd and September 13th and 14th and warned that the cardiac surgery unit must improve.

They found that morale was low amongst consultant surgeons who mistrusted each other, as did cardiologists, anaesthetists, and senior leaders.

The CQC also found:

  • A lack of cohesion and poor working conditions between surgeons

  • A culture of not learning from incidents

  • Poor quality mortality and morbidity meetings

  • Problematic multiple electronic patient record systems meaning notes were not centrally recorded

  • A lack of ongoing and regular oversight

However, although leadership was weak the CQC did find there were attempts underway to improve the service and there were no immediate concerns about the safety of patients who were well prepared for surgery.

Professor Ted Baker, England’s chief inspector of hospitals said in a media release: "We have told the trust it must now take steps to improve the morale, culture and systems within the unit. Colleagues at NHS Improvement have set up an independent scrutiny panel for cardiac surgery, to advise, challenge and support the trust through this difficult time.

"I expect to see improvements at the cardiac surgery unit and CQC will be monitoring the situation closely."

St George's Response

In a statement the Trust said it had taken a number of steps to stabilise and improve the service for staff and patients including:

  • Appointing an experienced cardiac surgeon from outside the organisation, to provide leadership

  • Appointing two additional cardiac surgeons

  • Moving to a consultant of the week model, which is considered best practice

  • Ensuring all new cardiac surgery cases are reviewed by a multi-disciplinary team on a daily basis

  • Rolling-out new software to capture mortality and morbidity data in real-time

Jacqueline Totterdell, chief executive of St George’s, said: "The service experienced significant challenges earlier this year, and it will be reassuring to the communities we serve that the CQC has confirmed it is safe.

"Of course, this does not change the fact that significant improvements are required – and significant progress has been made since the CQC’s visit back in August.

"I am grateful to many of our cardiac surgery staff for the commitment and dedication they have shown – they deserve a huge amount of praise during what was a difficult period for the service."

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