Watford General Hospital has failed five out of six areas of Care Quality Commission inspection

Watford General Hospital fails five of six areas in NHS watchdog inspection

Watford General Hospital fails five of six areas in NHS watchdog inspection

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Watford Observer: Photograph of the Author by , Chief Reporter

Failures in infection control, hygiene, staff levels and medical records have been uncovered at Watford General Hospital, following an unannounced inspection.

The hospital, in Vicarage Road, failed to meet NHS standards in five of six key areas when a health watchdog team visited in December.

A report by the Care Quality Commission (CQC) raised concerns after its team found dried blood in a corridor, medical records containing information about the wrong patients and treatment being delayed due to staffing pressures.

However the commission’s report also praised the way staff treated patients and highlighted areas where the hospital was improving under the new management team.

The CQC sent an inspection team to the hospital on December 17 and spoke to 29 patients and 40 staff members during the visit.

Responding to the report, Samantha Jones, the chief executive of the trust incharge of the hospital, said efforts were already being made to improve care at the hospital.

In its report the team found patients were largely positive about the way they were dealt with by staff.

"In most case people were complimentary about the attitude of the staff," the report said.

"Comments included, ‘the staff are wonderful’, ‘staff are brilliant, I couldn’t fault them’, ‘it’s constantly busy but nothing is too much trouble for them’."

However the team observed cases were treatment was being given without cubicle curtains being drawn and without staff explaining the treatment to the patients.

The inspectors also noted the list of confused patients, such as dementia sufferers, in the Acute Admissions unit (AAU) - a ward which most patients in the hospital pass through - was called "wander watch".

Looking at treatment patients received, the inspectors praised the trust for bringing down its mortality rate for people who have fractured a hip from 12 per cent to six per cent, which is below the national average.

Yet in the AAU ward, inspectors found that patient transfer time targets meant the treatment of patients was often interrupted or delayed as staff dealt with incoming patients.

The report said: "This meant that the pressure of bed management may place people at risk of unsafe care or treatment by delaying them in receiving the tests and treatment required."

The report also said poor hygiene and cleanliness at the hospital was leaving people at risk of infection.

Inspectors found cases of mattresses not being cleaned properly as they went around the wards.

In A&E they discovered a pillow on a bed "marked with large stains" and a dried blood on the floor between the department and the fracture clinic.

When inspecting a cubicle in Aldenham Ward, the CQC team discovered "high levels" of dust as well as a used plaster, a straw and orange fruit under the bed and a large dark stain on a chair cushion. In another ward they found a blood stain on the toilet wall.

Looking at staffing levels the, CQC concluded there was not enough experienced staff in AAU to meet patients’ needs. Inspectors were also not convinced that staff were being sufficiently monitored and found low numbers of doctors had been appraised.

The report criticised the trust for not having an effective system in place to regularly access and monitor the quality of service patients received. It said the governance department was significantly understaffed and found that serious incidents investigations were not always completed by trained investigators.

The CQC also discovered two patients’ medical records, which contained blood tests results and a request for a scan relating to someone else.

It also uncovered reports stating patients were not at risk of malnutrition that did not include vital information such as their weight or height.

Comments (20)

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11:14am Fri 14 Feb 14

D_Penn says...

Unannounced inspections are always going to find weak areas and they are a vital requirement towards maintaining high standards.

However, I hope there are people who read this article and work at the hospital who could comment because sometimes the trouble with these instant inspection reports are that you cannot be sure if they have unearthed an endemic problem or just happened upon one off incidents. Some inside feedback can prove useful.

On a personal level though, I have always found staff at the hospital to be excellent and have been very happy with the level of care.
Unannounced inspections are always going to find weak areas and they are a vital requirement towards maintaining high standards. However, I hope there are people who read this article and work at the hospital who could comment because sometimes the trouble with these instant inspection reports are that you cannot be sure if they have unearthed an endemic problem or just happened upon one off incidents. Some inside feedback can prove useful. On a personal level though, I have always found staff at the hospital to be excellent and have been very happy with the level of care. D_Penn
  • Score: 2

11:43am Fri 14 Feb 14

newbie says...

D_Penn I completely respect your comment, but as a frequent visitor and service user to WGH, I can without a doubt tell you this is not a one off incident especially concerning staff levels and hygiene. I've had numerous conversations with staff about staff levels which I have noted is a top complaint from them and have personally noted the state of wards when there. I warn other patients when they've been in the same room my family had occupied because we carry MRSA (having been in hospitals so often, this was bound to happen). I don't have faith in the cleaning processes that this won't be passed onto the next serivce user.

The CQC are absolutely correct to praise the trust for caring staff especially with the pressures they are under; they deserve the recognition.
D_Penn I completely respect your comment, but as a frequent visitor and service user to WGH, I can without a doubt tell you this is not a one off incident especially concerning staff levels and hygiene. I've had numerous conversations with staff about staff levels which I have noted is a top complaint from them and have personally noted the state of wards when there. I warn other patients when they've been in the same room my family had occupied because we carry MRSA (having been in hospitals so often, this was bound to happen). I don't have faith in the cleaning processes that this won't be passed onto the next serivce user. The CQC are absolutely correct to praise the trust for caring staff especially with the pressures they are under; they deserve the recognition. newbie
  • Score: 14

11:45am Fri 14 Feb 14

HornetJJ says...

I was waiting in A&E last Sunday morning and it was very dirty. The staff were absolutely fine but the state of the place was disgusting. We were then transferred to the Ambulatory Care Unit where it was a different world. Very clean and comfortable.
I was waiting in A&E last Sunday morning and it was very dirty. The staff were absolutely fine but the state of the place was disgusting. We were then transferred to the Ambulatory Care Unit where it was a different world. Very clean and comfortable. HornetJJ
  • Score: 4

11:56am Fri 14 Feb 14

D_Penn says...

It will be very good to get many people feeding their expreiences here. If there's a trend then we can see it.

Newbie's comment about feedback direct from the staff is an important example. As we all know one of the greatest issues these days is that any member of staff who raises an issue publically does not get thanked by management for their honesty. Usually they are rewarded with a P45.

If there are failings, let's get them out in the open. That's the only way that problems can be fixed. Then there will be no reason why we cannot have one of the best hospitals in the country.
It will be very good to get many people feeding their expreiences here. If there's a trend then we can see it. Newbie's comment about feedback direct from the staff is an important example. As we all know one of the greatest issues these days is that any member of staff who raises an issue publically does not get thanked by management for their honesty. Usually they are rewarded with a P45. If there are failings, let's get them out in the open. That's the only way that problems can be fixed. Then there will be no reason why we cannot have one of the best hospitals in the country. D_Penn
  • Score: 6

12:02pm Fri 14 Feb 14

TRT says...

The good news is that they've got lots more staph on the wards now.
The good news is that they've got lots more staph on the wards now. TRT
  • Score: 2

12:12pm Fri 14 Feb 14

garston tony says...

My last experience at the hospital was a few years ago and it seems nothing has changed really.

Most of the staff were great but on the ward especially obviously overstretched and we saw a few incidents where because of shortage of staff care wasnt at it should have been.

But the hospital itself was dirty, why such a basic and simple thing is not being done properly is beyond me. On one occassion we saw a cleaner 'cleaning' the floor in a long corridor by dragging a mop behind her as she slowly sauntered up and down its entire length texting the entire time! There were also stains of what seemed obviously bodily fluids on walls where it had not been cleaned off.
My last experience at the hospital was a few years ago and it seems nothing has changed really. Most of the staff were great but on the ward especially obviously overstretched and we saw a few incidents where because of shortage of staff care wasnt at it should have been. But the hospital itself was dirty, why such a basic and simple thing is not being done properly is beyond me. On one occassion we saw a cleaner 'cleaning' the floor in a long corridor by dragging a mop behind her as she slowly sauntered up and down its entire length texting the entire time! There were also stains of what seemed obviously bodily fluids on walls where it had not been cleaned off. garston tony
  • Score: 10

12:33pm Fri 14 Feb 14

D_Penn says...

There seems to be a long standing issue with keeping hospitals clean across the country. The core problem appears to reside where cleaning is contracted out. To win the business, cleaning companies often put in ridiculously low tenders which them means they cannot then deliver the required service.

Maybe a solution is to make cleaning company owners and directors responsible in law for hygiene. If a company fails an inspection it could be hit with unlimited fines and the management could face criminal prosecution in the worst cases. That would focus the minds on getting the job done and putting in a sensible tender when bidding for the business. I don't think you'd see cleaners texting on the job once the law was enacted!
There seems to be a long standing issue with keeping hospitals clean across the country. The core problem appears to reside where cleaning is contracted out. To win the business, cleaning companies often put in ridiculously low tenders which them means they cannot then deliver the required service. Maybe a solution is to make cleaning company owners and directors responsible in law for hygiene. If a company fails an inspection it could be hit with unlimited fines and the management could face criminal prosecution in the worst cases. That would focus the minds on getting the job done and putting in a sensible tender when bidding for the business. I don't think you'd see cleaners texting on the job once the law was enacted! D_Penn
  • Score: 3

1:17pm Fri 14 Feb 14

MazzieL says...

My husband was in WGH in June last year, admitted through A&E and then on a ward. I can honestly say it wasn't a good experience. The nurses who as we all know are on the front line of care were clearly overworked - each time I visited the hospital there was one nurse who was in tears. She was actually a fantastic nurse, I am not sure what was upsetting her so much, but it didn't bode well.

Throughout his stay I wasn't told his diagnosis and treatment options... whatsmore he was transferred to a London hospital in the middle of the night and I wasn't informed (despite leaving my contact details on multiple occasions.)

The hospital is old and dirty, which is a shame because I can tell that the staff want to make it as good as it can be, but in my humble opinion they need to get more staff and re-build.
My husband was in WGH in June last year, admitted through A&E and then on a ward. I can honestly say it wasn't a good experience. The nurses who as we all know are on the front line of care were clearly overworked - each time I visited the hospital there was one nurse who was in tears. She was actually a fantastic nurse, I am not sure what was upsetting her so much, but it didn't bode well. Throughout his stay I wasn't told his diagnosis and treatment options... whatsmore he was transferred to a London hospital in the middle of the night and I wasn't informed (despite leaving my contact details on multiple occasions.) The hospital is old and dirty, which is a shame because I can tell that the staff want to make it as good as it can be, but in my humble opinion they need to get more staff and re-build. MazzieL
  • Score: 5

1:49pm Fri 14 Feb 14

G_Whiz says...

garston tony wrote:
My last experience at the hospital was a few years ago and it seems nothing has changed really.

Most of the staff were great but on the ward especially obviously overstretched and we saw a few incidents where because of shortage of staff care wasnt at it should have been.

But the hospital itself was dirty, why such a basic and simple thing is not being done properly is beyond me. On one occassion we saw a cleaner 'cleaning' the floor in a long corridor by dragging a mop behind her as she slowly sauntered up and down its entire length texting the entire time! There were also stains of what seemed obviously bodily fluids on walls where it had not been cleaned off.
Ah, you have noticed that too - some of the contract cleaners do seem to be in a competition to see who can move the slowest - I know it's hard work, but we do need it to be done properly.

Incentives? Maybe they should be paid a bit more?
[quote][p][bold]garston tony[/bold] wrote: My last experience at the hospital was a few years ago and it seems nothing has changed really. Most of the staff were great but on the ward especially obviously overstretched and we saw a few incidents where because of shortage of staff care wasnt at it should have been. But the hospital itself was dirty, why such a basic and simple thing is not being done properly is beyond me. On one occassion we saw a cleaner 'cleaning' the floor in a long corridor by dragging a mop behind her as she slowly sauntered up and down its entire length texting the entire time! There were also stains of what seemed obviously bodily fluids on walls where it had not been cleaned off.[/p][/quote]Ah, you have noticed that too - some of the contract cleaners do seem to be in a competition to see who can move the slowest - I know it's hard work, but we do need it to be done properly. Incentives? Maybe they should be paid a bit more? G_Whiz
  • Score: 14

2:10pm Fri 14 Feb 14

D_Penn says...

@G_Whiz

You ask that maybe the cleaners should be paid a bit more?

Maybe, but low pay is not an excuse for not doing a job properly and putting people's lives at risk. How is it that with unemployment still high, lazy workers cannot be sacked and replaced with somebody who takes a bit of pride in doing an important, worthwhile job and doing it well?
@G_Whiz You ask that maybe the cleaners should be paid a bit more? Maybe, but low pay is not an excuse for not doing a job properly and putting people's lives at risk. How is it that with unemployment still high, lazy workers cannot be sacked and replaced with somebody who takes a bit of pride in doing an important, worthwhile job and doing it well? D_Penn
  • Score: 5

3:42pm Fri 14 Feb 14

TRT says...

D_Penn wrote:
@G_Whiz

You ask that maybe the cleaners should be paid a bit more?

Maybe, but low pay is not an excuse for not doing a job properly and putting people's lives at risk. How is it that with unemployment still high, lazy workers cannot be sacked and replaced with somebody who takes a bit of pride in doing an important, worthwhile job and doing it well?
It's finding one of those that's unemployed and willing to work for the same pay as someone who isn't.
[quote][p][bold]D_Penn[/bold] wrote: @G_Whiz You ask that maybe the cleaners should be paid a bit more? Maybe, but low pay is not an excuse for not doing a job properly and putting people's lives at risk. How is it that with unemployment still high, lazy workers cannot be sacked and replaced with somebody who takes a bit of pride in doing an important, worthwhile job and doing it well?[/p][/quote]It's finding one of those that's unemployed and willing to work for the same pay as someone who isn't. TRT
  • Score: 4

3:49pm Fri 14 Feb 14

G_Whiz says...

D_Penn wrote:
@G_Whiz

You ask that maybe the cleaners should be paid a bit more?

Maybe, but low pay is not an excuse for not doing a job properly and putting people's lives at risk. How is it that with unemployment still high, lazy workers cannot be sacked and replaced with somebody who takes a bit of pride in doing an important, worthwhile job and doing it well?
I can't argue with that!
[quote][p][bold]D_Penn[/bold] wrote: @G_Whiz You ask that maybe the cleaners should be paid a bit more? Maybe, but low pay is not an excuse for not doing a job properly and putting people's lives at risk. How is it that with unemployment still high, lazy workers cannot be sacked and replaced with somebody who takes a bit of pride in doing an important, worthwhile job and doing it well?[/p][/quote]I can't argue with that! G_Whiz
  • Score: 4

4:06pm Fri 14 Feb 14

garry.armstrong232@btinternet.com says...

SORRYB TO SAY THIS BUT ABOUT TIME BECUSE IT ALL TRUE THE NURSES ARE GREAT AS THERE ALL UNDER THE PRESUR AS FOR THE REST OF IT THE CLEANERS WELL YOU CANT CALL THEM CLEANERS SAME CLOTH FOR EVERY THING SAME WATER WHAT IV SEEN AN AS FOR PAPER WORK THATS UNDERSTANDERBULL AS THEY PUT IT DWON GET CALLED AWAY FOR GET TO PUT IT AWAY SO MISTAKES WILL BE MADE. BJUST ONE MORE THING IF ALL THE OTHER HOSPITALS WERE NOT CLOSED THIS WOULD NOT HAPPEN AN NURSES WOULD NOT BE UNDERSTRESSED WELL DONE NURSES AN DOCTORS
SORRYB TO SAY THIS BUT ABOUT TIME BECUSE IT ALL TRUE THE NURSES ARE GREAT AS THERE ALL UNDER THE PRESUR AS FOR THE REST OF IT THE CLEANERS WELL YOU CANT CALL THEM CLEANERS SAME CLOTH FOR EVERY THING SAME WATER WHAT IV SEEN AN AS FOR PAPER WORK THATS UNDERSTANDERBULL AS THEY PUT IT DWON GET CALLED AWAY FOR GET TO PUT IT AWAY SO MISTAKES WILL BE MADE. BJUST ONE MORE THING IF ALL THE OTHER HOSPITALS WERE NOT CLOSED THIS WOULD NOT HAPPEN AN NURSES WOULD NOT BE UNDERSTRESSED WELL DONE NURSES AN DOCTORS garry.armstrong232@btinternet.com
  • Score: -3

9:37pm Fri 14 Feb 14

Cuetip says...

HornetJJ wrote:
I was waiting in A&E last Sunday morning and it was very dirty. The staff were absolutely fine but the state of the place was disgusting. We were then transferred to the Ambulatory Care Unit where it was a different world. Very clean and comfortable.
The more people report unsatisfactory levels of care, the more chance something might be done and not 'simply'swept under the carpet'.
[quote][p][bold]HornetJJ[/bold] wrote: I was waiting in A&E last Sunday morning and it was very dirty. The staff were absolutely fine but the state of the place was disgusting. We were then transferred to the Ambulatory Care Unit where it was a different world. Very clean and comfortable.[/p][/quote]The more people report unsatisfactory levels of care, the more chance something might be done and not 'simply'swept under the carpet'. Cuetip
  • Score: 6

8:49am Sat 15 Feb 14

Johan_Cruyff says...

I have worked in the healthcare cleaning industry and it is an incredibly low margin business. Cleaning alone is probably no more than 1-2% GP. Companies now bu dle services together to gain more efficiency but it is not a business where anyone gets rich quick. As a result investment in training and support is non existent.. The NHS wants services outsourced because old NHS contracts for cleaning staff were ridiculous in terms of salary and conditions. The NHS has little budget so it is less about contractors putting in low bids, and more about what the hospital management will or actually will not pay.
I have worked in the healthcare cleaning industry and it is an incredibly low margin business. Cleaning alone is probably no more than 1-2% GP. Companies now bu dle services together to gain more efficiency but it is not a business where anyone gets rich quick. As a result investment in training and support is non existent.. The NHS wants services outsourced because old NHS contracts for cleaning staff were ridiculous in terms of salary and conditions. The NHS has little budget so it is less about contractors putting in low bids, and more about what the hospital management will or actually will not pay. Johan_Cruyff
  • Score: 1

10:16am Sat 15 Feb 14

D_Penn says...

If my earlier suggestion of making owners/directors of cleaning companies legally liable for the standard of cleanliness, the problem of the NHS paying too little would go away.

Why? Because at the moment there are always business chancers who think they can make money at the low price the NHS wants to pay. If they had to sign a contract that makes them potentially criminally liable for hygiene failings with the inherent implication of bankruptcy and imprisonment, nobody is going to risk that and the NHS would find that it has to pay more or have nobody to clean the hospital.

Well run cleaning businesses, who at the moment probably do not even bother to tender for NHS work, would welcome the legislation because they know that with better remuneration they could do the job properly.

The NHS management would be happier because they could be certain that the firm they use would be forced, by law, to provide a good service.

All of us would gain because we would have sparkling, clean hospitals.

All it needs is for a government with a bit of gumption and understanding of business to create and enact the law. Within a year I'll guarantee we'd have the cleanest hospitals in Europe.
If my earlier suggestion of making owners/directors of cleaning companies legally liable for the standard of cleanliness, the problem of the NHS paying too little would go away. Why? Because at the moment there are always business chancers who think they can make money at the low price the NHS wants to pay. If they had to sign a contract that makes them potentially criminally liable for hygiene failings with the inherent implication of bankruptcy and imprisonment, nobody is going to risk that and the NHS would find that it has to pay more or have nobody to clean the hospital. Well run cleaning businesses, who at the moment probably do not even bother to tender for NHS work, would welcome the legislation because they know that with better remuneration they could do the job properly. The NHS management would be happier because they could be certain that the firm they use would be forced, by law, to provide a good service. All of us would gain because we would have sparkling, clean hospitals. All it needs is for a government with a bit of gumption and understanding of business to create and enact the law. Within a year I'll guarantee we'd have the cleanest hospitals in Europe. D_Penn
  • Score: 1

7:44pm Sat 15 Feb 14

Johan_Cruyff says...

The problem with that idea is twofold. Firstly there is burden of proof. Who made it unclean and when? Actually many of the worst clean areas are those where there is the highest public use - the publics use and behaviours in those areas leaves a lot to be desired.
The second is cost. With risk of liability comes cost to avoid that liability so you wont get the cleaning at the price which is within the hospital budget. If you are prepared to pay more, then you will get better cleaning anyway so why the need for the liability?
The problem with that idea is twofold. Firstly there is burden of proof. Who made it unclean and when? Actually many of the worst clean areas are those where there is the highest public use - the publics use and behaviours in those areas leaves a lot to be desired. The second is cost. With risk of liability comes cost to avoid that liability so you wont get the cleaning at the price which is within the hospital budget. If you are prepared to pay more, then you will get better cleaning anyway so why the need for the liability? Johan_Cruyff
  • Score: 2

11:09pm Sat 15 Feb 14

D_Penn says...

The burden of proof is whether an inspection is passed. A dirty toilet on its own is not going to be a failure. There will be a contract and that will define what is a fail. If the fail is bad enough to be considered negligent then the legal system can be brought into play. The threat is a powerful one that would virtually ensure that a high standard of cleanliness would be maintained.

Liability costs in the NHS islargely a secondary issue largely created when the 'No win, no fee.' system produced a wave of claimants who could use the civil legal system to get money with no financial risk to themselves. It is a source of enormous drain on the NHS who often settle dubious claims for thousands to avoid litigation defence costs. The appalling system that has made lawyers rich should not have been brought in because the government of the time were warned that similar problems would arise to those created by the ambulance chasers which plague America. Those who advocated caution were ignored but have been proved right. The cure is to return to a system where people who sue for negligence can find themselves seriously out of pocket when they are simply trying to wring pound notes out of the NHS.

I challenge the assertion that just paying more will result in better cleaning. Using the carrot without having a stick will just mean that some firms will take a tender and still cut corners to boost profits. I promise that even the best tender system in the world would still fail to weed out all the swindlers, but the threat of legal action with teeth would.
The burden of proof is whether an inspection is passed. A dirty toilet on its own is not going to be a failure. There will be a contract and that will define what is a fail. If the fail is bad enough to be considered negligent then the legal system can be brought into play. The threat is a powerful one that would virtually ensure that a high standard of cleanliness would be maintained. Liability costs in the NHS islargely a secondary issue largely created when the 'No win, no fee.' system produced a wave of claimants who could use the civil legal system to get money with no financial risk to themselves. It is a source of enormous drain on the NHS who often settle dubious claims for thousands to avoid litigation defence costs. The appalling system that has made lawyers rich should not have been brought in because the government of the time were warned that similar problems would arise to those created by the ambulance chasers which plague America. Those who advocated caution were ignored but have been proved right. The cure is to return to a system where people who sue for negligence can find themselves seriously out of pocket when they are simply trying to wring pound notes out of the NHS. I challenge the assertion that just paying more will result in better cleaning. Using the carrot without having a stick will just mean that some firms will take a tender and still cut corners to boost profits. I promise that even the best tender system in the world would still fail to weed out all the swindlers, but the threat of legal action with teeth would. D_Penn
  • Score: 0

9:04am Sun 16 Feb 14

Johan_Cruyff says...

Well good luck with that but you get what you pay for alas. With risk comes cost to mitigate. When you look at cleaning of pharmaceutical manufacturing areas they are pristine. Clear standards with clear and rigid processes backed up with compliance measures, but it costs. If you want better hospital cleaning, set clear standards and specifications with enforcement and compliance rules but dont be upset when it costs a lot more.
Well good luck with that but you get what you pay for alas. With risk comes cost to mitigate. When you look at cleaning of pharmaceutical manufacturing areas they are pristine. Clear standards with clear and rigid processes backed up with compliance measures, but it costs. If you want better hospital cleaning, set clear standards and specifications with enforcement and compliance rules but dont be upset when it costs a lot more. Johan_Cruyff
  • Score: 1

11:27am Sun 16 Feb 14

Watfordhog says...

2001 my father went into WGH with a broken hip,caught MRSA & died.His treatment there was disgusting.Seems nothing changes.
2001 my father went into WGH with a broken hip,caught MRSA & died.His treatment there was disgusting.Seems nothing changes. Watfordhog
  • Score: 1

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