The Telegraph News 6 JULY 2016 Cristina Criddle
A hospital’s chief executive has “secretly quit” after a patient reportedly lay dead for up to four-and-a-half hours before being discovered at an A&E unit.
The emergency department at North Middlesex University Hospital, one of London’s busiest, has been ordered to make improvements after regulators found that there were not enough doctors to meet demand.
Inspectors with the Care Quality Commission (CQC) rated the hospital’s urgent and emergency care services as “inadequate”.
Staff at the hospital told inspectors they were worried about patient safety because of the competency of middle-grade doctors. These doctors were often left in charge of the emergency department overnight – with no consultant presence in the department after 11pm,inspectors were told.
The hospital’s chief executive, Julie Lowe, is believed to have secretly quit following the findings.
Staff have said Ms Lowe is on “leave” but a source inside the hospital claimed she was, in fact, ousted by NHS chiefs appalled at her leadership.
The hospital was given a surprise inspection in April after staff put out a tannoy announcement in February telling patients to go home unless they were “dying”.
Inspectors also found vital equipment, including a portable resuscitation trolley, was often missing or broken.
Walk-in patients were seen by a receptionist, who judged if they were suitable for the urgent care centre or needed to go to the main emergency department, according to the CQC’s report.
The unit logged 22 serious incidents in the past year, the BBC reported, including the failure to discover the dead patient.
Others included a patient being left sitting on a bedpan for more than an hour, the broadcaster reported.
In August 2014, David Burrowes, MP for Enfield Southgate, told the Mail on Sunday how, despite arriving with a burst appendix, he was left on a trolley “curled up in pain” for 12 hours in the “chaotic” A&E before being treated.
The MP said he was “dismayed but not surprised” by the report.
“Whilst I recognise that the hospital has now turned the corner with new clinical leadership and consultants and doctors, it has taken far too long to respond to the siren calls made for over two years,” he added. “It is hugely disappointing that the CQC has found that the A&E has got worse since 2014.”
He said his constituents had been let down and said assurances of support must be “urgently delivered”.
The report added: “Members of staff told us there was a culture of not calling consultants out at night. They said that middle grade doctors seemed to assume that it was acceptable to leave patients in ED (emergency department) overnight, thus treating it as if it were a hospital ward.”
Meanwhile nurses told inspectors they spent a “substantial amount of time supporting and advising more junior doctors”.
In recent weeks it has emerged that the General Medical Councilissued preliminary warnings to North Middlesex Hospital leaders because of a lack of training for junior doctors.
Sir Mike Richards, CQC’s chief inspector of hospitals, said: “People going to the emergency department at the North Middlesex University Hospital NHS Trust are entitled to a service that provides safe, effective, compassionate and high quality care. When we inspected we found that patients were waiting for a long time to be seen, without being assessed by a doctor in the first place.
“North Middlesex University Hospital is one of the busiest A&E departments in London – so it is worrying that we found that there were not enough experienced doctors on call to deal with demand. We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue.”
He added that a new leadership team was in place and the trust has called on consultants from within the hospital to provide routine daily support to A&E.
“The evidence from our latest inspection last week is that North Middlesex’s emergency department has turned a corner, but there is still much more that needs to be done. We will be watching their progress very closely,” he added.
North Middlesex University Hospital said it would receive support in making further improvements in A&E from the Royal Free London NHS Foundation Trust.
“Chief executive Julie Lowe is currently on leave,” the hospital added in a statement.
“In her absence, Libby McManus, currently at the Royal Free London NHS Foundation Trust and previously the interim chief executive at Chelsea and Westminster Hospital NHS Foundation Trust, has agreed to take on the role of interim chief executive at North Middlesex from Thursday July 7, with David Sloman, chief executive of the Royal Free, taking on the role of accountable officer on an interim basis.”
Dr Cathy Cale, the North Middlesex University Hospital medical director, said: “We are extremely sorry for the current problems in A&E and for the long waiting times for some patients.
“We are committed to getting back to the standards that we and our patients expect and, working with our health partners, are taking all the necessary steps to address the concerns raised, particularly the shortage of doctors which lies at the heart of it.”
In a joint statement, Niall Dickson, chief executive of the General Medical Council (GMC), and Professor Ian Cumming, chief executive of Health Education England (HEE), said: “Significant concerns have been raised about the care provided in the emergency department at North Middlesex University Hospital Trust and about the lack of proper support for and supervision of doctors in training.
“We are pleased to see that a number of key improvements have already been made and a programme of further measures is being put in place over the next few weeks.”
Accepting “there is more to be done” to cope with pressure, they added:
“In the meantime the GMC and HEE – the two organisations responsible for postgraduate medical training – have placed conditions on the continuation of medical training posts in the emergency department and the situation will be closely monitored with daily rigorous checks.
“We have made it clear that we will not hesitate to act if we consider patients or staff are being put in unsafe situations.”
Julie Lowe has been approached for comment.
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