NHS regulator the Care Quality Commission (CQC) has identified significant areas of good and outstanding practice at the Royal Free London NHS Foundation Trust (RFL) despite a fall in its overall rating.

The RFL has been rated as ‘good’ in three of the five domains inspected by the CQC which asks five questions about services: Are they safe? Are they caring? Are they effective? Are they well-led? Are they responsive to people’s needs?

The RFL received three ‘good’ ratings for being effective, caring and well-led. Inspectors found that services were safe and responsive however they said improvements were required in these areas.

The trust remains one of the safest in the NHS with mortality rates among the lowest in the country. Under the care of the RFL, 25 patients every month survive who would not at other hospitals.

Across the RFL’s three main hospitals – Barnet Hospital, Chase Farm Hospital and the Royal Free Hospital ­– 108 ratings were given with the trust receiving a total of 89 ‘good’ scores and 19 ‘requires improvement’.

However, following the inspection in December 2018, the overall rating for the RFL fell from ‘good’ to ‘requires improvement’.

Caroline Clarke, chief executive of the Royal Free London group, said: “While we are obviously disappointed, it was only a fine margin which prevented us from maintaining our ‘good’ status.

“We recognise we have to improve and will not shy away from the reality that our performance has not been good enough in some areas – for example when it comes to waiting times and stamping out bullying. These are areas on which we were focussing before the CQC’s routine inspection and I am confident progress is already being made. 

“One thing the CQC was absolutely clear about was the commitment and pride they saw in our staff who are among the best in the NHS. Our patients agreed, telling inspectors they were treated with kindness, compassion, patience, dignity and respect.

“The CQC also recognised the commitment of the RFL to innovate, learn and improve. All of these ingredients fill me with optimism for the months and years ahead. Our ambition has always been to become a trust with an ‘outstanding’ rating and that has not changed.”

Inspectors identified a number of areas of outstanding and good practice stating: “We found a strong organisational pride and culture of collaboration, team-working and support with a focus on improving the quality and sustainability of care and people’s experiences. Staff were proud to work for the Royal Free London and spoke highly of the leadership team.”

The CQC report found:

  • Staff treated patients with kindness, dignity and respect
  • Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes
  • There is a clear commitment to improving services by learning, promoting training, research and innovation
  • The organisation is well-led, the majority of staff felt well supported by managers who encouraged effective team working
  • The organisation is credited for being a ‘sector leader’ prepared to support other NHS organisations and put wider patient interests before its own.
  • Services managed patient safety incidents and controlled infection well
  • ‘Speaking up champions’, introduced to help stamp out bullying were positive and proactive

Areas identified as needing improvement included:

  • Some of the issues identified during the previous inspection, which impacted on the safety and responsiveness of services, had not been addressed
  • Mandatory training for staff in key skills, including safeguarding, fell below the trust’s target for compliance
  • Staff did not consistently follow best practice when prescribing, giving, recording, storing and disposing of medicines
  • Services did not always have sufficient numbers of staff, with the right mix of qualifications and skills, to keep patients safe and provide the right care and treatment
  • While the majority of staff felt the culture of the organisation had improved and described the leadership team as accessible and supportive, there remained a culture of bullying within the operating theatres
  • There were long waiting times in A&E and waiting times from referral to treatment and decisions to admit patients were not always in accordance with best practice recommendations

CQC’s Deputy Chief Inspector of Hospitals, Nigel Acheson, said: “Although The Royal Free London NHS Foundation Trust’s rating has fallen from ‘good’ to ‘requires improvement’, there is much still to be proud of at the trust, including some outstanding practice.

“The trust was rated ‘good’ in three of the main categories that we rate, though it was let down in the safe and responsive areas. We want to see improvements quickly and the CQC will monitor the areas where the trust is not doing so well.”

Caroline Clarke added: “The past two years have been a period of great change for the Royal Free London. We are one of only four trusts in the NHS selected to implement a ‘group model’; we have opened the brand new Chase Farm Hospital on time and on budget; and we have implemented a new electronic patient record faster than any other trust.

“All of this has been achieved successfully and safely. Now it’s time to consolidate and turn our attention to making sure we get the basics right. This report will help us focus our attention on some key areas where we know we need to improve and we look forward to inviting the inspectors back in the near future to show them just how much progress we have made.”