We undertook this focused inspection to follow up on the concerns identified in two Section 29A Warning Notices served in July 2018, following an inspection of the trust in June 2018. We Judged that the requirements of the warning notice had been met. The warning notices set out the following areas of concern, where significant improvement was required:

In maternity there were several concerns which we listed in our warning notice:

• We were not assured that there were robust systems in place to ensure that all the correct staff were bleeped on an ongoing basis.

• We were not assured that there was a system in place to ensure that the correct staff were bleeped at all times.

• We were not assured that systems were in place to ensure that unauthorised persons could not gain access to the maternity surgical theatres via use of the staff/theatre lift.

• We observed that the doors to the delivery suite from the theatres were not controlled by a secure access system.

• We were notified that the main doors to the maternity unit could be forced opened, allowing unauthorised persons to enter the building.

In critical care we found two concerns, which we listed in our warning notice:

• We were not assured that there were sufficient handwashing facilities to mitigate the risk of cross-contamination.

• We were not assured that the beds within critical care were appropriately located to enable staff to perform emergency lifesaving care and treatment.

Our key findings were as follows:

In maternity we found:

• Several improvements had taken place since the comprehensive inspection report published in August 2018.

• The main security issues in maternity had been addressed.

• The maternity service had installed new outer main doors which could not be opened by force.

• The estates team reconfigured the lifts in maternity to prevent public access into the theatres corridor.

• New doors had been installed between the delivery suite and theatres to improve the overall security within the maternity department.

• Access to the building and in particular to the delivery suite was controlled by 24 hour receptionists in the delivery suite who were able to monitor visitors via security camera.

• Security staff told us that they patrolled the building regularly to check on and remove any unauthorised persons who may have gained access to public corridors.

• A member of the estates team told us that they were continuing to review security systems in this area of the trust to see what further improvements could be made.

• Switchboard tested the bleep system twice a day and recorded and acted upon the outcomes.

However, there were also areas of poor practice where the trust needs to make improvements.

• All information to the public regarding tailgating, which lifts to use and the closing times of the maternity link corridor was in English only. Senior staff we spoke with told us that work was in progress to get the signs translated into up to 3 other commonly spoke languages.

• It was still possible, because of the need to ensure safe evacuation of the building for members of the public to allow access to the building by pressing an access button. This was mitigated by the secure access systems into the maternity unit itself.

• There was no nominated list of relatives or friends or equivalent that an expecting mother could set up to control the people visiting the maternity department.

In critical care we found:

• The removal of two beds in critical care and the repositioning of the remaining furniture to allow staff to deliver emergency lifesaving care and other treatment effectively was completed promptly and efficiently.

• Additional hand washing facilities have been inserted into critical care to mitigate the risk of cross contamination.

In addition the trust should:

• Continue to ensure robust security measures are in place across the trust.

• Look at further ways of verifying and controlling people entering and exiting the maternity department building.

Professor Edward Baker

Chief Inspector of Hospitals

Our rating of services stayed the same. We rated it them as requires improvement because:

• We rated caring at Northwick Park hospital as good. We rated safe, effective, responsive and well-led as requires improvement.
• Critical care improved from requires improvement to good.
• Maternity went down from requires improvement to inadequate.
• Urgent and emergency services, medical care, surgery and children and young people’s services remained as requires improvement.
• We rated well-led as inadequate in medical care and maternity.
• We rated safe as inadequate in maternity services.