The colourful banners that greet visitors after they come through the main entrance to North Middlesex hospital, past the WH Smith and coffee shop, seem designed to reassure and impress. “Great Care … It’s in our nature,” they proclaim.
The north London hospital’s website is similarly upbeat. “These are exciting times at North Middlesex University hospital trust. We’ve modernised and grown, with over £200m of investment in our buildings and services over the last five years,” it boasts. It also promises “better, safer care every day of the week that meets the key NHS London quality standards”.
Located on the site of a 19th-century workhouse built to serve the destitute of Edmonton, Enfield and Hornsey, the first hospital buildings were established in 1909. In 2009 most of the ex-workhouse buildings were demolished as part of a redevelopment that included £123m spent on a new A&E, critical care unit and outpatients department. Today it looks modern and inviting, in stark contrast to the peeling paint and ageing décor of so many other hospitals.
Behind the scenes, though, North Middlesex is a hospital in crisis. Last week the Care Quality Commission slapped a warning notice on it after it staged an unannounced inspection in April. “It must make significant improvements in the quality of the healthcare it provides in the emergency department. The inspectors found that the treatment model for patients was not effective,” the NHS care regulator declared. Patients were not getting the care they needed, it added. The CQC’s full report, due by the end of June, is likely to make for grim reading.
The 2,800 staff at the hospital, in Edmonton in the outer north London borough of Enfield, are used to bad publicity, especially over its A&E unit. In August 2014, David Burrowes, the MP for Enfield Southgate, gave the Mail on Sunday a detailed account of how, despite arriving with a burst appendix, he ended up being left on a trolley for 12 hours in the “chaotic” A&E before finally having the CT scan he needed so staff could diagnose the problem.
“I now realise I could have died waiting so long to get my scan and operation. For six hours my wife, mother and a friend were being told ‘yes, yes, yes – he will be seen’. But they were being fobbed off. They found out I had not been booked in for a scan on the system. In the meantime I was on a trolley, in an A&E cubicle that doubled as a storeroom, curled up in pain,” the MP recalled. The hospital apologised to Burrowes and explained that he had arrived during a three-day period when it had faced unusually heavy demand for care, which had caused “exceptional challenges which resulted in delays in A&E treatment”.
In February it made headlines again when the emergency department got so busy one Friday evening that, with more than 100 patients waiting to be seen, a PA announcement implored people to “please go home unless you have a life-threatening illness”. Most days about 500 people come to what is one of the biggest and busiest emergency departments in London.
Last Friday at noon, seated around two vending machines displaying “out of order” signs, about 20 people from a cross-section of London society waited to be seen in the A&E. There were a few babies, though the average age was closer to 60. A television screen on the wall said the waiting time for all but the most urgent cases was three hours.
Less than an hour later, the numbers waiting had more than doubled, leaving little space on the rows of plastic chairs before the traditional Friday night influx. A sign on the wall advised people to use the urgent care centre at nearby Chase Farm hospital for any medical treatment or advice that did not require them to be in A&E.
The downgrading in late 2013 of what had been a fully fledged A&E unit at Chase Farm to an urgent care centre, despite a huge campaign of opposition, led to a 20% increase in the number of sick people seeking treatment at the North Middlesex. Many are from deprived and ethnically diverse parts of the boroughs on Enfield and Haringey, which brings particular challenges.
Outside the A&E, a woman who had presented with her infant son said she had been happy with the facilities and conditions there, including a separate waiting area for people with children. But she added: “There was a man with his son who had been waiting for quite a while and he was told that he would have to make his own way over to Chase Farm instead because of some service that they lacked here. He wasn’t too happy.”
Comments about patients’ experience at North Middlesex posted on the NHS Choices website show how care there can be excellent or very poor. One woman who had recently given birth there gave its maternity unit five stars, saying “everything felt very human and we were treated like more than just another number”. However, another gave the same unit just one star and complained that the midwives did not help to speed up her labour because they were close to the end of their shift, and that staff forgot to give her baby an antibiotic.
While 91% of patients using any of the hospital’s services said they would recommend it to friends and relatives, only 49% of the 2,812 commenters who had used its A&E said the same. A poster called “Zoom77” related how he had arrived there one day last month with a broken foot, had to hobble over to collect a form to fill in, then waited three hours to see a triage nurse, and had to come back the next day to have an X-ray. After finally getting a moonboot and crutches, he was given no advice on how to use them. “Thanks North Mid, you’re crap,” he wrote.
The hospital says its A&E problems are due to a chronic lack of doctors, which has led to some patients enduring with what the chief executive, Julie Lowe, admits are unacceptably long waits to be treated. “The key issue is the availability of consultants and their willingness to work in a busy A&E department that is not a designated trauma centre in a high-cost area of outer London,” a hospital spokesman said.
But unpublished internal NHS briefing papers suggest the North Middlesex’s problems are more complex. They say there has been “a bullying culture” which has not yet been eradicated, despite various initiatives. A longstanding lack of proper education, training and supervision of junior doctors has prompted talented medical graduates to pursue their careers elsewhere.
A spokesman for the hospital said: “Where concerns have been raised we always investigate full. We have recently adopted a bullying and harassment resolution pathway to support this important work.”
The documents make clear a lack of belief among bodies such as the General Medical Council and Health Education England that the hospital can be turned around under its current leadership.
