St George's University Hospitals NHS Foundation Trust is being placed in special measures after an inspection by the Care Quality Commission back in June found it lacking on a stream of safety and efficacy scores.
The number of trusts in England failing to hit efficacy standards now stands at 18, fuelling fears over the health service's ability to cope with demand particularly during the winter months.
A CQC inspection of the trust, which provides care to people at its St George's and Queen Mary's hospitals in London, found "a marked deterioration in the safety and quality of some of the trust services as well as to its overall governance and leadership".
Contributing factors for this deterioration include: neglect of buildings maintenance; failure to ensure the requirements of the fit and proper persons regulation had been implemented; and a leadership culture weighted towards achieving financial stability "which inadvertently impacted on the quality of services being provided," the watchdog noted.
An attitude of 'learnt helplessness' existed across the organisation, and both the chairman and chief executive recognised the need to improve staff engagement, develop a long term sustainable vision and strategy, and to re-introduce accountability and strong leadership across all divisions within the trust, it said.
On the safety side, a few of the problems highlighted were operating theatres not fit for purpose, inadequate fire detection systems, risk of water contamination, specifically legionellosis, due to ageing building, and variable adherence to infection control measures.
A failure to meet certain national standards was also a persistent issue, with the four-hour accident and emergency target, waiting times for diagnostic imaging within six weeks and outpatient appointments within 18 weeks, and the urgent two week referral target for patients with suspected cancer being missed.
The CQC did note that at the time of its inspection, the trust had introduced a range of supportive and recovery mechanisms as a means of stabilising the organisation, which included the appointment of an interim chair and chief executive.
Also, while the trust was rated as inadequate overall, good care was seen in several areas and some outstanding practice in maternity "for which clinical and support teams should be commended".
"Real progress has been made since June. However, as we've always said, there will be no quick fix to the problems we face," said Sir David Henshaw, interim chair at St George's.
"Many of these challenges are due to very poor Board and senior management decisions in the past, and a failure to tackle the big challenges head on. We owe it to our staff and patients to make St George's better again, and the CQC's report is a key part of this improvement journey."
Looking forward, the CQC says the trust must now develop a long term strategy and vision and move towards having a stable, substantive leadership team. It must also that all of its premises and facilities are safe, well-maintained and fit for purpose, and review and implement robust governance processes, "so that patients receive safe and effective care."