South-east London hospital's A&E 'not fit for purpose'

Inspectors said the Queen Elizabeth Hospital requires improvement

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A London hospital's accident and emergency department (A&E) has been declared "not fit for purpose" by hospital inspectors.

The chief inspector of hospitals in England found that the department at the Queen Elizabeth Hospital, in Woolwich, was inadequate.

A report looked into the quality of services at two hospitals in the Lewisham and Greenwich NHS Trust.

The trust said it was developing an "action plan" to tackle the issues.

Exceeded waiting times

The summary of the report by an inspection team led by Dr Nigel Acheson of NHS England said: "On the Queen Elizabeth site the A&E environment is not considered by the inspecting team to be fit for purpose.

"Following admission via A&E, delays in access to investigation were witnessed, and also delays in accessing specialist internal opinion and by external transfer to specialist units."

Waiting times regularly exceeded the government's waiting target, the report found.

Inspectors also said that capacity in the department was limited and there was a heavy reliance on agency staff which led to delays in further investigation.

Chief inspector of hospitals, Professor Sir Mike Richards, acknowledged that the trust was "relatively new" as it was created following a merger in October 2013.

"The biggest problem here is in the A&E at Queen Elizabeth Hospital, which we have rated as inadequate," he said.

"Waiting times there regularly exceed the four-hour target, there isn't enough space for the number of people using the service, and the patient pathway from A&E to the ward doesn't work as well as it should."

Lewisham Hospital Inspectors made unannounced visits to University Hospital Lewisham

In a statement, the Lewisham and Greenwich NHS Trust, said: "While much progress has already been made, we have lots to do and over the next month we will be developing an action plan in response to all the issues highlighted by the Care Quality Commission (CQC)."

Overall the Queen Elizabeth Hospital was rated as requires improvement, with its maternity and family planning services being declared good.

'Lack of staff'

The reports released by the CQC also covered University Hospital Lewisham, which was rated as requiring improvement overall.

Its intensive and critical care and children's care was rated as good.

CQC inspectors made both announced and unannounced visits to the sites and spoke with members of staff and the public.

In some wards, patients told inspectors they felt there was a lack of staff as it could take up to 30 minutes for call bells to be answered, the report said.

The trust was told it must make improvements in a number of areas, including ensuring that it had enough staff members to allow them to work safely and effectively, as well as reviewing the capacity and constraints for accident and emergency departments.

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    Det Ch Insp Andy Chalmers said: "During this investigation I found out a lot about what Alice was like as a person. She was a bright, talented young girl.

    Alice Gross

    "Those who loved and knew her talked of her beauty inside and out and the spark she had."


    Her body was weighed down with bricks tied to a bicycle wheel and logs which were so heavy that the fire brigade required heavy lifting equipment to remove them.

    Log used to weigh down her body

    Alice was found naked and tied up.

    Where Alice was found

    Her body was found in chest high, still water with a thick layer of sentiment. She was discovered under low lying branches and thick foliage that formed a canopy over her hidden body.


    The Met said Latvian authorities confirmed to them on 11 September his murder conviction.

    As the force had still not ascertained his whereabouts by 16 September, a public appeal for his whereabouts was made.

    By 17 September, officers had identified him on the CCTV footage as being in the area when Alice went missing.

    The next day he was named as a suspect.


    As the Met releases CCTV images of Zalkalns' last known movements in 4 September, the force has revealed that he was reported missing by his partner on 5 September.

    Homicide Command, the team that was investigating Alice's disappearance, was informed of his disappearance on 8 September.

    Last sighting of Zalkalns

    Inquiries were sent off to Latvia via Interpol to establish his history.


    In this video report by Robert Piggot that was made days before Alice's body was discovered, Zalkalns' mother-in-law warns that he is a dangerous man.

    Viktorija Zalkalne

    More information about Zalkalns' arrest in 2009 over an alleged indecent assault on a 14-year-old girl has been released.

    • It is said to have happened near to Grand Union Canal in Boston Manor
    • Police say the allegation was "thoroughly investigated" but the complainant declined to support the prosecution so Zalkalns was not charged
    • No checks were made to see if he had any overseas convictions because it was not the Met's policy to do so
    • Detectives say even if the conviction was known about, it would not have altered charging decision
    • Police say it's "very unlikely" Zalkalns would have been deported had conviction been known about

    Here is the CCTV footage that the police have released of Zalkaln and Alice's movements on the day she was killed.

    Arnis Zalkalns

    Alice's inquest has been put back and will now not take place as planned on Thursday.

    A new date has yet to be fixed.


    The family said they were also "astonished" by the continuing support for Alice's Youth Music Memorial Fund. So far £17,000 has been raised.

    Family picture of Alice with her father, mother and sister

    "We are planning to hold a music event in the summer as a celebration of Alice's life and passion for music.

    "We also hope that in time an annual event can be launched to promote opportunities for young musicians, in tribute to Alice's aspirations."


    Alice's family said although they now have certain information as to how she died, they still had unanswered questions on what the authorities knew or should have have known about when Zalkalns came to the UK.

    "Alice believed in the free movement of people and so do we. For her sake we are determined to ask these questions responsibly and sensitively.

    "For that reason we have asked Liberty to help us and we look to the forthcoming inquest into Alice's death to help us find answers to these questions."


    The general labourer, who worked at a building site in Isleworth, west London, is thought to have come to the UK in 2007.

    He served seven years in prison doe murdering his wife Rudite Zalkalns.


    Latvian court documents about the 1998 murder case reveal a psychologist assessed Zalkalns as being mentally stable and said he knew exactly what he was doing when he murdered his wife and buried her in a shallow grave.

    Arnis Zalkalns

    In a confession Zalkalns - an experienced welder who took his wife's surname - told police he made a metal pole and an eight-inch knife, which he used to hit and stab her.


    Who was Arnis Zalkalns?

    In this profile on the Latvian builder, he was described as a "threat to society" by his mother-in-law. He had bludgeoned and stabbed his wife Rudite to death in 1998.

    Arnis Zalkalns and his wife who he murdered

    Viktorija Zalkalns said: "A person like that is sick. He should be put into a hospital."

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    In a statement, Alice's family thanked the local community in west London for their support.

    "Hanwell is a multi-cultural and multi-faith area; the search and grief for Alice united the whole community in an extraordinary display of sympathy and compassion, and this has continued.

    "We are very grateful."


    Alice's iPhone case was found in a narrow void at the rear of Zalkalns' garden.

    Alice with her phone

    Officers said while it is not possible to positively identify it by reference to a serial number, as it does not have one, Alice's sister is confident it is hers.


    Her body was found on 30 September here in the River Brent.

    Place where Alice's body was found

    Alice's trainers were found in her rucksack which was along the canal path.

    Traces of Zalkalns' DNA were found on the back of the shoes.

    Trainers and backpack

    Alice's body was weighed down in the water with a wheel, bricks and logs.

    Bricks and logs used to weigh down Alice's body

    At the press conference, Det Ch Insp Andy Chalmers said: "Boy do I wish we found her [Alice] earlier".

    Her body was found in the River Brent just over a month after she was last seen.


    His body was found here in Boston Manor Park on 4 October.

    Boston Park

    CCTV evidence suggested Zalkalns would have passed Alice on the towpath at about 16:10 on 28 August, when he stopped for at least 80 minutes, police said.

    CCTV of Alice Last sighting of Alice

    When he reappeared on camera, his appearance indicated he might have been in the water.


    The Met Police has released images of the last sighting of Zalkalns.

    Arnis Zalkalns

    Here he was visiting a newsagents several days after he was alleged to have murdered Alice.


    CCTV timeline:

    • The last known sighting of Alice is of her walking north at 16:26
    • The last connection between her phone and a cell mast was at 16:28
    • Her phone disconnected from the network at 17:11
    • Zalkalns would have overtaken Alice on the tow path at about 16:10
    • CCTV suggests he must have stopped for at least 80 minutes, and when he reappeared on camera his appearance indicated that he may have been in the water
    • Zalkalns returned to the tow path that evening, the following morning - when there is a significant period of time unaccounted for- and again on the evening of 29 August.

    Here's a recap of the key points which have come out of today's press conference with the detective in charge of the investigation.

    • The single DNA sample from Alice's skin "strongly supports" a match to Zalkalns
    • Zalkalns returned to the tow path near Alice's body three times
    • Police say even if they had known earlier about Zalkalns' murder conviction in Latvia it would not have saved Alice

    For more details, see the BBC News report.

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    Det Supt Carl Metha tells BBC London 94.9 they are confident the Latvian builder was responsible for Alice's murder last year.

    In the 11:00 bulletin, he describes some of the evidence they found against Zalkalns.


    Det Ch Insp Andy Chalmers said: "I believed it was important for the CPS to assess the evidence that the investigation team had found against him (Zalkalns) to reassure Alice's family and the community, who were so affected by her disappearance.

    "The public support for our investigation in the local community was overwhelming.

    "I hope that the CPS's decision that, if he was alive, Zalkalns would have been charged with Alice's murder will in some way help the community come to terms."


    Police also revealed that Zalkalns had returned twice to the area where Alice was last seen and had searched her name online as reports of her disappearance emerged.


    The family added: "Although we now have certain information about how Alice died, we are still left with some serious unanswered questions about what the authorities knew or should have known about the man who is believed to have killed our daughter when he came to the UK."


    In a statement today, Alice's family said: "It remains impossible to describe the pain of losing Alice. Her death has left a hole in our lives that can never be filled.

    Alice's family Alice's father Jose, mother Rosalind Hodgkiss and sister Nina Gross

    "Every day is a reminder of her life and her loss, and it is hard to imagine a future in which we can find peace and healing.

    "Her brutal murder remains shocking, an appalling senseless act that is still difficult to believe or understand."


    Arnis Zalkalns was first linked to Alice's disappearance after he was filmed cycling along Brentford Lock canal towpath shortly after the school girl walked along it.

    Arnis Zalkalns

    Key points:

    • At a press conference held today, the Met said the key suspect in her disappearance, Arnis Zalkalns, would have been charged with Alice Gross' murder
    • His body was found hanged in a park several days after the 14-year-old's body was discovered
    • Police said the motive for her death was "most likely sexual"
    • Alice went missing on 28 August near to her home in Hanwell, west London
    • She died from compression of the chest
    10:17: Danny Shaw Home affairs correspondent, BBC News

    Alice's body weighed down with bricks, sections of tree trunks, covered with branches. The bag used to conceal her body matched the next bag on roll from Zalkalns' workplace.


    Although police think the motive was sexual, there was no evidence that she was sexually assaulted, said BBC London reporter Nick Beake who is at the press conference.

    10:01: News on the hour BBC London 94.9 Radio

    Get the latest from the press conference on Alice Gross with reporter Anna O'Neill in the 10:00 bulletin.


    Her cause of death was given as compression of chest probably caused by a heavier body lying on and crushing her weaker body.

    The conclusion was reached by a process of elimination as no other obvious marks or injuries were found on her body.


    Her cause of death was "compressive asphyxia".

    Alice Gross
    09:39: Danny Shaw Home affairs correspondent, BBC News

    Police say even if they'd known earlier about Mr Zalkalns' murder conviction in Latvia it would not have saved Alice.


    No-one else was involved in Mr Zalkalns' death. He was found hanged in woodland in Boston Manor Park, near Hanwell, on 4 October.

    Check BBC London's timeline for more details of how Alice's murder.


    Her disappearance captivated the local area, with yellow ribbons and flowers adorning Hanwell throughout her disappearance.

    Flowers and messages of condolence besides the clock tower in Hanwell

    Det Ch Insp Andy Chalmers said the motive for her death was "likely sexual".

    The scientific evidence does not link him directly to her death but evidence as a whole would have been enough to charge him with abduction and murder.


    BBC London's Nick Beake tweets: "Graphic: Alice Gross's body was wrapped in bin bag and weighed down with bricks, logs and a bicycle wheel."


    At a news conference, the Met also said there was no evidence to suggest Mr Zalkalns was responsible for any other reported crime.

    Arnis Zalkalns

    But the 41-year-old Latvian builder was a convicted murderer who had served seven years in prison in his native country for bludgeoning and stabbing his wife Rudite to death.


    The police think Alice was murdered before she was reported missing on 28 August. Her body was found on 30 September.

    09:16: Alice Gross Danny Shaw Home affairs correspondent, BBC News

    The iPhone cover thought to belong to Alice was found hidden in Mr Zalkalns' garden while a cigarette butt with his DNA on was discovered close to her body.

    09:15: Alice Gross

    Alice's disappearance sparked what the Met said was its largest inquiry since the 7/7 bombings in 2005.

    Alice Gross

    Hundreds of officers from several forces around the country helped with the investigation. She was last seen walking along a canal near her home in Hanwell, west London, at the end of August.

    Her body was found more than a month later.


    The CPS says it would have charged Mr Zalkalns if he had been alive although there was no forensic or eyewitness evidence, only circumstantial.


    The Met Police have sent a report to the Crown Prosecution Service saying Arnis Zalkalns was responsible for the murder of 14-year-old school girl Alice Gross.

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