17th Feb, 2020

CQC takes action after inspection finds local A&E department 'Inadequate'

Ross Crawford 13th Feb, 2020 Updated: 13th Feb, 2020

THE Care Quality Commission (CQC) has used its urgent enforcement powers to protect people using Accident and Emergency at the Worcestershire Royal and the Alexandra Hospital in Redditch, following inspections which rated them inadequate.

Prompted by patient safety concerns, the watchdog visited both A&Es on December 16 and found patients waiting too long for treatment. They also found patients were treated on corridors too frequently and not referred to specialists quickly enough.

Health chiefs took action to protect people by imposing conditions on the provider’s registration. This included requiring a clinical assessment of all patients arriving at Worcestershire Royal Hospital’s emergency department by ambulance within 15 minutes, ensuring the sickest patients are quickly identified.

CQC bosses have also asked for dynamic risk assessments of patients in the department – involving increased observations – so people receive timely referral to the most appropriate clinical area and have demanded a reduction in the wait for further treatment for patients

CQC chief inspector of hospitals, Professor Ted Baker, said: “Our latest inspection of emergency departments at Worcestershire Royal Hospital and Alexandra Hospital found patients waited too long for assessment and treatment.

“At Worcestershire Royal Hospital, the trust failed to meet national standards requiring clinical assessment of 95 per cent of ambulance-conveyed patients within 15 minutes of arrival. Some people brought by ambulance waited more than three hours before being handed over to trust staff for care and treatment.

“The trust recognised an increase of patients sustaining pressure damage while waiting in Worcestershire Royal Hospital’s emergency department.

“It had taken action however, patients remained on trolleys for extended periods, due to lack of space in the department for them to be transferred to a more appropriate hospital bed.

“Overcrowding was our biggest concern in Alexandra Hospital’s emergency department. The layout of the department and too few cubicles led to it becoming overwhelmed quickly, posing a risk to patient safety.

“Underpinning the issues in both departments was a lack of capacity and capability in the trust and wider health system. CQC has raised these issues since 2015, but the response so far has been insufficient and new improvement plans have not been progressed enough to take effect.

“However, in both departments we saw professional and caring staff who remained cheerful and engaged with patients, even when working under pressure. Interactions were positive and respectful. Leaders and staff were committed to driving improvements to keep people safe and to improve patient experience.

“Following the inspection CQC used its urgent enforcement powers, requiring the trust to ensure timely assessment and treatment. The trust’s board knows it must deliver these essential improvements.

“We continue to monitor these departments and the wider trust, including through further inspections.”

The trust has been given a list of things it must do, including:

• Ensuring ambulance handovers are timely and effective.

• Assessing all patients in a timely manner, and ensuring assessment and treatment takes place in appropriate environments.

• Ensuring patients receive timely medical and specialty reviews.

• Providing consultant and nurse cover that meets national guidelines, with trainee consultants not being classed as ‘consultants’ on rotas.

• Fully implementing trust-wide actions to reduce overcrowding.

• Maintaining patient privacy and dignity.

THE CHIEF Executive of Worcestershire Acute Hospitals NHS Trust has apologised to patients for the trust’s failure to tackle A&E waiting times at the Royal and the Alexandra Hospital.

In a statement following the publication of the CQC report, Matthew Hopkins said patients were waiting too long despite the ‘enormous efforts of staff, alongside GPs, community staff and social care’

“We know some patients are still waiting too long to get into our Emergency Departments or are spending too long in the Emergency Departments waiting to be moved onto a ward. On behalf of the Trust and all of our partners across the county, we apologise for this,” he said.

“This is yet another reminder of why it’s so important that every organisation in our local health and care system is working together to close the gap between the capacity we have to care for patients who need urgent or emergency care and the growing number of people in need of that care.

Mr Hopkins highlighted the praise for A&E staff in the report for their compassion, team work and resilience despite working in extremely difficult conditions.

“We know there is more our Trust has to do and we are absolutely committed to doing it,” he said.

“Since the CQC visit we have, for example, increased the number of nurses in A&E at the Alexandra and Worcestershire Royal Hospitals and increased the number of senior doctors working in our Acute Medical team in the afternoons and evenings at Worcestershire Royal.”

Mr Hopkins hailed the launch of the Onward Care Teams (OCTs) at both sites to bring together social care staff, community nurses and discharge nurses and the long-awaited 33 new beds at the Worcestershire Royal available from next week.

“The OCTs work closely with our ward teams to ensure patients who no longer need an acute hospital bed are able to go home, or wherever they call home, or move on to another care setting, in a safe and timely way,” he said.

“We will continue to work hard to support our A&E teams but this is not a problem they can solve without our support and the continuing active involvement of the whole of our health and care system.”

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