15th Jul, 2020

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

Ross Crawford 13th Feb, 2020

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

Prompted by patient safety concerns, CQC undertook focused inspections of the A&Es on 16 December 2019. Inspectors found people waited too long for assessment and treatment.

They also found patients were treated on corridors too frequently, and not referred to specialists quickly enough.

Following the inspection, CQC rated the departments Inadequate.

Both departments were previously rated Requires Improvement, following a comprehensive inspection in May 2019.

CQC also took action to protect people by imposing conditions on the provider’s registration.

This included requiring 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 also requires dynamic risk assessments of patients in the department – involving increased observations – so people receive timely referral to the most appropriate clinical area.

A third condition requires reduced patient waits for medical or surgical escalation.

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 over 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 told it must:

• 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.

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