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.
Responding to the CQC report, Matthew Hopkins, Chief Executive of Worcestershire Acute Hospitals NHS Trust, said: “Despite the enormous efforts of our staff, alongside GPs, community staff and social care, we know that 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.
“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.
“Although the focus of this report is on our Emergency Departments (EDs), to resolve many of the difficulties that it highlights will require the active involvement of teams across our hospitals and in our partner organisations.
“Our ED staff are rightly praised 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.
“Since the CQC visit we have, for example, increased the number of nurses in our EDs 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.
“We are continuing to make more improvements as part of our HomeFirst Worcestershire programme, which is actively supported by clinical and managerial teams from across our Trust as well as our system partners.
“This week saw the launch of Onward Care Teams (OCTs) at both the Alexandra and Worcestershire Royal. The OCTs bring together social care staff, community nurses and discharge nurses.
“The OCTs work closely with our ward teams to ensure that 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. That in turn helps to improve patient flow and frees up beds for patients most in need of them, easing pressure on our EDs and improving ambulance handovers.
“Next week we will open an additional 33 new beds at Worcestershire Royal, in addition to the beds we have already added across the WRH and Alexandra sites over the past year.
“Everything that we and our partners are doing will help us to make sure that more patients get the right care in the right place at the right time – not only in our hospitals but also at home or in community settings.
“We will continue to work hard to support our ED 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.”