The Care Quality Commission (CQC) has found improvements at University Hospitals Plymouth NHS Trust in its medical care and emergency department (ED).
CQC carried out an unannounced inspection of the trust’s emergency department and medical care services at Derriford Hospital in October 2021. CQC also looked specifically at management and leadership of the trust to answer the key question: Is the trust well-led?
Inspectors visited Derriford Hospital during a period of high pressure on medical services across England and there was a marked increase in the number of seriously ill patients attending the department.
As this was a focused inspection, the rating for the emergency department did not change and remains as requires improvement. The rating for medical care services also remains requires improvement.
The well-led inspection has seen improvements in some individual service ratings, but the trust’s overall rating remains requires improvement. How well-led the trust is has improved from requires improvement to good.
Catherine Campbell, CQC’s head of hospital inspection, said:
"Throughout our inspection of University Hospitals Plymouth NHS Trust, we saw improvements within the emergency department and medical care service, as well as in the senior leadership team.
“The senior leadership team was open to challenge and understood the problems the service faced. They were supporting staff to manage the priorities and issues and deal with difficult circumstances. The trust has now been rated good overall for being well-led as a result.
“However, the impact of a high number of patients attending to receive care, combined with reduced staffing levels in the emergency department, created issues that the trust couldn’t solve alone and further support was needed from the local health and social care system.
“Patients weren’t being discharged in a timely way because there weren’t enough beds available in adult social care services outside the hospital. As a result, there were delays moving some patients from the emergency department to medical wards, because there were no free beds. This in turn, meant that some people were being cared for in ambulances outside the hospital as there were no beds in the overcrowded emergency department. This overcrowding meant social distancing wasn’t always possible, and pathways designed to reduce cross-infection couldn’t always be followed.
“Winter pressures on the hospital, combined with the COVID-19 pandemic, have created a perfect storm, and posed a significant challenge for staff and the trust leadership. We are mindful of the pressure that the NHS is under and how hard staff are working to provide excellent care for patients under the circumstances. We also know that the trust is trying to work in partnership with the wider care system to resolve the issues, but they can’t do it alone, and there needs to be more input from the local healthcare system to ensure these problems are alleviated for people using services. We have imposed conditions upon the trust to ensure that this joint working happens in order to overcome these challenges and ensure that its staff are supported to deliver safe, high quality care
“We have highlighted areas for urgent local improvement, and the University Hospitals Plymouth NHS Trust has developed a detailed improvement plan. We will return to check on their progress.
Throughout the emergency department, inspectors found the following:
- As a result of the COVID-19 pandemic the trust set up the Plym Unit as a nine bedded area for the streaming of patients considered at risk of having COVID-19. The unit opened at the start of the pandemic with the specific air flow needed for safer practice when treating patients with COVID-19
- In the Plym Unit, patients suspected of having COVID-19 were tested and remained in the department until their results were received, usually within 90 minutes. However, there were exceptions, and in one case, a patient had been in the corridor for nine hours before receiving a positive COVID-19 test, leaving the patients and staff in the department exposed to the risk of contracting COVID-19
- There were times when both negative and positive COVID-19 patients had to remain in the Plym Unit for extended periods of time as the hospital was full. During a time when the Plym area was full there were four patients who tested positive for COVID-19 and could not be moved because the hospital did not have the capacity in a designated ward
- The Plym Unit was regularly short staffed, with two staff looking after 15 suspected or confirmed COVID-19 patients, often under a tremendous amount of pressure. This had an effect on how infection control was managed in this area
- In the ambulatory assessment unit, there were socially distanced chairs for use by patients whilst they waited. The trust had followed best practice guidelines and spaces were marked to be kept vacant, but there was no regular checking of this, and the guidelines were mostly ignored by the public. Inspectors saw that most of the time, all seats were taken, and patients were sitting or lying on the floor
- The pressure the department was under meant that patients were being routinely cared for in areas not intended for clinical use. Spaces were marked on the floor for patients to be cared for in the corridor
- Patients on trolleys did not have any privacy and their dignity was compromised
- Despite the pressures, the majority of staff felt respected, supported and valued and were focused on the needs of patients receiving care
- There was an open culture where patients, their families and staff could raise concerns without fear
- There were a number of new strategies covering a wide range of areas, for example health inequalities, quality assurance and quality improvement
- Compassionate leadership was demonstrated, which had helped build a culture of trust and honesty within the board
- Leaders and staff actively worked with patients, staff and the public to plan and manage and improve services for patients
- Communication with staff was a challenge due to the pressures staff were under. They were often too busy to read emails or other notifications, and the trust was aware not all communication efforts were having the desired impact.
Full details of the inspection are given in the report published on our website.
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