The Care Quality Commission (CQC) has published a report following a focused inspection of The Princess Royal University Hospital’s emergency department.
The inspection took place in June to follow up on concerns raised, and enforcement action that was taken after the previous inspection in November 2019. At that time, the service was rated inadequate overall.
Following the recent inspection, the overall rating for the emergency department has moved up from inadequate to requires improvement. The ratings for safe, well-led and responsive have also moved up from inadequate to requires improvement. The rating for caring has moved up from requires improvement to good.
The Princess Royal University Hospital, which is in the London Borough of Bromley, is run by King’s College Hospital Foundation Trust. The overall rating for both the hospital and for the trust is requires improvement.
Nicola Wise, CQC’s head of hospital inspection, said:
“I am pleased to report that we saw a number of improvements when we inspected The Princess Royal University Hospital’s emergency department recently. When we went in in November 2019, we found there were issues with the governance and leadership of the service which were impacting on the overall culture, and this in turn was affecting staff morale and the care being provided to patients.
“Since then, leadership at the trust has strengthened and staff spoke highly of senior leaders, particularly the chief executive, who they felt was championing their needs and taking action to address issues that had previously been ignored. Staff wellbeing is now clearly a priority, which it should be in normal circumstances, but even more so now, due to the additional pressures caused by the COVID-19 pandemic.
“We did still have some concerns though, particularly around waiting times in the emergency department. The waiting area is shared with the Urgent Care Centre (UCC), which is operated by a different organisation. When the department was busy, this made it difficult to manage the number of people in the waiting area. Our inspectors saw people standing and sitting on the floor without social distancing. In the evenings, there was no security guard at the main entrance, so patients were entering with friends or family when they shouldn’t have been. Although there were escalation processes in place to deal with this situation, they were not always consistently applied. This also had an impact on ambulance handovers, with some patients being seen by staff in ambulances, as there were not enough cubicles available to assess patients.
“We have told the trust that it must ensure the waiting area is managed effectively to allow for social distancing. We were shown plans for a new streaming system and waiting room for the UCC which would accommodate up to 40 extra people and provide more space for people attending the emergency department. However, we are yet to see this plan implemented.
“The trust must also ensure that children are monitored regularly to check for any signs of deterioration, and that there is oversight that these checks are being completed correctly. We will continue to monitor the service to ensure that these improvements have been made.”
CQC inspectors found:
- People could not always access the service and receive the right care promptly when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards
- The design and use of some parts of the department did not always keep patients and staff safe, despite the efforts that had been made during the pandemic, and inspectors were concerned about crowding in the patient waiting area
- In some of the records reviewed by inspectors, paediatric early warning scores (PEWS) had not been completed, and the department was not auditing these to ensure staff were completing them correctly. PEWS are used to enable the early recognition of sick children and manage any deterioration
- Incidents were not always dealt with in a timely manner.
However:
- Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues. They were mostly visible and approachable in the service for patients and staff
- Leaders operated effective governance systems throughout the department, although they recognised that some of these required further embedding into the service
- The service had enough nursing staff and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed staffing levels and skill mix
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. However, medical staff relied on nursing staff to make safeguarding referrals
- The service provided mandatory training in key skills, including the highest level of life support training to all staff. Although the pandemic had hampered efforts for a better compliance rate with this training, the trust had a better system of monitoring mandatory training with staff
- The service generally controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean
- The mental health safe room had been made free of ligature points and non-movable furniture had been installed to remove any risk of people trying to harm themselves. This was an improvement since the previous inspection
- The service used systems and processes to store medicines safely.
Full details of the inspection are given in the report published on our website.
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