The Care Quality Commission (CQC) has warned University Hospitals Plymouth NHS Trust that it must make significant and immediate improvements to the urgent and emergency care department at Derriford Hospital.
CQC carried out an inspection of the hospital’s urgent and emergency care department in March as part of its winter pressures programme. Following the inspection, CQC issued the trust with a warning notice outlining the areas for improvement in the department, including two breaches of legal requirements that must be put right.
As this was a focused inspection, CQC only looked at how safe, responsive and well-led the service was. Inspectors found that there had been a deterioration in the quality of services being provided, which resulted in some rating changes. The safety of this service at Derriford Hospital was previously rated as requires improvement, but it is now inadequate; and where the service used to be good for being well-led, it is now rated as requires improvement. Responsive was not rated on this occasion so the previous rating of requires improvement remains. The overall rating for the urgent and emergency care service at Derriford Hospital remains requires improvement.
CQC also looked at the diagnostic and imaging services in response to concerns about the safety and quality of the service, and to check on the progress of improvements made following a previous inspection. During this focused inspection, CQC looked at how safe, effective and well-led the diagnostic imaging service at Derriford Hospital was. Due to the narrow focus of the inspection, the overall rating for diagnostic imaging did not change and remains requires improvement.
The overall rating for both University Hospitals Plymouth NHS Trust and Derriford Hospital also remains unchanged and is requires improvement in both cases.
CQC’s head of hospital inspection for the south, Amanda Williams, said:
“When we inspected Derriford Hospital’s urgent and emergency care department, we found that people were waiting too long to be seen. This meant that there was a risk to patients who were unable to access care and treatment in a timely way. There was also a further risk, because ambulances were being held for too long in the system, which meant they were unable to respond to calls from other patients who needed urgent assistance.
“Following the inspection, we issued the trust with a warning notice and told it to send us a report outlining what action it is going to take to make the required improvements. We will continue to monitor the service to ensure that sufficient improvements are made to keep people safe.
“We also inspected the diagnostic imaging service and I am pleased to report that governance processes are now operating effectively and the service is being well run. Staff felt respected, supported and valued and they felt that the leaders were proactive with their support.”
Inspectors found the following concerns in the urgent and emergency care department:
- The trust faced challenges with access and flow which meant they could not always ensure patients accessed the emergency department when needed to receive timely treatment. Performance data showed delays in patients accessing the emergency department and waiting to be seen. Improvements had not been sustained for effective patient flow
- We were not assured there was adequate oversight and responsibility of the patients who were waiting to be seen and patients were not being seen in priority order, based on their clinical need
- We were not assured patients safety was maintained while they waited in crowded areas and we identified some lapses in practice around infection prevention and control
- Patients with mental health needs were not always seen in a timely manner or cared for in an appropriate environment
- The service did not have enough medical staff to meet the recommended guidance for the department. There was no full-time paediatric consultant and no specific rostering of staff to the paediatric area. The medical rota was not always meeting planned levels and there was a reliance on locum staff to fill gaps. The pressures of COVID-19 meant the service struggled at times to have enough nursing staff, but measures were taken to ensure staff were brought in where possible to reach safe numbers
- Leaders within the emergency department were new in role and support was being provided to develop them. Although leaders told us about the priorities and issues the service faced, these were not being effectively managed, or risks being appropriately mitigated
- Risks and issues were not always identified, or appropriate actions taken to reduce their impact. Although there were systems to report and understand performance, data was not always easily accessed or visible.
Full details of the inspection are given in the report published on our website.
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