Portsmouth Hospitals NHS Trust A&E rated Inadequate

The Care Quality Commission (CQC) has told Portsmouth Hospitals NHS Trust that it must make significant improvements to protect patients using its urgent and emergency department.

During an unannounced inspection in February and March, inspectors found the emergency department at the Queen Alexandra Hospital was over-crowded with patients not being assessed or treated in a timely way. Some patients found themselves waiting in lengthy queues instead of being seen immediately.

In a CQC report which is published today, the trust has been rated Inadequate for Urgent and Emergency services and Requires Improvement for Medical Care.

Inspectors found that the trust’s inability to deal with emergency admissions was impacting on partner organisations. Southampton General Hospital and Solent NHS trust were both supporting the trust by supplying diverted patients with care despite dealing with their own emergency admissions.

Inspectors also found that at one time, South Central Ambulance Service had a number of ambulances equating to a third of their South East Hampshire fleet queuing outside the emergency department. This reduced their fleet and meant they were not meeting their own response times. There were two serious incidents where response times for life threatening conditions had not been met; this included a road traffic accident on the M27 where a tent had to be erected whilst waiting for an ambulance.

Following the inspection CQC placed four conditions on the trust’s registration to ensure immediate improvements:

• The trust must operate a more effective system in the emergency department at the Queen Alexandra Hospital It must ensure patients are assessed, treated and seen by specialist in an appropriate and timely way.
• The trust must stop using the large multi occupancy ambulance, known as the "Jumbulance," to accommodate emergency patients unless there was a major incident which required extra support.
• The trust must ensure that there is effective leadership within the emergency department, with the authority to ensure decisions were made and able to take swift and appropriate action in response to problems as they occurred.

Professor Edward Baker, CQC’s Deputy Chief Inspector of Hospitals, said:

“On previous inspections we have expressed our concerns about the flow of patients through the emergency department and into the hospital, as well as the hospital’s reliance on using the Jumbulance to accommodate patients needing urgent attention. If the patient flow through the hospital was effectively managed there should be no requirement for the Jumbulance unless there was a major emergency.

“It is a matter of some concern that, despite previous assurances, the trust has been failing to manage emergency admissions and this has been affecting partner organisations who may already be stretched beyond capacity.

“To ensure swift and effective improvement takes place, we have decided to place conditions on the trust’s registration to ensure that emergency admissions are managed effectively and that patients are assessed and treated in a timely manner.

“While we have placed conditions on the registration, it is clear that the trust cannot achieve these improvements on its own. It will require the combined determination and effort of the whole health and social care community in the area to ensure that the level of service that the people of Portsmouth are entitled to expect is consistently provided.”

The inspection identifies a number of specific areas where the trust must improve, including:

• Patients waiting in the corridor, or in ambulance vehicles, must be adequately observed and monitored by appropriately trained staff.
• The hospital must accept full clinical responsibility for patients waiting on the ambulance apron
• All medicines must be stored safely in the Medical Assessment Unit
• Patient notes must be stored securely across the hospital to prevent unauthorised access
• All patients in MAU must have care based on plans developed to support identified risks
• Patients must receive timely discharge from hospital. Plans to change the urgent medical pathway must be implemented in a timely manner
• Staff in the MAU must adhere to infection control policies and procedures
• There must be better and more accurate monitoring information to reflect patient safety and the quality of care

Full reports have been published on the CQC website at: www.cqc.org.uk/provider/RHU

Ends

For further information please contact CQC Regional Engagement Officer Farrah Chandra on 07917 594 574 or, for media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the duty press officer is unable to advise members of the public on health or social care matters).

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