The Care Quality Commission (CQC), has rated urgent and emergency services at The County Hospital, also known as Hereford County Hospital, as requires improvement, following an inspection in December.
The County Hospital, run by Wye Valley NHS Trust, provides urgent and emergency services to people across Herefordshire and the surrounding areas.
The service has an emergency department with sections for treating different levels of illness and injury, and separate area for treating children and young people.
The rating for safe has dropped from requires improvement to inadequate. How responsive, effective and well-led they are remains as requires improvement. Caring has been re-rated as good. The rating for urgent and emergency services remains requires improvement overall.
The overall rating for the hospital remains as requires improvement. The rating for Wye Valley NHS Trust remains as requires improvement overall.
Craig Howarth, CQC deputy director of operations in the midlands said:
“When we inspected urgent and emergency services at The County Hospital, we found it was overstretched and under pressure and, although staff were doing their best, the demand was taking a toll on people’s safety.
“We found poor governance, a lack of risk management and the service wasn’t always learning from incidents. People’s care records were incomplete and risk assessments weren’t always being carried out when they arrived putting people at risk of harm or their condition deteriorating.
“Long waits had been normalised, and staff weren’t always able to respond quickly when people called for help. People were also waiting too long for pain relief after asking. Leaders need to address this urgently and put in place mitigations to keep people safe while they are waiting to be seen.
“Leaders didn’t always ensure staffing levels were always safe. The service had low capacity which meant it was struggling to cope with the rising demand of the local population. Some people were waiting a long time for treatment, to be discharged, or to be moved to another ward.
“Due to the lack of space people were being treated in corridors and non-clinical reception staff were also expected to navigate people to the minor injuries waiting area without proper training. However, some of the challenges with space were due to a lack of beds in the community, which meant there was poor flow through the hospital departments.
“We found staff were working hard to care compassionately for people in a challenging environment. Staff were committed to improving the services and the trust was working to allow them to have the time and space to do this.
“We will continue to monitor the service, including through future inspections, to ensure improvements are made and people are provided with a good standard of care.”
Inspectors found:
- Children were being put at risk because staff working in the children’s department weren’t up to date on their training. This included areas like paediatric life support, paediatric competencies, and safeguarding
- People being cared for couldn’t always reach call bells to ask for help, and staff didn’t always respond quickly when called. People who were treated in the corridor didn’t have call bells and their families had to shout if they needed assistance. Inspectors saw occasions where people in the corridors had shouted for assistance, but staff walked past without attending to them
- The layout of the department meant people weren’t always visible to clinical staff who were responsible for their safety and welfare, but this was improved during the inspection
- Consultant numbers were significantly below recommendations and there was no paediatric emergency consultant in the service, which is required by the Royal College of Paediatric and Child Health
- Medicines weren’t always given on time, including time critical medicines, and pain relief wasn’t always given when people needed or requested it. Inspectors spoke to two people who had been waiting more than one hour for pain relief after speaking to staff
- People weren’t always offered food and drink at regular intervals. Inspectors spoke to some people who had stayed overnight without being offered food or drink.
However:
- Leaders were visible and approachable in the department and staff worked well as a team and supported one another
- People using the service were given emotional support and treated with compassion, considering their individual needs
- Staff understood duty of candour and were open and honest with people using the service when things had gone wrong.