The Care Quality Commission (CQC) has published a report following an inspection of medical and urgent and emergency services at Worcestershire Acute Hospitals NHS Trust in November.
This inspection looked at the following services at the trust; urgent and emergency care at Worcestershire Royal Hospital and Alexandra Hospital, and medical care (including older people’s care) at Worcestershire Royal Hospital and Alexandra Hospital.
Following this inspection, the overall rating for urgent and emergency services at Alexandra Hospital and Worcestershire Royal Hospital has gone up from inadequate to requires improvement. Medical care at Alexandra Hospital and Worcestershire Royal Hospital remains as requires improvement.
The overall rating for Worcestershire Acute Hospitals NHS Trust remains as requires improvement.
Charlotte Rudge, CQC deputy director of operations in the midlands, said:
“When we inspected urgent and emergency and medical services at Worcestershire Acute Hospitals NHS Trust, it was positive to see improvements had been made since our last inspection, but further work is needed to ensure people receive appropriate care.
“The trust has started to make progress in urgent and emergency care at both hospitals where we saw leaders running services well and staff being supported to develop their skills.
“It was good to hear leaders at Worcestershire Royal Hospital’s emergency department had a proactive approach to staff welfare, especially following the pandemic when staff had been under considerable stress. There was a particular focus on supporting staff who had suffered violence or aggression during very busy times.
“However, staff didn’t always complete risk assessments in a timely way for each person on arrival and there were sometimes long handover times from ambulance to the department which delayed assessment and treatment.
“In medical care services, people told us staff were kind and caring and gave examples of being supported emotionally by staff. We saw many thank you cards displayed on all the wards we visited.
“However, our rating for well-led in medical services at both hospitals has moved down to requires improvement. While leaders had a positive vision and strategy to improve, some staff felt leaders didn’t have oversight of the discharge lounge and ward and weren’t always responsive to concerns they raised about safety or processes.
“We will continue to monitor the trust, including through future inspections, to ensure these improvements are embedded and sustained, as well as making sure that further necessary improvements are made so people are safe and can continue to receive a good standard of care.”
Inspectors found the following during this inspection:
At Alexandra Hospital:
- Medical services staff worked well together for people’s benefit, advising them on how to lead healthier lives, supporting them to make decisions about their care, and having access to good information
- Children identified as being at risk while in the emergency department were referred to the trust safeguarding team and to the local authority appropriately. There was a system to flag up known concerns about children and families
- Staff understood how to protect people from abuse and the service worked well with other agencies to do so. However, not all staff were updated with the relevant training.
However:
- The service did not have paediatric nurses and not all nurses were trained in paediatric competencies
- Managers did not always have oversight for some of the issues within the department including lack of paediatric nurses, duplicating of medicine charts and lack of strategy for managing the poor flow
- The medical service did not always have safe process and systems in place to manage the prescribing, storage, and monitoring of medications
- The medical service didn’t always have effective processes in place to protect people from harm during the discharge process. People were regularly admitted onto discharge units against standard operating procedure criteria.
At Worcestershire Royal Hospital:
- Emergency department staff treated people with compassion and kindness and as individuals. They took account of their individual needs and helped them understand their conditions
- The medical service engaged well with people and the community to plan and manage services and all staff were committed to improving services continually
- Managers in the emergency department monitored the effectiveness of the service well and made sure staff were competent.
However:
- There were delays in moving people off ambulances into the department. This resulted in delays in assessment and treatment for some patients
- Outcomes for people in medical care were mixed. People could not always access parts of the service when they needed it, particularly stroke services
- Medical care staff didn’t always feel respected, supported, and valued. Morale was low amongst some staff, who felt that their concerns weren’t always listened to by leaders.