The Care Quality Commission (CQC) has again rated urgent and emergency services at Cumberland Infirmary, run by North Cumbria Integrated Care NHS Foundation Trust as requires improvement.
CQC carried out the inspection in February and March as part of its winter pressures programme. Inspectors found breaches of regulation regarding safe care and treatment, premises and equipment, staffing and how the service is managed.
Following the inspection of the emergency department, a warning notice was issued to the trust due to significant concerns about the safe care and treatment of people using the service. The notice required the trust to focus on making immediate improvements in this area. A condition was also imposed on the trust to ensure CQC were kept informed of all changes in the department.
Following the inspection, CQC has dropped the rating from requires improvement to inadequate for being safe, caring has declined from good to requires improvement, and responsive, effective and well-led are rated as requires improvement again.
Roger James, CQC director of operations in the north-east, said:
“When we inspected urgent and emergency care at Cumberland Infirmary, we found staff were kind and working hard to meet people’s needs under considerable pressure, but leaders needed to mitigate risks to ensure the department ran smoothly even at very busy times.
“We saw concerns identified at the last inspection still hadn’t been resolved which continued to place people at risk. For example, the system used to direct people to appropriate services once they’d arrived in A&E was ineffective, meaning there were more people waiting than staff had the capacity to manage.
“People reported concerns over delays and lengthy waits, and staff weren’t monitoring people properly, including those at risk of deterioration or people with mental health needs. Additionally, people often remained on chairs and trolleys for prolonged periods due to a lack of beds and treatment areas.
“Additionally, there weren’t enough cubicles to accommodate demand with several people being cared for in temporary escalation spaces. These environments didn’t always have call bells and didn’t support people’s privacy and dignity. Nurses were unable to maintain continuous observation of these areas meaning they wouldn’t be able to respond quickly if someone’s condition deteriorated.
“Despite these challenges, we also saw examples of effective multidisciplinary working within the department. For example, physiotherapists worked hard to ensure people returned home safely with appropriate equipment and community support, reducing the need for re-admission.
“We have told leaders where we expect to see other rapid, and continued improvements and will continue to monitor the service closely to keep people safe during this time.”
Inspectors found:
The department appeared visibly dusty and, in some areas, unclean. Resuscitation bays and temporary escalation spaces were cluttered with equipment which reduced the ability to clean these areas effectively.
Staff didn’t ensure people had individualised care plans in place to support their ongoing needs.
Leaders needed to address the significant backlogs of incidents that hadn’t been reviewed or investigated yet.
The service didn’t have a dedicated toilet, baby changing or breastfeeding facilities within the paediatric area.
Staff didn’t always follow good hand hygiene practices or bare below the elbow principles.
Commenting on the report, Dr Gill Findley, Chief Nurse at NCIC, said: “While we fully accept the findings of the CQC report naturally we are disappointed, as we know that all of our colleagues come to work to do a good job for their patients and we want patients to feel confident that they will receive good care when they come into our hospitals.
“When we received the enforcement notice in March, we took immediate action to resolve the issues raised. Some of the improvements will take time to put in place but we are determined they are resolved on a permanent basis and not just a temporary fix. As the well as the actions listed above, our colleagues in ED are attending mental health training which is being provided by the University of Cumbria. We are also undertaking a number of improvements to the facilities and environment in the ED, including painting and decluttering the cubicles and making improvements to our toilet facilities.”
“We recognise that we need to improve our urgent care facilities at the Cumberland Infirmary. The ED was originally designed to accommodate 30,000 patients a year and we are now seeing around 70,000. This is why we have invested £4m into our urgent and emergency care services to help us to stream less urgent cases to the most appropriate place and free up ED for critically ill patients. The Urgent Treatment Centre, which is co-located with the ED, is now up and running following successful recruitment efforts.
“We have been very open about the challenges we continue to face around crowding in our ED department and the use of undesignated areas for providing care, commonly known as ‘corridor care’. We are clear that corridor care is unacceptable and is not the standard we want for our patients. However, it is something we have had to do as a temporary measure when we are at capacity across our hospitals. The key to stopping this and to seeing further improvements in the ED department overall is to make sure patients are not staying in hospital longer than they need to be. We know it is not good for anybody to stay in hospital once they have received the treatment they need and people recover better in the place they call home with appropriate support in place.
“I am particularly disappointed that the CQC found that areas were cluttered which prevents effective cleaning and that some staff were not demonstrating good hand hygiene practices and were not bare below the elbow. We all agree that there is no excuse for this and we have been working hard to reiterate the importance of adhering to infection prevention standards.
“I would like to thank the ED team for their ongoing response to the CQC’s findings and the commitment they are showing to make improvements despite the challenging environment they are working in. We know that the only way to solve some of the issues in ED is to solve issues across our hospitals and community services, it really is a whole team effort. I would also like to offer reassurance to our local communities that we take this report extremely seriously and will continue to do all we can to improve our services.”
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