Surprise GWH inspection finds more A & E safety concerns despite December warning

In December, a warning notice was imposed on the department and assurances were provided that remedies to the problems highlighted would be in place by April.

However, when the Care Quality Commission visited the hospital at the end of that month they found that many of the failings were still happening.

The purpose of this inspection was to assess whether sufficient progress had been made by the trust in response to the warning notice issued in December.

It found that despite promises by the GWH management team, the changes required by the warning notice had not been satisfactorily implemented.

The inspectors found that risks to patient safety were not always addressed in a timely way and that accurate and up-to-date records of care and treatment were not consistently maintained to ensure that patients were protected against the risk of inappropriate care and treatment.

The report raised continued concerns that staff did not consistently comply with safety systems in place to identify seriously unwell or deteriorating patients.

Staffing levels also continued to pose a problem for the Trust.

Inspectors noted that the emergency department was not consistently staffed to ensure that defined safe staff to patient numbers were met.

The department had not set out how safe staffing levels should be maintained when the department was over capacity.

There was also insufficient reporting or scrutiny of staff concerns with regard to staffing levels and capacity. 

Inspectors also had continuing concerns about the safety of patients and staff in the emergency department observation unit, an area that had been highlighted in a previous report.

Plans to relocate or reconfigure the unit to improve safety had not been finalised and the report highlighted one particular incident where elderly patients had been left scared after an patient turned aggressive at a time when only one nurse was working.

The report also found that there were still a significant number of gaps in nurse training.

A training plan to address identified gaps had not been developed and management oversight of this had yet to be implemented.

The report did praise the limited progress made by the Trust over a challenging winter period however that progress was to be found at the management and planning level rather than in changes being felt directly by patients.

It found that comprehensive improvement plans were in place and progress against these plans was overseen by executive management, progress had been made against some milestones.

In recognition of the significant work to be done, temporary management support had been provided to the management team in the emergency department.

Nerissa Vaughan, Chief Executive of Great Western Hospitals NHS Foundation Trust, said:

“The report shows the progress we have made during the busiest winter the NHS has ever seen, something the CQC have described as commendable.

“In addition to increasing the number of staff in our Emergency Department by 20 per cent since last autumn, we have recruited a further nine nurses and an additional senior matron.

“We’ve also started new safety checks for critically ill patients and have strengthened care plans to ensure that patients waiting longer than we would like, receive care similar to that which is normally provided on a hospital ward.

“At a time when we are seeing more than 230 emergency patients every day, our hard working teams have also improved our performance in admitting, transferring and discharging patients to just under the national four hour target.

“Our progress has not gone unnoticed, but there is still a long way to go and we will continue to focus on delivering the improvements needed.”

We will be exploring the report further throughout the day and bringing you more detail on where the inspectors need the Trust to improve moving forward.

Check back for more updates later.