WATCHDOG inspectors have warned of crowding at Swindon’s A&E, with patients facing unacceptable delays.

Again rating Great Western Hospital as requiring improvement, the Care Quality Commission told the Swindon NHS trust it must improve A&E performance. The health watchdog issued four requirement notices, ordering the hospital to take steps to bring treatment practices in line with that expected by NHS regulations.

While there was no improvement in GWH’s overall rating, the CQC praised the leadership at the trust and noted that systems designed to manage the flow of patients through the hospital had significantly improved.

GWH said there was more work to do, particularly to ensure safe care at busy periods for the hospital.

Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said: “Since our last inspection, Great Western Hospitals NHS Foundation Trust has made some progress to address our main areas of concern, but more is required.

“Whilst there had been significant improvements in the flow of patients and capacity through the emergency department, some concerns remained. Patients waited too long in some cases for care or treatment and this needs to be resolved as a priority.”

Concerns about overcrowding at the design of A&E raised by the CQC in 2017 had still not been addressed. The department was still frequently crowded and patients faced long waits.

Inspectors warned of a shortage of nurses and a reliance on temporary care staff on the medical wards. There were not enough beds for patients recovering from surgeries, forcing them to be cared for on unsuitable wards and units.

However, the CQC’s Nigel Acheson said A&E staff provided compassionate care despite the huge pressures they were under: “Everyone was clearly working hard to deliver the best care they could in the circumstances.”

Inspectors praised examples of outstanding care, including the actions of community nurse Laura Deville who saved a patient’s life when she found them gravely ill at home after they failed to attend a routine appointment. The majority of hospital departments were rated good by the CQC.

Investments will improve A&E, hospital says

In response to the report, GWH chief executive Nerissa Vaughan said a £30m government grant to improve A&E would help tackle overcrowding problems: “Our emergency department was built for 48,000 patients a year and our team now see almost double this number.

“Since the inspection we’ve expanded our services for patients needing urgent care with our new ambulatory care and triage service and created extra capacity in our urgent care centre.

“Earlier this month, we also celebrated the news that we will be receiving £30 million to expand capacity within our emergency department and develop new models of care to help us meet the healthcare needs of a growing and ageing population.

“We’re constantly making changes to improve our services and we’re currently exploring new ways of caring for people in the community to reduce hospital admissions in the first place and to help patients leave hospital as soon as they're well enough.”

How the CQC ratings are broken down

GWH was given an overall rating of requires improvement.

In coming to that assessment, the CQC inspected the hospital against five broad categories. The watchdog rated GWH as requires improvement for two of these categories: safe and responsive. But the hospital was found to be good against three categories: effective, caring and well-led.

Additionally, individual hospital departments were given a CQC rating.

The following were deemed to require improvement: outpatients and diagnostic imaging; urgent and emergency services; medical care; and surgery.

Community services - inspected by the CQC for the first time this year - was rated as good, as was criticial care, maternity and gynaecology, outpatients, services for children and young people, and end of life care.

Read the full CQC report.