A DAMNING report has been published listing the failings of emergency care provision at Queen Alexandra Hospital.
Following two inspections on February 22 and 23 and March 3 and 4 this year, the Care Quality Commission (CQC) has deemed the Cosham hospital’s A&E department as inadequate.
The rating comes as inspectors saw 16 ambulances waiting to transfer patients, a multi-occupancy ambulance known as a jumbulance being used to assess and treat patients due to overcrowding and patients not being triaged, assessed or treated within a timely manner.
In some circumstances, people admitted with serious conditions such as sepsis, chest pain and a fractured neck or femur where left waiting for more than two hours.
Portsmouth Hospitals NHS Trust, which runs the hospital, says they are looking to learn from the report and are making changes.
The trust has also apologised to its patients for the standard of care.
These concerns are long-standing ones which have not been addressed from the previous inspection.Flick Drummond
The CQC, which regulates all health services, published its report today following the unannounced inspections earlier this year.
As the hospital has been deemed inadequate, more unannounced inspections can happen at any time.
The CQC decided to carry out the inspections after receiving information of concern about the trust’s performance with its emergency care provision.
Two risk summits had been help in December last year and January but the hospital had failed to improve.
Following the publication of the report, Portsmouth South MP Flick Drummond said: ‘This is a very worrying report that highlights there must be better strategic leadership at the trust and that patients are being let down in their greatest time of need.
‘It’s comforting to see that staff at the emergency department know what needs to be done but they now have to be listened to by managers who really do need to raise their game immediately.
‘These concerns are long-standing ones which have not been addressed from the previous inspection.
‘I am very pleased the CQC is doing a good job highlighting these problems and offering support to improve the situation.
‘But it really should not have come to this. The people of Portsmouth deserve better and I have written to the secretary of state for health Jeremy Hunt to ask for immediate action.’
She added: ‘I’m not interested in recrimination or heads to roll at this time.
‘However I will ask the Mr Hunt to make expertise from elsewhere in the NHS available if that will help the management deal with this situation.
‘Those in place now need to sort this out as a matter of urgency.
‘I hope that this CQC report will be acted on immediately and these issues do not come up again in a future inspection.’
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The CQC report looked at the emergency department of QA Hospital as well as medical care including the Medical Admissions Unit (MAU).
MAU was rated as requires improvement.
Key findings in the inspection report found that:
- the trust was failing to ensure emergency patients received care and treatment.
- the risk to patients was unacceptable.
- only 65 per cent of ambulance patients were assessed within 15 minutes.
- some patients had two members of clinical staff assess them while others had none. The process was described as chaotic.
- elderly, frail patients were waiting in ambulances for longer than two hours.
- the corridor outside the ambulance handover was being used by nine patients on trolleys waiting to be treated.
- the safe storage of medicine was inconsistent in the MAU.
- infection control procedures and practises were not consistently adhered to throughout the MAU.
The report added: ‘During our inspection CQC staff had to intervene to keep patients safe on several occasions, including asking staff to assess patients in the ambulance and the corridor.
‘We had to prevent a patient from leaving the department when there was not a member of staff present.’
After the inspections, the CQC issued an enforcement notice which required the trust to take immediate action at their A&E department.
They trust had to appoint a clinical transformation lead to ensure effective leadership in the department; not use the jumbulance unless a major incident is declared and send daily monitoring information to the CQC.
As well as the enforcement notice, following the publication of the report, the trust now also has to ensure:
- patients waiting in the corridor or in ambulances must be adequately observed and monitored by appropriately trained staff.
- the hospital must accept full clinical responsibility for patients waiting in an ambulance.
- medicines are stored safely.
- patients receive timely discharge from hospital.
- staff in the MAU adhere to infection control policies and procedures.
Professor Edward Baker, CQC’s deputy chief inspector of hospitals, said: ‘On previous inspections we have expressed our concerns about the flow of patients through the emergency department and into the hospital, as well as the hospital’s reliance on using the jumbulance to accommodate patients needing urgent attention.
‘If the patient flow through the hospital was effectively managed there should be no requirement for the jumbulance unless there was a major emergency.
‘It is a matter of some concern that, despite previous assurances, the trust has been failing to manage emergency admissions and this has been affecting partner organisations who may already be stretched beyond capacity.
‘To ensure swift and effective improvement takes place, we have decided to place conditions on the trust’s registration to ensure that emergency admissions are managed effectively and that patients are assessed and treated in a timely manner.
‘While we have placed conditions on the registration, it is clear that the trust cannot achieve these improvements on its own.
‘It will require the combined determination and effort of the whole health and social care community in the area to ensure that the level of service that the people of Portsmouth are entitled to expect is consistently provided.’
To see the full report, visit cqc.org.uk.