QUEEN Alexandra Hospital has been heavily criticised for the care it is providing in a damning report.
The Care Quality Commission (CQC) has said Portsmouth Hospitals NHS Trust, which runs the Cosham site, has failed to ensure the safety of its patients.
It comes after two inspections by the CQC in February and May which identified a series of concerns for people using the hospital – from patients at risk of malnutrition, to staff not responding to patients in need.
One shocking incident included a patient being left to choke on food while two staff members stood nearby. The CQC inspector had to intervene to ensure the patient’s safety.
They also found improvements previously made had not been sustained and the trust board ‘appeared to have no real understanding of what was happening on the wards’.
Inspectors found security staff were the only group who demonstrated excellent knowledge and understanding of the Mental Health Act and the Mental Capacity Act, while staff knowledge was not sufficient enough.
During our inspection in February we found the quality of care on the medical wards was very poor, especially for the most vulnerable patients, whose needs were not being dealt with properly, and who were at risk of avoidable harm.Professor Ted Baker
In response to its findings, the CQC issued a warning notice, which are rarely issued and only used when immediate action is required to ensure improvements are made.
The notice issued to QA requires the trust to improve safety, patient consent, dignity and respect, safeguarding and overall leadership.
At the same time the health watchdog has also placed six conditions on the trust requiring specific action until they can demonstrate that patients are safe.
Professor Ted Baker, the chief inspector of hospitals at the CQC, said: ‘At previous inspections we have found some very good services at this trust. But during our inspection in February we found the quality of care on the medical wards was very poor, especially for the most vulnerable patients, whose needs were not being dealt with properly, and who were at risk of avoidable harm.
‘Such was the level of our concern that we took enforcement action instructing the trust to implement improvements.
‘We undertook a follow up inspection in May to look further into the wider culture, governance and leadership.
‘It is a matter of concern that on this return inspection we found the trust had still not effectively got to grips with these issues.’
He added: ‘There was a distinct lack of management oversight.
‘The board appeared to have no real understanding of what was happening on the wards.
‘We concluded the trust leaders were not giving sufficient attention to many of the concerns we identified or the concerns of their own staff.’
The CQC has published a report today looking at the leadership of the trust as well as the urgent and emergency care and medical care in the Acute Medical Unit, 10 medicine wards including older persons, the discharge lounge and the cardiac and renal day units.
Urgent and emergency care was rated ‘requires improvement’ overall. Of the five criteria looked at, it was rated ‘inadequate’ for being safe, ‘good’ for being effective and caring and ‘requires improvement’ for being responsive and well-led.
But the medical care services were rated as ‘inadequate’ overall with only the responsive category rated requires improvement, the rest were inadequate.
In the report it said: ‘Quality of care on the medical wards in relation to emergency care was very poor.
‘The inspection team had significant concerns about the safety and care of vulnerable people. Shortages on junior medical staff and consultants meant unwell or vulnerable patients did not receive the appropriate level of care and supervision.’
The report also said due to escalation beds being used, in the event of a major incident in the Portsmouth area, there were concerns on limited capacity for patients to be admitted.
A lack of beds comes as QA has high numbers of patients who are well enough to go home taking up beds.
The CQC noted 230 patients needlessly taking up beds.
Prof Baker added: ‘Portsmouth Hospitals has been under pressure for some time – too many beds are taken up by patients who are medically fit for discharge but unable to leave hospital until social care becomes available.
‘This in turn creates pressure on the wider healthcare system.
‘All system leaders must help resolve this issue.
‘We have taken further action by placing specific conditions on the trust that demand clear progress over the coming months.
‘The trust is required to send us weekly reports, and we have been working closely with NHS Improvement to ensure that the trust gets the support it obviously needs at the highest level.
‘If the trust fails to meet these conditions, or if there is a continuing failure to provide services that are of sufficient quality, we will take further enforcement action to protect patients who depend on these services.’
As part of the report, the CQC have given instructions QA must follow including staff having knowledge of the Mental Capacity Act, reviewing the safeguarding of vulnerable adults and ensuring staffing numbers and skill mix to reflect the patient numbers and acuity.
Chief executive of the trust Mark Cubbon said a number of improvements had already been made in the last six months.
‘There is some very helpful feedback from the CQC in the report but I know for patients, their relatives and staff that it is a difficult read,’ he said.
‘We have been working since both inspections and are making sure we are already starting to put in place actions that will improve areas criticised in the report.
‘I am confident that we can and will do better and the plans we have in place already are starting to show signs of improvement.’