Overcrowding in the accident and emergency department at Royal Sussex County Hospital and a lack of progress in addressing issues previously raised during a recent unannounced inspection by regulators.
Care Quality Commission inspectors have rated the trust’s urgent and emergency services as “inadequate” following an inspection of them in June.
“Some patients coming in to the urgent and emergency services departments continue to experience a poor level of care and treatment”
Inspectors said they observed that the A&E did not always have the staff or facilities to ensure the safe accommodation of patients in the emergency department.
Patient safety was compromised because the initial assessment of patients was not done quickly enough, concluded the regulator’s latest report on Brighton and Sussex University Hospitals NHS Trust, which was published today.
In addition, patient flow from A&E into hospital beds was poor, with many patients waiting to be admitted to wards.
At times inspectors found there not always enough nurses on duty in the emergency department with the right skills over each 24-hour period to care for patients safely.
Overcrowding meant patients were lined up on trolleys, wheelchairs or chairs when cubicles were full.
However, the CQC noted that staff treated patients with compassion, dignity and respect while providing good clinical care once they were being treated.
The CQC said some of the problems were identified during its previous inspection in May last year, but the actions the trust took “have not been sufficient to mitigate the risk”.
The trust only saw 91.1% of patients within four hours according to the latest data which covers August, against the national 95% target.
Staffing numbers and the skill mix of staff “did not support” a timely assessment of patients arriving at the emergency department.
The trust has not “comprehensively addressed” the recommendations from previous reports, including from the Emergency Care Intensive Support Team and a compliance action given by the CQC in May last year.
Despite “intense operational pressure”, staff provided “compassionate and good clinical care” to patients, noted the CQC.
Professor Edward Baker, CQC deputy chief inspectors of hospitals, said: “Despite the best efforts of staff the flow from the emergency department into the hospital was not being managed well and this affects the care patients received and staff morale.
“While there is evidence that the new management is committed to delivering necessary changes in the department and the inpatient wards, I do not feel the board has done enough to address these issues and the board agrees that more must be done to protect patients,” he added.
“We are making significant changes to how we work across the hospital”
Trust chief executive Matthew Kershaw said: “We recognise the issues raised regarding urgent and emergency care and we are making significant changes to how we work across the hospital.
“Specialist surgical and medical clinicians are now working alongside the emergency department team to ensure patients are seen by the right clinical teams earlier which will lead to quicker assessment and treatment,” he said.
“We are also improving the way we provide tests, treatments and therapies for patients on our wards, which will help patients return home quicker, freeing up space for other patients who need to be admitted to a hospital bed,” said Mr Kershaw.
He added: “We have opened a ward at Princess Royal Hospital to give us additional beds and more beds will become available soon on a new community ward in Newhaven.”
He also said he was pleased the CQC had recognised that staff provided “good clinical care and highlighted the good feedback they received from patients”.
“We now have to ensure that the entire experience of every patient in our care matches those standards and I am confident these changes will help us achieve that,” he said.
23 October 2015