Emergency departments run by Worcestershire Acute Hospitals NHS Trust were found to be “overwhelmed” due to lack of staff, during an inspection by the Care Quality Commission.
England’s chief inspector of hospitals Professor Sir Mike Richards has issued warning notices to the trust and placed a condition on its registration demanding urgent action on staffing.
The move was first revealed in May but full details have now emerged with the publication of the CQC’s report.
It follows an unannounced inspection of the accident and emergency departments at the trust’s Worcestershire Royal Hospital and Alexandra Hospital in March.
“Our inspectors were concerned at what they found in the emergency departments at Worcestershire Acute,” said Professor Richards.
“There were delays in handovers from ambulance crews, there was a shortage of nursing and senior medical staff and we had concerns about safeguarding procedures concerning children and the management of medicines. That is why we took immediate action.”
“Our inspectors were concerned at what they found in the emergency departments”
Inspectors found a shortfall in nursing numbers and at both sites found evidence of the departments being “overwhelmed”, said the CQC inspection report
They identified shortcomings in rota planning and the trust’s escalation process. “There was no evidence shifts were being planned to reflect the patients’ acuity and therefore the planning staffing did not always meet the needs of the patients in the department,” stated the report.
“Senior staff told us they had escalated concerns about staffing and capacity in the department to senior managers, as they considered the department was ‘not safe’ at times due to the high volume of patients,” the report added.
When the A&E departments were under severe pressure, inspectors found the escalation process could not always be carried out “because there were no more staff available”. “This meant that the department was not able to manage the situation safely,” said the report.
The CQC placed a condition on the trust’s registration with regard to the service at Worcestershire Royal, stating it must ensure appropriately skilled and qualified staff were in place to assess patients when they arrived in A&E, and there were systems in place to ensure prompt handover from the ambulance service to the emergency department.
“We know there is a long journey towards sustaining improvements across the trust”
Warnings were issued regarding both emergency departments with reference to staffing levels, security relating to children cared for at the two hospitals and maintenance of equipment.
Earlier this year the trust was hit by the resignation of five A&E consultants who accused managers of undermining services at Alexandra Hospital, though this was challenged by medical directors.
It also appeared in the national media in April after a “disaster doctor” was drafted in to help relieve A&E pressures at Worcestershire Royal.
Chris Tidman, acting chief executive of Worcestershire Acute, said the CQC inspection report reflected “a very difficult time for our emergency departments”.
He said improvements had already been made since the CQC inspection, including expanding the A&E department at Worcestershire to create an extra 12 cubicles, increasing staffing levels and recruiting “emergency department assistants” to provide extra support.
“Although we are in a much stronger and stable position now, we know there is a long journey towards sustaining improvements across the trust,” he said.
“Our focus remains on ensuring that all of our hospitals are fit to cope with the growing pressures we are facing to provide safe, quality care for all of our patients,” he added.
Other local service providers, including the West Midlands Ambulance Service Foundation Trust, said they had already seen improvements.
Mark Docherty, ambulance service director of nursing, quality and clinical commissioning, hailed “notable improvements in ambulance handover times in recent weeks”.
The CQC has yet to give an overall rating to the trust, based on its new inspection regime. The organisation will undergo a comprehensive inspection next month when the CQC will follow up the findings of the March visit.