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Pressures on A&E and beds flagged in Gloucestershire

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Gloucestershire Hospitals NHS Foundation Trust has been rated “requires improvement” by the Care Quality Commission.

While the inspectors found the acute trust’s services to be safe and caring, they flagged the lack of consultants in acute and emergency medicine, and delays in ambulance handover times.

“It is well known that patients have been waiting too long in A&E”

Mike Richards  

The trust was told it must reduce the time that patients spent in its two accident and emergency departments to ensure that patients were assessed and treated within appropriate timescales.

It must also do more to ensure patients with mental health needs who attended A&E out of hours received prompt and effective support from appropriately trained practitioners, said the CQC in its report.

The trust is responsible for providing acute specialist and elective care across three sites – Gloucestershire Royal, Cheltenham General and Stroud Maternity Hospitals.

In addition, the regulator raised concerns that bed occupancy across the trust was constantly over 91%, a level broadly accepted to affect the quality of care provided to patients.

This had placed significant pressures on the staff delivering the services and had affected the care, treatment and wellbeing of patients, said the CQC.

While staffing was found to be at safe levels in many services, inspectors found a shortage of consultants in acute medicine, general and old age medicine, with more junior doctors needed in medicine and emergency care.

CQC chief inspector of hospitals Sir Mike Richards said he was satisfied there is a “positive and open culture” at the trust.

“It is a well led, caring, organisation which has made the safety of its patients a priority at all levels,” he said.

But he said it was “well known that patients have been waiting too long in A&E” and that pressure on emergency departments and delayed discharge were “significant factors” affecting safety.  

“This has led to patients not always being treated on the most appropriate ward for their condition and to overcrowding in both emergency departments,” he added.

“Clearly the winter was a very challenging period for us”

Frank Harsent

The inspectors, who visited the trust in March, found every service to be caring, with “outstanding” critical care at both Gloucestershire Royal and Cheltenham General hospitals.

In its report, the CQC highlighted several other areas of outstanding practice, including that patients living with dementia at Gloucestershire Royal were encouraged to maintain their skills and independence by taking part in an activity group with their relatives.

Also commended by the CQC was a mobile chemotherapy unit, enabling patients to receive treatment closer to home, and the care given to bereaved relatives and patients nearing the end of life.

Trust chief executive Frank Harsent called the report “an important opportunity for us to reflect on feedback and improve our services”.

He said the trust has already begun to address the areas the CQC highlighted for improvement.

“Clearly the winter was a very challenging period for us and this has had an impact on our performance,” he added.

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