Insufficient staffing levels, poor hygiene and infection control procedures, and nursing staff not always treating patients in a caring way are among the problems found at Colchester General Hospital by inspectors.
The Care Quality Commission, which visited the hospital in November and December, used urgent enforcement powers at the time to place conditions on Colchester Hospital NHS Foundation Trust’s registration procedures to improve patient assessment, discharge and transfer.
Its report from an inspection of the hospital’s urgent and emergency services and medical care provision was released last week, revealing both services to be “inadequate” overall.
“The trust is aware of what action it now needs to take”
Inspectors “routinely observed” poor hand washing techniques from staff between patients and poorly completed patient records.
During their assessment of the emergency assessment unit they saw a nurse wearing gloves while checking some paperwork, adjust an alarm on a monitor then give another patient some intravenous medication, with the same gloves on.
They also saw nurses and care assistants carrying out tasks such as taking blood pressures, temperatures and helping patients, without washing or sanitising their hands inbetween.
In the A&E department, inspectors were concerned about how staff treated patients, particularly those who were very unwell, dying or deceased.
Some patients who had been in the emergency department overnight were not routinely offered drinks or snacks, with one who had not been offered refreshments until they were transferred to the ward the following day.
On the follow up visit on 23 December, inspectors observed an elderly patient in the resuscitation area whose blanket had slipped leaving them naked underneath.
As the cubicle curtains were pulled back, the patient was visible to people walking through the department, the report noted.
“This patient’s dignity was not being respected and we had to ask a nurse to assist and protect the patient’s dignity and make them comfortable,” said the inspectors.
“Inspectors visited at a time of unprecedented demand… [our] clinicians were very busy and working under considerable stress”
They identified a lack of experienced emergency department nurses with specific skills in areas such as triage. Meanwhile, the resuscitation area was found to be understaffed, with one qualified nurse to four patients, when guidance states there should be 1:2 or 1:1 support.
CQC chief inspector of hospitals, Professor Sir Mike Richards, said: “The trust is aware of what action it now needs to take and our inspectors will return to check on whether the required improvements have been made. We will then decide whether or not it is appropriate to remove the conditions placed on the services at Colchester General Hospital.”
But trust chief executive Dr Lucy Moore said the report did not reflect the “unprecedented pressures” the trust was under at the time of inspection, or the “considerable progress” that had been made in the past year.
“While being exceptionally busy can never be an acceptable excuse for providing sub-standard care, it is not unreasonable to point out the inspectors visited at a time of unprecedented demand within the NHS when, frankly, many hospitals like ours were struggling,” she said.
“Many people – including our staff – will not be surprised to read that clinicians were very busy and working under considerable stress,” she added.
The trust has been in special measures since 2013, when CQC inspectors received reports from staff that they had been bullied into changing patient data to help meet cancer treatment waiting targets.