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Trolley death trust criticised for ‘culture’ of treating A&E patients in corridors

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A troubled hospital trust where patients died on trolleys last winter has failed to meet a deadline to resolve outstanding failures of care, according to Care Quality Commission inspectors.

A summary of a CQC preliminary report on Worcestershire Acute Hospitals NHS Trust – included in its May board papers – has revealed that patients were being placed in trolleys in A&E corridors, even when space was available in the department.

“Going forward we will be able to show that we have improved”

Trust statement

The findings were based on two unannounced CQC inspections in April, following a warning letter issued in January requiring the trust to make care and governance improvements by 10 March.

Inspectors found continuing 12-hour target breaches at Worcestershire Royal Hospital (WRH) and said there was a “culture” of treating the corridors as an extension of the A&E department.

“Concerns continue regarding the care of patients in the WRH emergency department corridor as their privacy and dignity was significantly compromised,” the report said.

“Patients were moved to and cared for in the corridor even when there was other capacity in the department,” it added.

In the same A&E department, the CQC said an inspector had to personally intervene after a patient was not given time critical intravenous antibiotics.

“It is vitally important that we quickly and effectively resolve the outstanding actions”

Vicky Morris

There were also “some examples of prescriptions which had not been given on numerous occasions, without clear reasons for the omission being recorded”.

It accepted the CQC’s concerns and that it was developing an improvement plan to deliver consistent high quality care, the trust said in a statement to Health Service Journal.

This would be aided by a more settled management team, something which the trust’s chair Caragh Merrick had previously highlighted as a major factor in the trust’s woes earlier this year. A new permanent chief executive, Michelle McKay, started at the trust in March.

The trust’s statement said: “We have, with the support of NHS Improvement and our local CCGs, put in place an improvement programme to address the concerns raised by the CQC. Going forward we will be able to show that we have improved and others will be able to see the improvement for themselves.”

Worcestershire Acute’s emergency departments came under immense pressure last winter, with health secretary Jeremy Hunt singling it out as the trust the Department of Health was “most worried about”.

Warnings that the trust’s emergency services were at crisis point were raised with NHS England as early 22 December, 2016, days before three patients died on trolleys at the trust. However, other problems there had previously been reported by Nursing Times.

Trust figures show in the three months to the end of February, 2017, 308 patients waited for more than 12 hours in A&E.

This peaked at 167 patients in January, an average of more than five a day, accounting for 17% of all 12 hours A&E waits in England that month. However, breaches have since then dropped significantly to just 14 in March.

Other outstanding concerns raised in the preliminary CQC report included:

  • A lack of child safeguarding training among staff, which staff claimed had been suspended because of a “lack of resources”
  • Poor infection control at Worcester Royal and parts of Alexandra Hospital, with inspectors observing staff failing to wash their hands before and after seeing a patient
  • Some locum doctors did not have log-ins to clinical systems, and used permanent staff’s log-in instead, potentially compromising information governance
  • Failed resuscitation equipment, which was identified by the night staff who failed to pass the information on to the day shift

Improvement had been made in some areas identified in the CQC warning letter, including better pressure care, improved paediatric early warning sign assessment in some parts of the trust, and fewer mixed sex breaches.

The trust’s board paper concerning the latest CQC report, which was presented by trust chief nursing officer Vicky Morris, said it was “vitally important that we quickly and effectively resolve the outstanding actions” identified in regulator’s letter.

The “current phase” of improvement were expected to be completed by the end of May, while a three-year quality improvement strategy would be presented to the board in July.

A full CQC inspection report into Worcestershire Acute is expected to be published later this month.

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