Weston Area Health NHS Trust says it will temporarily close the accident and emergency department at Weston General Hospital overnight, because it cannot ensure safe staffing.
The trust announced the “difficult decision” to close A&E at night in the wake of a Care Quality Commission inspection, which rated emergency and urgent care services as “inadequate”.
“The flow of admissions and discharges was not on everyone’s agenda”
The temporary closure at the hospital in Weston-super-Mare, North Somerset, will come into force on 4 July when A&E will close between 10pm and 8am.
The trust, which was issued with an official warning notice by the regulator, said the drastic move would give it the time to work with local partners to redesign the service.
Safety concerns highlighted by CQC inspectors included the fact patients were regularly cared for in a corridor and delays in bringing patients in from ambulances.
“We found the trust had been under increasing pressure to manage flow in the hospital for several months, with sustained pressure on the emergency department, leading to overcrowding and patients waiting too long to be admitted,” said CQC chief inspector of hospitals Sir Mike Richards.
In particular, inspectors found there were not always enough senior doctors on duty in A&E to ensure safe care – especially overnight – due to ongoing difficulties in recruiting senior medical staff.
“The corridor was staffed by nurses on a one nurse to three patient ratio”
Meanwhile, efforts so far to alleviate the pressure on A&E had not worked. For example, the trust had tried using emergency nurse practitioners to assess and treat minor injuries and also an ambulatory emergency care unit for clinically stable patients.
According to the CQC’s latest report on the trust, staff told inspectors some patients were cared for on a corridor “most days” and this had become “the norm” rather than a last resort. This corridor was managed by the matron or nurse in charge.
“The corridor was staffed by nurses on a one nurse to three patient ratio and staff told us that stable patients only were located on this corridor,” according to the CQC report, which was published today.
“Should a patient’s condition deteriorate the nurses would swap the patient with a more stable patient in the majors area,” it said. “No incidents had been reported as a result of this arrangement; however, this is a poor patient experience.”
Despite the pressures, inspectors highlighted that staff in the emergency department continued to deliver compassionate, professional and respectful care.
“Staff in the emergency department remained professional and capable while under considerable pressure in a full to capacity and pressured environment,” stated the report.
“They were seen to take the time to speak with patients and those close to them in a respectful and considerate way,” it said. “We saw staff delivering compassionate care and treating patients with kindness, dignity and respect.”
The inspection, which took place in February and March this year, also flagged up wider trust issues including a lack of recognition that pressures in A&E were a problem for the hospital as a whole.
“There was no sense of urgency to resolve this,” said Professor Richards. “The bed management meetings were not as well attended as they should be. The flow of admissions and discharges was not on everyone’s agenda.”
“Our staff have worked incredibly hard to shore-up the department”
Trust chief executive James Rimmer said he fully accepted the CQC’s findings and that urgent and emergency care services were “not sustainable in the way they are currently organised”.
He said the A&E department had been “fragile for years” due to severe challenges in recruiting senior doctors to staff the department round the clock, seven days a week.
“Our staff have worked incredibly hard to shore-up the department but, despite significant efforts, we just can’t recruit enough permanent doctors and are very dependent on temporary and locum staff,” he said.
“That isn’t sustainable for such a highly specialist clinical team and poses an intractable problem for the trust,” added Mr Rimmer.
He announced that the trust was closing A&E from July 4 between 10pm and 8am “because we can’t provide safe staffing levels overnight from then”.
“This is not an easy decision to make, but patient safety is our number one priority,” he stated.
Sir Mike Richards
The department will remain fully open during the day between 8am and 10pm. The trust said this period was when about 80% of people who use Weston General’s A&E tend to turn up.
Trust medical director Peter Collins said the issue was not simply about not having enough staff, but the fact “we need a permanent team to lead and develop our urgent and emergency care service”.
“A temporary overnight closure gives us time to work with local GPs, community services, social care colleagues and neighbouring hospitals to strengthen, redesign and rebuild our urgent and emergency care service in North Somerset,” he said. “It is our ability to recruit that is our challenge, not our ability to care.”
He added that neighbouring hospitals, out-of-hours GPs and the ambulance service would work with trust staff to ensure patients needing urgent and emergency care were seen and treated when the department was closed.
While urgent and emergency care services at the hospital were rated as “inadequate” by the CQC, medicine and older people were rated “requires improvement”, and surgery and critical care were rated as “good”. Overall, the regulator judged Weston General Hospital as “requires improvement”.