The Care Quality Commission has told Great Western Hospitals NHS Foundation Trust that it must improve its acute services, especially for accident and emergency patients.
Overall, the trust was rated as “requires improvement”, although it was rated “good” for caring following the CQC’s latest inspection in October.
“There were particular concerns with staffing levels and how this compromised patient safety in the emergency department”
The main acute hospital in Swindon was rated as “requires improvement”, with maternity and gynaecology services and end of life care rated as “good” overall.
All four of its community services inspected were rated as “good” in all key questions, with services for children and young people rated as “outstanding”.
Inspectors found the trust had struggled to manage the access and flow of patients through the main hospital, according to reports published yesterday by the regulator.
Despite having a bed occupancy rate higher than the England average, there were fewer cancelled operations than the average.
But there were high numbers of patients who could not be discharged because there were no suitable places for them to go to. While not designed for that purpose, the day surgery unit was frequently used to accommodate patients overnight, noted the CQC.
There were concerns with staffing and how this impacted upon patient safety. Within the emergency department the design and layout meant that waiting patients, including children, were not adequately observed.
“Many of these challenges were already known to us and are similar to those facing all NHS organisations, for example staffing”
The physical isolation of the observation unit and lack of environmental safeguards posed unacceptable risks to patient and staff safety, said the CQC. Staffing levels did not take into account the requirement to care for patients queuing in the corridor or the sub-waiting room.
There were also concerns about the level of staffing within the children’s emergency department. The midwife to patient ratio did not meet recommended levels and one to one care for women in established labour was not achieved all of the time.
However, the CQC report noted that patients were treated with compassion, kindness, dignity and respect.
Staff within the children and young people’s community teams were focused on the needs of the children and young people, putting them at the heart of everything they did. Care was delivered with empathy and honesty, added the regulator.
The CQC said it had identified 26 specific areas for improvement, including that nurse staffing levels and skill mix must be reviewed in the emergency department including the children’s ED, the ED observation unit and minor injury units.
Sir Mike Richards
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “I know that the trust has been under some financial pressure, and this may well have had an impact on patient care.
“We found a marked variation in the quality of the services between the acute hospital at Swindon and the services based in the community,” he said.
“There were particular concerns with staffing levels and how this compromised patient safety in the emergency department where people were queuing in corridors,” he added.
The organisation provides acute hospital services at the 450-bed Great Western Hospital. It also provides community health services across Wiltshire.
In a response statement, trust chief executive Nerissa Vaughan said: “Many of these challenges were already known to us and are similar to those facing all NHS organisations, for example staffing, a key priority for the trust going forward.
“Although we have made steady progress in this area with more than 200 extra nurses on our wards compared to this time last year, the coming months will see us build on our local recruitment efforts and extend our search for new staff to the Philippines,” she said.