A South East London hospital has been criticised by inspectors over “instances of poor care” on medial wards and long waits in its accident and emergency department.
The Care Quality Commission has told the Queen Elizabeth Hospital in Woolwich that it must make improvements to the emergency department and medical care.
“We observed some instances of poor care on the medical wards”
The regulator rated both as “requires Improvement” following its latest inspection in June, which was sparked by concerns raised by patients and a high number of safeguarding incidents.
Queen Elizabeth Hospital, which is part of Lewisham and Greenwich NHS Trust, provides hospital services for people living in Greenwich, Bexley and other neighbouring boroughs.
During a full inspection in February 2014, the trust was rated as “requires improvement” overall, with the A&E department being rated as “inadequate” and medical care as “requires improvement”.
In June this year, inspectors found some progress had been made in A&E, including an improved pathway to the urgent care centre, opening a clinical decision unit and a frailty assessment unit.
However, inspectors found some aspects of the service had not improved. Rapid assessment and treatment was not being provided for all patients, and vital signs were not always monitored.
Patients were seen being cared for in chairs – and in public corridors – and were experiencing long waiting times in the emergency department, said the CQC’s latest report on the trust.
“Patients who wanted to wash their hair often had to wait considerable lengths of time”
The trust had introduced some initiatives to help improve patient flow, including a discharge lounge. However, on the first two days of the inspection, the CQC found the discharge lounge was being used as overflow area for patients who were unwell rather than those who were ready for discharge.
On the medical wards, inspectors observed “some patients being treated with a lack of kindness”, said the CQC. “We were told by patients and staff of some instances of poor personal care being given and support for patients with dementia was limited,” said the inspectors.
Examples cited in the regulator’s report included patients in some areas without access to regular showers and short staffing in some areas resulting in a ”reduction in the ability of staff to meet the personal needs of patients”.
For example, on ward 18 patients who wanted to wash their hair often had to wait considerable lengths of time because there were not enough staff to help them, said the report.
Meanwhile, in the acute medical unit, some patients who were able to use commodes had to wear incontinence pads instead, because staff were too busy to help them. “This had a significant impact on dignity and personal wellbeing,” stated the CQC report.
The inspectors said they also saw a number of staff speak or interact with people in an “unacceptable manner” and some patients told them of a lack of involvement in their care and poor communication from staff, such as not being told why they needed a test.
Professor Sir Mike Richards, the CQC’s chief hospital inspector, said: “We witnessed long waiting times in the emergency department. The emergency department was full and patients were being cared for in public corridors and transferred to areas that did not meet their needs.
“We observed some instances of poor care on the medical wards,” he said. “The leadership in medical services was variable. Some of the problems we found were not being adequately managed.
“It is disappointing that these shortfalls remain. The trust needs to come back with a plan which addresses these issues in full,” he added.
Queen Elizabeth Hospital provides a full range of adult, elderly and children’s services across medical and surgical disciplines and has just under 500 beds.
In 2015-16 150,219 patients attended the emergency department and in 2015 medical services treated 30,525 patients.
Claire Champion, the trust’s director of nursing and clinical quality, said: “The examples of poor care which are described in the CQC report are not acceptable and I was extremely disappointed when I learned about them.
Hospital warned over ‘lack of kindness’ to patients
“Since the CQC visit, our senior nursing team and I have worked with our colleagues to address the concerns highlighted in the report,” she said. “We have also strengthened how we monitor standards of inpatient care through our quality ward rounds.
“I have emphasised that I consider it to be gross misconduct and a failure of nursing care for patients to have to wear incontinence pads as staff say they not have time to take them to the toilet, or for patients to have to wait such a long time to get their hair washed,” she said.
She added: “The few examples of poor care cited in the CQC report do not reflect our overall standards as an organisation, or general performance across the trust. As well as noting many cases of good care the CQC report praises the caring attitude of our emergency department staff.”