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Trust's A&E safety rating downgraded after concerns

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A teaching trust in Merseyside has had its rating for the safety of urgent and emergency services downgraded to “requires improvement” by the Care Quality Commission, with unsafe nurse staffing levels among the concerns raised.

The safety of A&E and urgent care services at Aintree University Hospital NHS Foundation Trust had previously been rated “good” after a full inspection in 2014, but the regulator returned unannounced in April this year, following concerns.

“Nurse staffing levels were lower than the safe recommended amount”

Mike Richards

As a result of the follow-up visit, the trust has now been given a “requires improvement” rating for patient safety in A&E and urgent care. However, it has retained its overall “good” rating as an organisation.

The latest visit focused on several areas including the emergency department, observation unit, acute medical unit and a frailty unit. 

Staffing levels were among the key concerns raised, according to the regulator’s report on the inspection, which was published on Tuesday. 

“Nurse staffing levels were not always filled to the safe staffing establishment, and staffing was below this threshold on the surgical assessment unit, ward 31 and in the accident and emergency department at the time of the inspection,” it said.

“There were periods of understaffing over a number of days prior and post inspection and there was evidence that staff had raised staffing concerns using the incident reporting process,” it added.

The regulator said it was also concerned that processes for recognising and escalating the care of deteriorating patients were not always followed, which put people at risk.

CQC chief inspector of hospitals Professor Sir Mike Richards said: “At our previous comprehensive inspection in May 2014 we rated Aintree University Hospital’s urgent and emergency services as Good for being safe. We have re-inspected these services as a result of concerns that were raised with us about their quality, and we have now rated them as Requires Improvement for safety.

Sir Mike Richards

Sir Mike Richards

Sir Mike Richards

“We were concerned upon inspection, that the processes in place for recognising and escalating the care of deteriorating patients were not always followed which put people at risk,” he said. ”We reported these urgent concerns to senior staff at the trust at the time of inspection and actions were put in place to address this issue. We have been monitoring these actions regularly to make sure improvements were being made.”

“We also saw that nurse staffing levels were lower than the safe recommended amount. We do acknowledge that the trust was taking action to address the nurse vacancy rate but it remained evident during our visit that the wards were not always staffed as they should be,” he added.

Aintree University Hospital NHS Foundation Trust is a large teaching hospital with 706 inpatient beds serving a population of around 330,000 in North Liverpool, South Sefton and Kirkby. The hospital provides care and treatment for people living in some of the most deprived areas in England.

Aintree was one of 63 trusts flagged by NHS Improvement in July as warranting questions about potential over-recruitment. This was based on the trust’s pay bill growth, which NHS Improvement said would need further investigation to determine whether the growth was necessary.

  • This story has been updated to state that the trust retained its overall “good” CQC rating. An earlier version was incorrect. It was downgraded specifically within the safety domain for urgent and emergency services.
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