The Care Quality Commission (CQC) has again rated urgent and emergency care at St Mary’s Hospital as requires improvement, and re-rated medical care as good.
St Mary’s Hospital, run by Isle of Wight NHS Trust, serves an island population of around 140,000 people, with a higher proportion of people aged over 65 than the national average.
An inspection was carried out in February as part of CQC’s continual checks on the quality and safety of health care services. Inspectors looked at urgent and emergency care and medical care (including older people’s care) at St Mary’s Hospital.
As a result of this inspection, inspectors issued a warning notice around the need to ensure effective clinical management of the emergency department waiting room.
St Mary’s Hospital as a whole remains rated good
Urgent and emergency services
CQC has re-rated safe, effective, responsive, and well-led as requires improvement.
Caring was downgraded from good to requires improvement.
The service was in breach of legal regulations relating to safe care and treatment, the environment and overall management of the service.
Medical care
CQC has re-rated caring, responsive, effective and well-led as good.
Safe was downgraded from good to requires improvement.
The service was in breach of regulations relating to safeguarding and an action plan will be requested to address this.
Warning notice issued
Catherine Campbell, CQC deputy director of hospitals, secondary and specialist care in the south west, said,
“At this inspection of St Mary’s Hospital, we found an emergency department where too many people faced long waits in unsuitable environments.
“Inspectors were concerned that staff had limited visibility of the waiting room and wouldn’t be able to respond quickly if people deteriorated. In fact, inspectors had to seek help for some distressed people during this visit.
“We found the trust wasn’t meeting the NHS standard for seeing people within four hours of them arriving at the emergency department. There were also long waits for people who were being admitted to hospital, with some people waiting more than 12 hours for a bed.
“We identified a number of environmental risks that leaders hadn’t addressed. Staff regularly had to place people in corridor spaces, which blocked access to cubicles and could delay timely access in the event of an emergency.
“We were also concerned there was limited evidence the trust was effectively managing ligature risks, with no ligature-free toilets available in the department which posed a risk to people in a mental health crisis.
“Despite these safety concerns, we found signs of a positive culture that the trust can build on to drive forward the necessary improvements. We saw staff worked well together across all grades and worked closely with dementia, learning disability and end-of-life care teams to provide person-centred care and avoid unnecessary admissions. Leaders had also ensured staff felt comfortable raising concerns, which is crucial for identifying risks and driving improvements.
“We’ve told leaders where we expect to see rapid and continued improvements and issued a warning notice to focus their attention on the most urgent concern. The trust has since provided an action plan and assurance on addressing this. We’ll continue to monitor this closely to ensure people are kept safe.”
Inspectors found:
Urgent and emergency services
- Leaders hadn’t ensured staff in the emergency department could access information about people’s mental health risks, which put people and staff at risk.
- The service was consistently meeting targets for ambulance handovers, with the majority of these completed within 15 minutes.
Medical care
- Leaders had instilled a positive learning culture where staff logged incidents appropriately and leaders shared feedback about the action taken to reduce the risk of them happening again.
- Staff consistently treated people with kindness, dignity and respect, and were actively involved in decisions about their care.
- The trust didn’t always ensure there were enough staff to meet people’s needs, which meant people couldn’t always receive the 1-2-1 care they were assessed as needing.
- Leaders hadn’t ensured all staff knew how to respond to safeguarding concerns or that they had completed mandatory safeguarding training. This meant staff might not identify or escalate concerns about people at risk of harm, abuse or neglect.
The report will be published on CQC’s website in the coming days.
Trust responds to CQC findings
Penny Emerit, Chief Executive of Isle of Wight NHS Trust, said,
“We fully accept the CQC’s findings, which clearly identify areas where we need to make improvements at pace. While we have made progress, there is more to be done and I’m confident that the positive culture of learning identified by inspectors, alongside the compassionate care delivered by our teams, means that we can make the improvements needed.
“None of us want patients to experience delays or uncertainty around their care and we were already taking steps to tackle this. This includes working with our community, social care, and mental health providers to introduce new pathways to help our patients get the care they need sooner, in the most appropriate place.
“Our focus remains on addressing the areas identified by the CQC and ensuring every patient receives safe, timely and high-quality care. We are committed to continuing to work with our patients, colleagues and health and care partners to achieve this.”
New pathways to speed up care
Steve Thomas, Chief Nursing Officer at Isle of Wight NHS Trust, said,
“It was reassuring to see that despite the challenges faced by our services, patients and their family or carers shared how staff treated them with kindness and dignity, with good communication throughout.
“There is much for us to do to improve, but I am confident that with our teams’ culture of continuous improvement including a reduction of falls, and strong performance in services such as lung cancer care and endoscopy, we have the right people in place to make meaningful improvements for our patients and staff.”
Robertson: I saw for myself people being treated on rows of trolleys
Joe Robertson, Conservative MP for Isle of Wight East, told OnTheWight,
“I am sadly unsurprised by the CQC’s findings in relation to emergency care at St Mary’s Hospital. When I visited earlier in the year, I saw for myself people being treated on rows of trolleys and in unsuitable places like a converted cupboard.
“There were also ambulances parked outside with patients still in them because there was no space in the building. The staff were doing their absolute best in impossible circumstances.
“But the fact remains that one of the biggest contributing factors to this desperate situation is a crisis in social care meaning that people cannot be discharged to a safe home environment and around 25 percent of beds on the wards are occupied by people who do not have a medical reason for being there.
“Until the Government grasps this issue by better supporting our Council the crisis will not be solved. The Island is not a city. The funding rules that apply elsewhere do not work for us and the unique challenges we face.”
News shared by Elaine on behalf of the CQC. Quotes from NHS sought and added by OnTheWight. JR comment sent unsolicited. Ed
