Despite the criticisms and concerns, the CQC was positive about three areas
Urgent and emergency services at a major Merseyside hospital have been told they require improvement following an inspection in March. Staff also reported to inspectors “low morale due to a stressful working environment” and “overcrowding meant people’s dignity and privacy was being compromised.”
The Care Quality Commission (CQC) visited Wirral’s only emergency department at Arrowe Park Hospital after concerns were flagged about the emergency department. The A&E hospital, visited by 8,500 people a month, was told its emergency services as well as safety and responsiveness required improvement though ratings for the effectiveness, level of care, and leadership were rated good.
One patient who spoke to the CQC said corridor care “shouldn’t be happening” and “staff taking bloods in the middle of a waiting room and privacy screens weren’t always used around people on trolleys in the corridors.” Wirral University Teaching Hospital NHS Foundation Trust has previously defended corridor care arguing this allows for ambulances to be discharged back out to the community.
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However senior leaders were found to be visible and approachable to staff and Wirral University Teaching Hospital worked closely with the local mental health trust to properly assess people coming into A&E with mental health needs. The CQC also noted several projects underway to improve care.
One of the CQC’s deputy directors Karen Knapton said: “We found staff were doing their best in a busy, high pressure environment with significant safety risks because of overcrowding.
“Staff told us overcrowding meant they weren’t functioning as an effective emergency department and people were being cared for in areas not designated for care and treatment. Leaders were also struggling to mitigate the risks of staff shortages due to a high rate of sickness absence.
“Leaders had a plan to safely manage the number of people in the emergency department, but we found this wasn’t always being followed. On both visits during the inspection, people were being treated in corridors in the emergency department as well as in the main hospital corridor.
“The ambulance arrival zone was also used for additional beds due to challenges of patient flow through into the main hospital. Staff told us many people in the department were waiting for a medical review, or to be transferred to a hospital ward, rather than for emergency care.
“Although people were assessed quickly on arrival, staff didn’t always check for signs of deterioration if people were sent back to the waiting room. Staff working to triage people were often called away to help with other areas so there wasn’t always somebody with consistent oversight of the condition of people in the waiting room.
“Staffing issues were also having a knock-on effect on other healthcare partners. The local ambulance trust staff told us they often had to wait and monitor patients they dropped off at Arrowe Park, which was reflected in what we saw. This was preventing some ambulance crews from responding to other emergency calls.
“Despite these challenges, people in the emergency department gave mostly positive feedback about staff. When we spoke to people who were receiving treatment in corridors they hadn’t all been told how long they would be in the corridor, but they knew whether they were waiting to be moved to another hospital bed or if they were going to be discharged. We also saw staff using accessible language tools to communicate with people.”
Dr Nikki Stevenson, Deputy Chief Executive and Executive Medical Director at Wirral University Teaching Hospital, said: “We thank the CQC for their inspection as we continually improve our emergency care services. They have acknowledged that we have already begun addressing issues identified.
“They also referenced building work which causes short term challenges during the construction of a multi-million pound Urgent and Emergency Care Facility being built while the Emergency Department remains open. It will offer a greatly improved experience for patients.
“To be rated as ‘Good’ in three out of five domains is extremely positive. This includes a ‘Good’ rating for being Effective, Caring and Well-led and this is a testament to the continued hard work of our staff and the care they give to patients.
Dr Stevenson said the trust also scored ‘better’ for how well patients were kept informed about their wait and what would happen next, involvement in decisions around their care, and staff discussing with patients whether they needed health or social care services after leaving A&E.
Referencing high levels of people attending A&E, she said: “Unplanned care across the wider healthcare system created a real pressure point in the Emergency Department when the inspection was carried out in March, resulting in CQC inspectors requiring more assurance around the Safe and Responsive domains which remained as ‘Requires Improvement’.
“The CQC inspection report is critical of the practice of providing care to patients in the corridor of the hospital. This is an issue of national significance not isolated to our department and is as a result of a number of factors including our commitment to release ambulance crews back into the community to attend to those in need, unplanned care demand and bed occupancy.
“We understand the concern and we are working with local partners, NHS England and the Advancing Quality Alliance to improve pathways for patients into the department to mitigate against the concerns that accompany care being provided within corridors.
“As part of our winter planning, we are creating additional bed capacity which will help to reduce corridor care. Going forward, our integration plans with Wirral Community Health and Care Trust will improve and streamline care to the residents of Wirral, including those requiring urgent and emergency care. We remain committed to providing the best care to the communities we serve.”
