Updated 19 January 2022
We carried out this unannounced inspection of urgent and emergency care and medical care services provided by University Hospitals Plymouth NHS Trust as part of our continual checks on the safety and quality of healthcare services, because at our last inspection we rated the trust overall as requires improvement, and because we received information giving us concerns about the safety and quality of the services.
We also inspected the well-led key question for the trust overall.
Our overall rating of services stayed the same. We rated them as requires improvement because:
- We rated caring as outstanding, effective as good, and safe, responsive and well led as requires improvement.
- We rated medical care as requires improvement.
- We have not rated the urgent and emergency care core service because of the pressure the emergency department was under at the time of inspection. As such we were not able to see the totality of the service.
- In rating the trust, we took into account the current ratings of the seven services not inspected this time.
Our inspection found significant concerns and challenges in urgent and emergency care and medical care, largely impacted by challenges within the wider health and social care system. Because of our concerns, we placed conditions on the trust’s registration requiring them to take action with the health and social care system to improve patient safety and experience. We took this action because:
- Services were not meeting the needs of patients. Patients did not always have timely access to services.
- There were continually patients being cared for in ambulances outside a crowded emergency department. Patients in the emergency department could not be moved promptly to medical and surgical wards because there was no capacity. Patients could not be discharged in a timely way.
- Patients were not always cared for in the best place for their treatment needs. Specialty patients were often cared for on non-specialty wards.
- There were not always enough staff with the right skills, training and experience to keep patients safe and to provide the right care and treatment.
- Social distancing was not always possible and pathways designed to reduce cross-infection could not always be followed.
However:
- Equipment and premises were visibly clean and clinical waste was managed well.
- Staff, while under immense pressure, worked hard to provide compassionate care to patients and to involve patients and those close to them in care and treatment decisions.
- Leadership had strengthened and although there was more still to be done to develop local leaders, staff felt supported by their local managers.
How we carried out the inspection
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.