Sandwell Health Campus

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service is not performing as well as it should, and we have told the service how it must improve.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 3 patients along with relatives and they told us they had experienced long delays in the department. Some had been waiting for many hours on the corridor waiting for a bed on a ward.

Most staff said they attended daily handovers within the department to get an overview of activities and issues for the day; however, we noted that not all staff including medical staff and nurses attended the huddles. We saw evidence of this in daily notes recorded, that were made available for staff to view.

Staff also attended some team meetings where they had an opportunity for shared learning and had one to one meetings with managers where they could discuss personal development.

During our assessment we were not assured that all staff within the department had full awareness of recent concerns and actions within the department.

The provider mostly shared lessons learned when things went wrong.

There were systems in place to identify when things went wrong. Incidents were investigated and the learning was shared with staff at team meetings. However, some staff said they did not always hear about incidents they had reported.

Staff felt they were encouraged to raise concerns and report incidents through the hospitals online reporting system. Not all staff received feedback from their reported incidents.

Staff received a structured induction on commencing employment. Staff we spoke with had received this induction and spoke highly of the programme.

Mandatory training for all staff was a mixture of face-to-face and online learning with modules such as equality and diversity, information governance, fire training, infection control and manual handling.

The trust used an electronic staff record system which alerted staff via automatic email when their training was due for renewal to remind them to book a session. However, staff could not always access training. Staff told us that while trust development opportunities were good, they struggled to attend training sessions due to staff shortages. Examples were given where staff members were stopped from attending training sessions to backfill shifts. Staff were then struggling to access the training. This meant that staff had not updated their skills and knowledge, which could affect their responses in an emergency or when performing those tasks related to the training.

Managers we spoke with told us that the trust were offering staff the opportunity to attend development sessions on bank shifts. However, none of the staff interviewed were aware of this initiative. The trust had a monthly half day where all elective activity was cancelled to provide clinical teams with protected learning time. These were known as quality improvement half days (QIHD). Each month there was a shared learning topic which all teams had to view and discuss, with some specific questions posed. However, the paediatric sessions were held predominately at the Sandwell Hospital and as such staff working at City Hospital could not always attend.

The trust’s sepsis policy did not guide staff to additional information. This could be accessed via the intranet. However, we found that the policy on the intranet referred staff to the sepsis pathway, sepsis screening tool and sepsis six treatment. We saw information boards detailing how to manage sepsis. Sepsis training was included in the basic life support module including the use of sepsis screening tools and use of sepsis care bundles; care bundles are a group of best evidence-based interventions which when instituted together, gives maximum outcome benefit.

Staff gave mixed feedback about the systems in place to deliver safe care.

Staff told us the clinical streaming process had recently changed and was helpful in managing the flow of patients through the emergency department (ED). However, some staff were concerned that although the nurses were fully qualified and received training in clinical streaming, not all of them were trained or experienced in emergency care. We were informed that streaming staff were commissioned by the integrated care board and were not the trust employees. The integrated board is statutory organisations that bring NHS and care organisations together locally to improve population health and establish shared strategic priorities within the NHS.

Staff told us that patients awaiting a mental health review once medically fit sometimes waited more than 100 hours to be seen by a mental health doctor or for a bed in a mental health facility. This meant that cubicles were often filled by patients who were medically fit but who couldn’t be sent home.

Staff also told us that patients often waited many hours to be seen by a speciality doctor such as the surgical team, and this often contributed to congestion within the department. When we visited, we saw that all cubicles were occupied by patients waiting to be seen by various speciality teams. This meant that some patients arriving at the department that required treatment within a cubicle were unable to access proper care and had to wait within the admission area.

The service had processes in place to manage clinical risk for people attending the ED. There was an area to rapidly assess patients being brought by ambulance whereby initial assessment was made by medical staff.

Patients who arrived on foot were booked in by a receptionist and seen by a clinical streaming nurse within minutes to quickly assess the best service to treat the patient. For example, patients may be referred directly to other urgent services within the trust or remain in ED where they received a face to face triage with a qualified nurse trained in triage procedure usually within 15 minutes of arriving as per the Royal College of Emergency Medicine. Patients who were most sick were prioritised and cared for in an area appropriate to their needs.

Patients who presented with a mental health issues received a mental health risk assessment as part of the triage process. If required, the mental health liaison team assessed people once they had received medical treatment and were deemed medically fit. However, there was sometimes a long wait for patients who were awaiting a bed in a mental health facility or for a review by a mental health doctor from the local mental health hospital. Psychiatric liaison teams offered a 24 hour service.

We saw that risk assessments were conducted routinely for patients as part of the triage process. This included a mental health risk assessment, however, if a patient appeared to lack capacity, nurses were unable to conduct a basic mental capacity act (MCA) assessment and waited for a doctor or the mental health liaison team to complete this.

There was no dedicated room to care for patients with a mental health disorder, however, staff had made a cubicle safe for patients which was within sight of the nurses station. Where the mental health risk assessment indicated a patient required 1:1 care, this was usually provided by agency staff within an hour of making the request.

Staff told us they had received safeguarding training and knew how to recognise abuse and how to report this. They gave examples of how they managed a safeguarding concern, and we observed comprehensive management of this when we visited.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients and relatives told us they were waiting long periods on corridors, but staff were attentive.

Staff told us they regularly experienced restrictions to flow within the department and cared for up to 4 patients in the corridor due to lack of capacity. However, the trust were moving all the ED facility to a new purpose-built hospital nearby which would provide more space. Many staff said things will be different once they move to the new hospital, but many also told us having a new bigger hospital would mean an increase in activity.

We saw that the department was sometimes crowded and that people waited for long periods in the main waiting area. There were designated waiting and observation areas for people being cared for with intravenous fluids, however, there were occasions where people who were potentially quite sick were having to wait in the main waiting area. Nurses observed people and conducted regular physiological observations to recognise the deteriorating patient, and they would then be moved if required to a higher level of observation area.

There was no dedicated mental health room. Staff used a cubicle near to the nurse’s station which they had made safe, in compliance with regulations and was in full view of staff.

The children’s area had 4 cubicles and a main waiting area which was appropriate for children. There was no resuscitation room or trolley in the area, however, staff told us there was always a dedicated children’s trolley available in the main resuscitation room nearby. We saw that this was safe and there had been no incidents.

Staff said there were usually enough staff to provide safe care. This included medical and nursing staff. However, nurse managers also said that there were often long waits for some specialist doctors to review patients as they were busy elsewhere within the trust. This led to overcrowding within the department and patients waiting longer in the waiting room to be seen.

Senior staff told us that the trust had undertaken a recruitment drive and that 4 paediatric emergency doctors had been recruited. One had already started and the other 3 were to start in October at the new hospital. However, the medical staffing levels for paediatrics was safe at the time of the assessment.

We observed the department to be well staffed with a suitable mix of qualified and support staff. There were medical staff always present in the main department.

The children’s area had medical staff assigned who attended when required. Doctors were not always paediatric trained doctors but had access to paediatric consultants for advice when needed.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.