You are here

The Princess Royal Hospital Inadequate

All reports

Inspection report

Date of Inspection: 25 April 2013
Date of Publication: 18 June 2013
Inspection Report published 18 June 2013 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 25 April 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. We reviewed information sent to us by other regulators or the Department of Health, reviewed information sent to us by other authorities, talked with other authorities and were accompanied by a specialist advisor.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

People did not always experience care, treatment and support that met their needs because care was not always planned or delivered to meet the individual needs or to ensure the health and welfare of people who used the service.

Reasons for our judgement

Prior to our inspection we met and spoke with other key partners from the health and social care sector and other organisations to gather their views about the hospital. We also spoke with senior members of the trust. Concerns were raised about how the trust was managing the increase in patient flow into and out of the hospital and that pressures on beds had been quite severe. The length of time people were waiting to be transferred to wards or discharged from A&E and the number of operations being cancelled due to increased pressures were also raised. We received concerns from the local authority about the increase in the number of people being referred into the safeguarding process and concerns about poor patient experiences that had impacted on their care and welfare. We were aware of some instances where patients were discharged with a lack of information or the wrong information, or where family or home situations were not taken into account. Information was not always provided in a timely way when patients were discharged to ensure people's safety and continuity of care.

We looked at patient flow across the hospital. A&E was used as a holding area for admissions for medicine and surgery when there were no beds. GP admissions were diverted to A&E. This had inevitably put pressure on the department and led to breaches of the A&E standards. A member of staff told us A&E was suffering from slow discharge into the community from the wards and lack of community support services. We saw the shift co-ordinator in A&E and the co-ordinator for MAU worked closely together to manage flow as well as possible. One member of staff felt that the medical staff moved around too much and the introduction of new doctors always resulted in delays in managing patients. They told us there was a shortage of medical staff in the department and the MAU was too small to accommodate the increasing numbers of patients. We spoke with a community matron in the Medical Assessment Unit (MAU) about their role. They told us they were doing a pilot project reviewing patients that could go home with the support of the District Nursing Team. Their view was that the patients required admission, review and stabilisation prior to discharge. They thought the focus should be on the complex discharges rather than admissions and would be feeding that back to the project lead.

In A&E we observed medical and nursing staff being attentive to patients’ needs when they were first assessed and treated. One patient told us, “They have been very efficient.” Another patient told us, “I’ve been here (in the cubicle) ages and ages and I don’t know who’s seeing to me, I’m fed up”. Although we had received concerns about patients being treated in inappropriate places (trolleys in corridors), we did not observe this during our inspection. The department was quiet and people were assessed and treated in cubicles.

We spoke to patients about their experiences of moving from A&E to other parts of the hospital. Patients should not wait for more than four hours in A&E before being discharged or transferred to a ward. The trust has experienced a high number of breaches to this target since January 2013, including one major incident being declared. Some patients told us that they had experienced long waiting times. One patient described their journey through A&E as, “Bedlam”. They told us they were waiting in the bay for hours and then moved to MAU, which was also very busy. They told us that patients were being moved in and out all of the time and said that the staff were, “Rushed”. One patient told us they had been, “Hours in A&E waiting for a bed to become available”. Another patient told us they had been transferred from A&E where it had been “Hectic” and they had been, “Stuck on a trolley for hours”. They said, “The care has not been bad however”. During our visit to A&E we did not observe any delays and patients told us that on their arrival the