The Care Quality Commission has found improvement in the services provided by Great Western Hospitals NHS Foundation Trust in Swindon.
Inspectors visited the hospital in March to review the progress made by the trust following an inspection in October 2015. At the time CQC issued a Warning Notice requiring improvements in the hospital’s emergency department.
Following this latest inspection the trust have been rated as Good for being effective, caring and well led, and Requires Improvement for being safe and responsive to people’s needs. CQC did not change the overall rating of the trust following this focused inspection - which remains at Requires Improvement.
There were areas of improvement in most areas. But further progress is still required.
During the inspection in in October 2015 CQC found the trust had struggled to manage the flow of patients through the main hospital. Patients could not be discharged because there were no suitable places for them to go to. Within the emergency department the design and layout meant that waiting patients, including children, were not adequately observed.
At this inspection in March CQC found that the trust board understood the significant challenges and had taken action to address them. The leadership team had developed a clear vision for improvement with realistic goals.
The urgent care centre was working in partnership with medical care, surgery, services for children and young people and outpatients and diagnostic imaging to improve patient admissions and flow through the hospital.
A number of steps had been taken to improve patient flow, which was still in need of improvement. This included moving the ambulatory care service to increase capacity and the introduction of a medical expected unit. There were also effective patient flow meetings to establish who could be discharged safely.
The Emergency Department was often full but staff worked hard against this challenge to ensure safe care could be maintained as much as possible. But there were times that it was not safe because of the number of people in the department.
In all areas feedback from patients was consistently positive. Care was described as being compassionate and involved patients as partners. Staff also discussed with patients how they were supported to cope emotionally with their care.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“I am pleased that we have found improvement in those areas that we had identified as a priority during our last comprehensive inspection. However it is clear that this is work in progress – and further work is needed."
“I am aware that there are wider challenges within the local healthcare system in Swindon – particularly in the provision of primary and community services – which are creating pressure on the hospital at a time when demand continues to rise."
“We know that the trust has been working strategically with local partners to shape long term improvements on these issues, as well as acting internally to improve the safety and responsiveness of the service. Both approaches are vital."
“I am confident that the trust is heading in the right direction. But this is of little comfort to someone who finds themselves today waiting for urgent attention in an overcrowded emergency department. We will continue to monitor the trust closely and return in due course to check their progress.”
The inspection has identified a number of areas where the trust still needs to make improvements including:
- The trust must ensure that the emergency department observation unit is sufficiently staffed to keep people safe.
- The provider must continue to develop and initiate plans and work streams in line with the improvement plan to improve flow in the emergency department as pace to improve safety and patient flow in the department.
- The trust must ensure that there are clear pathways in medical care, including staffing levels, regarding the care of patients who required non-invasive ventilation staffing levels on surgical wards must meet expected standards in line with hospital guidelines to keep patients safe.
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