The Care Quality Commission (CQC) has told Gloucestershire Hospitals NHS Foundation Trust that improvements are needed at Gloucestershire Royal Hospital’s emergency department.
CQC carried out a focused inspection of the emergency department in March as part of its winter pressures programme, which looks at whether a service is safe, responsive and well-led.
Following this inspection, the overall rating for Gloucestershire Royal Hospital’s emergency department went down from good to requires improvement. The rating for safe also went down from good to requires improvement, responsive remains unchanged and is requires improvement, and well-led also stays the same, and is good.
This inspection does not impact on the overall rating for the whole hospital which remains good. The individual domain ratings for the hospital also remain unchanged; safe, effective, caring and well-led are good, responsive is requires improvement.
Cath Campbell, CQC’s head of hospital inspections, said:
“During our inspection, it was clear that staff within Gloucestershire Royal Hospital’s emergency department were delivering patient focused care in incredibly challenging circumstances.
“However, we did have concerns regarding the flow through the emergency department, as unprecedented numbers caused by the COVID-19 pandemic meant that some patients were being treated in corridors in the department. We were assured by the trust’s rapid response to address this issue. We were also aware of the efforts to support the ambulance service in minimising handover times.
“The trust's leadership are aware of the issues we highlighted to them and were working to ensure improvements were in place and thoroughly embedded. We will return to check on the improvements made. In the meantime, we will continue to monitor the service closely to ensure that these improvements are on track.”
During the inspection, CQC found:
- The reconfiguration and use of some areas of the department did not always keep patients and staff safe, despite the efforts the service had made during the pandemic. Inspectors were concerned about crowding in the department, which did not promote safe social distancing
- Patients’ dignity and respect were compromised, and social distancing was not always possible because patients were cared for in corridors of the department
- Patients did not always receive care and treatment promptly, despite significant efforts which were made to keep them safe. Pressure from high demand and COVID-19 restrictions, meant that patients attending the emergency department did not get seen in a time considered to be safe and responsive to their needs
- Patients could experience long delays in handovers from ambulance crews. These delays can cause harm to patients, lengthen response times and delay ambulances needed in the community. However, staff were actively looking for improvements and short and long-term solutions, both internally and externally with system partners.
There were also many positive findings to report:
- Staff understood how to protect patients from abuse and acted on any concerns
- Staff kept detailed and comprehensive records of patients’ care and treatment
- Leaders in the emergency department understood and managed the priorities and issues the service faced. They were supportive, caring and approachable in the service for patients and staff
- Staff in the department felt respected, supported and valued by their colleagues. They were focused on the needs of patients receiving care
- There were strong examples of staff feeling able to speak up and raise concerns without fear. There were effective systems to recognise, report and understand performance
- The department had resolved several patient flow problems (this relates to a patient’s treatment from the front door to the ward).
Full details of the inspection are given in the report published on our website.
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