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CQC warns Mid Essex Hospital Services NHS Trust that it must improve Urgent and Emergency Services
The Chief Inspector of Hospitals has warned Mid Essex Hospital Services NHS Trust that it must make significant improvements to the quality of the healthcare provided to patients who use the Urgent and Emergency Services at Broomfield Hospital at Chelmsford.
The Care Quality Commission has issued a warning notice to the trust after concerns were raised around the flow of patients through the A&E department, whether care was being provided soon enough, and whether patients received sufficient pain relief. Concerns were also raised about patients who arrived by ambulance waiting too long to be being taken into the hospital. The inspection in April was the third inspection in less than a year in response to concerns.
Following the inspection, the Urgent and Emergency Services have been rated as Inadequate, although CQC found the service Good for Caring.
A full report of the inspection is available at www.cqc.org.uk/location/RQ8L0.
CQC has now asked the NHS Trust Development Authority to provide a package of support at executive level to ensure the trust addresses the longstanding issues which inspectors have identified as risks to patients.
Inspectors found that the emergency department was disorganised, with patients commonly experiencing delays in their care and treatment, with several people having to wait for more than 12 hours in the department.
The service did not protect patients from avoidable harm because staffing levels were not sufficient. Infection control practices in the emergency department were poor and concerns remained regarding the care and treatment for patients with mental health conditions.
Pain relief was not being monitored or provided effectively. Guidelines on sepsis, head injury, stroke, chest pain and fracture neck of femur were not always being followed.
Although patients were treated by caring staff who were dedicated and passionate about their roles, the overall performance in the emergency department had declined. There was a poor culture within the service associated with a fear of failure to meet targets significantly affecting staff morale.
The Chief Inspectors of Hospitals, Professor Sir Mike Richards, said:
"I am concerned that the Mid Essex Hospital Services NHS Trust has not taken sufficient action to address the requirements of our previous inspections, and that patients coming in to the Urgent and Emergency Services continue to experience a poor level of care and treatment.
"The flow through the emergency department, the high number of staff vacancies and the arrangements to triage urgent cases still had an impact on the care patients received, which in some cases was poor.
"On the basis of these findings, I have asked the Trust Development Authority to review our concerns and implement buddy and support systems for the trust to immediately drive improvement in urgent and emergency services and at trustwide leadership level.
"The trust has agreed to submit information to the Care Quality Commission to demonstrate the safety of patients, as well as how effective systems and process are within urgent and emergency services, and we will monitor this information closely and return in due course to check for ourselves.
"If, despite all these measures the trust fails to make sufficient progress I have no doubt that we will take further enforcement action to protect the interests of the people who rely on this service."
CQC has told the trust that it must make a number of improvements including:
- The trust must ensure medicines are administered in a timely way, especially for patients receiving intravenous antibiotics and time-critical medicines.
- Care documentation including care plans and risk assessments must be undertaken in a timely way, accurately, fully completed and reviewed when required.
- Staff training and awareness on mental health must improve so that the provision of care for patients with mental health conditions improves.
- Patients with mental health concerns must be risk assessed on arrival at the emergency department and patients with mental health concerns must be appropriately observed and monitored.
- Staffing levels must be reviewed on the reception desk in the emergency department.
- Resuscitation trolleys must be regularly checked and stocked.
- Staff knowledge and understanding of what constitutes a safeguarding referral for adults must improve.
- All safeguarding referrals for adults in the emergency department must be completed and actioned in a timely way.
- Hand washing techniques and infection control practices and techniques in the emergency department must improve.
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- Last updated:
- 29 May 2017
Notes to editors