The Care Quality Commission (CQC) has again rated urgent and emergency services at Cumberland Infirmary, run by North Cumbria Integrated Care NHS Foundation Trust as requires improvement.
CQC carried out the inspection in February and March as part of its winter pressures programme. Inspectors found breaches of regulation regarding safe care and treatment, premises and equipment, staffing and how the service is managed.
Following the inspection of the emergency department, a warning notice was issued to the trust due to significant concerns about the safe care and treatment of people using the service. The notice required the trust to focus on making immediate improvements in this area. A condition was also imposed on the trust to ensure CQC were kept informed of all changes in the department.
Following the inspection, CQC has dropped the rating from requires improvement to inadequate for being safe, caring has declined from good to requires improvement, and responsive, effective and well-led are rated as requires improvement again.
Roger James, CQC director of operations in the north-east, said:
“When we inspected urgent and emergency care at Cumberland Infirmary, we found staff were kind and working hard to meet people’s needs under considerable pressure, but leaders needed to mitigate risks to ensure the department ran smoothly even at very busy times.
“We saw concerns identified at the last inspection still hadn’t been resolved which continued to place people at risk. For example, the system used to direct people to appropriate services once they’d arrived in A&E was ineffective, meaning there were more people waiting than staff had the capacity to manage.
“People reported concerns over delays and lengthy waits, and staff weren’t monitoring people properly, including those at risk of deterioration or people with mental health needs. Additionally, people often remained on chairs and trolleys for prolonged periods due to a lack of beds and treatment areas.
“Additionally, there weren’t enough cubicles to accommodate demand with several people being cared for in temporary escalation spaces. These environments didn’t always have call bells and didn’t support people’s privacy and dignity. Nurses were unable to maintain continuous observation of these areas meaning they wouldn’t be able to respond quickly if someone’s condition deteriorated.
“Despite these challenges, we also saw examples of effective multidisciplinary working within the department. For example, physiotherapists worked hard to ensure people returned home safely with appropriate equipment and community support, reducing the need for re-admission.
“We have told leaders where we expect to see other rapid, and continued improvements and will continue to monitor the service closely to keep people safe during this time.”
Inspectors found:
- The department appeared visibly dusty and, in some areas, unclean. Resuscitation bays and temporary escalation spaces were cluttered with equipment which reduced the ability to clean these areas effectively.
- Staff didn’t ensure people had individualised care plans in place to support their ongoing needs.
- Leaders needed to address the significant backlogs of incidents that hadn’t been reviewed or investigated yet.
- The service didn’t have a dedicated toilet, baby changing or breastfeeding facilities within the paediatric area.
- Staff didn’t always follow good hand hygiene practices or bare below the elbow principles.