The Care Quality Commission (CQC) has downgraded the ratings of urgent and emergency care and medical care at The Queen Elizabeth Hospital in Kings Lynn, Norfolk from good to requires improvement following an inspection in April.
The Queen Elizabeth Hospital provides medical services across north and west Norfolk, north Cambridgeshire and south Lincolnshire.
The unannounced inspection was carried out at the hospital, which is run by The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, due to concerns CQC received about emerging risks.
Following the inspection, CQC rated urgent and emergency care as requires improvement for safe, effective and well-led, down from good. Responsive has been re-rated as requires improvement, while caring was rated as good.
The ratings for how effective, caring and well-led medical care at the hospital is have dropped from good to requires improvement. Safe and responsive have been re-rated as requires improvement.
The overall rating for The Queen Elizabeth Hospital remains requires improvement.
Inspectors found one breach of regulation in urgent and emergency care in relation to dignity and respect.
Inspectors also found six breaches of regulation across both urgent and emergency care and medical care relating to safe care and treatment, documentation of mental capacity assessments, mitigation of identified risk, mandatory training compliance, lack of medicines management and good management.
CQC also issued two warning notices following the inspection to highlight the urgent improvements needed to keep people safe and improve management of the services.
Sarah Ivory-Donnelly, deputy director of hospitals in the East of England, said:
“When we inspected The Queen Elizabeth Hospital, we found the safety and quality of care across both services had declined. The trust also needed to do more to reduce waiting times in urgent and emergency care.
“In urgent and emergency services, people and their families were positive about the care they received and told us staff treated them with kindness and respect. However, they felt that communication around waiting times could be better. During the inspection it was clear the department wasn’t meeting its 15-minute triage target, something that was also flagged as an area for improvement in our last assessment.
“We observed that people had to wait a long time to be seen within the department which impacted on their experiences and outcomes. Staff also weren’t monitoring people’s risk of deterioration in a timely and consistent way, and we had specific concerns around how staff stored and monitored medicines.
“People told us that while staff in medical care were kind and caring and did their best to provide care, they were clearly busy. There weren’t always enough staff to meet people’s needs and people had to wait for assistance when they used call bells. People also had to wait for pain relief at times due to low staffing levels.
“While staff understood how to raise concerns and report incidents and were encouraged to do so, many felt that this was used as a punitive measure and leaders didn't always use this information to encourage learning. We found that not all reportable incidents were submitted such as falls on the acute medical unit, which limited opportunities to prevent avoidable harm to people.
“We have told the trust where it needs to make further improvements and will continue to monitor the service to ensure people stay safe while this happens.”
Inspectors found in urgent and emergency services:
- Staff weren’t always fully compliant with their mandatory training including safeguarding training for adults and children, which could affect their ability to identify and respond to risks and keep people safe.
- Leaders hadn’t always made sure equipment was serviced and it wasn’t clear if it was fit for purpose, putting people at risk of harm.
Inspectors found in medical care:
- People didn’t always have sight of their care plan and weren’t aware of how to personalise it to meet their individual needs.
- Staff completed risk assessments when people were admitted to the service but didn’t always mitigate identified risks for people they cared for.
- Staff were given time to complete mandatory training to maintain high-quality care, but compliance was poor for 10 of the 29 topics.
- Leaders didn’t have oversight of staff performance to ensure internal standards were being met, and systems weren’t effective in identifying or addressing areas for improvement.