A HOSPITAL'S accident and emergency department is struggling to cope with unexpected surges in demand, inspectors found.
A report published today by the Care Quality Commission (CQC) said improvements were needed at the department at the Royal Sussex County Hospital in Brighton.
Inspectors said the department was consistently not meeting a target of seeing, treating and discharging patients within four hours.
They found two patients had spent more than 18 hours in the department before a bed was found.
Others were left in the care of ambulance staff because the A&E was too busy to admit them.
Inspectors said the problems were partly caused by a lack of beds elsewhere in the hospital.
Sources at the hospital said a high number of bed-blocking patients were adding to the pressures.
These patients are well enough to be discharged but stay because no nursing, care home or rehabilitation bed is available for them in the community or extra support they need in their own homes is not yet available.
Yesterday there were 64 patients waiting to go home at the Royal Sussex – enough to fill three wards.
The A&E results were one of 90 individual ratings highlighted in a detailed report into services run by Brighton and Sussex University Hospitals NHS Trust.
The four possible ratings are outstanding, good, requires improvement or inadequate.
The trust had a mixture of needs improvement and good scores, with responsiveness in A&E at the Royal Sussex the only section to be scored as inadequate.
The trust was given an overall rating of “requires improvement” following the visit by a CQC team in May.
Inspectors studied eight core services at the Royal Sussex and Princess Royal Hospital in Haywards Heath – A&E, maternity, critical care, surgery, medical care, children, end of life and outpatients. Each service was scored on its safety, responsiveness, leadership, caring and effectiveness and an individual rating given for each hospital. Both hospitals were rated overall as needing improvement.
Inspectors said the trust had made significant improvements in some areas in the six months since their last visit but more progress was needed.
They said services were caring and effective and staff communicated with and supported people in a compassionate way.
However the flow of patients from A&E through the hospital was affecting patient care and experience in a number of different departments and wards.
Some patients were being treated on wards which were not specific to their condition and patients were not being discharged fast enough to make room for those coming in.
The report found the trust was taking action to tackle some long-standing cultural issues, including race equality, and there were signs that progress was being made.
Inspectors also identified staffing issues, especially in medicine and surgery.
High usage of temporary staff placed pressure on workers but the trust had increased its employee levels, improved recruitment procedures and vacancies were being filled more quickly than before.
The CQC’s chief inspector of hospitals, Professor Sir Mike Richards, said: “We found that – across the board – staff were working hard to deliver compassionate care to people using trust services.
“I know that there is a significant change programme under way and we saw that senior managers have a clear understanding of the challenges facing the trust.”
Trust chief executive Matthew Kershaw said: “We acknowledge and accept that overall the trust requires improvement.
“The area of challenge which is the most complex and requires the most attention is the inadequate rating we were given for A&E responsiveness at the Royal Sussex.
“There are lots of elements of this we need to do better and we have been working very hard on these for some time and are making progress.
“But this is not an issue we can solve in isolation.
“The flow of patients into, through and out of the hospital is as much about the health and social care services and support provided in the community as what happens in the hospital itself and those responsible are working positively with us to increase and improve these services as a real priority.”
Rob Jarrett, lead member for adult care and health at Brighton and Hove City Council, said: “We’re working proactively with the trust and the clinical commissioning group to ensure older and vulnerable people are well supported by social care and health working closely together.
“This ensures that unnecessary hospital admissions are avoided by the right services being available in the community and where people do need to go to hospital ensuring that all the organisations in the city work together to provide the best outcomes for people who have had a crisis or are unwell. “ GMB Organiser Gary Palmer said: “There is rightly deserved praise for front line NHS staff's compassion and professionalism towards patients and their families, despite as this report suggests they may often find themselves understaffed, overworked and under extreme pressure, through funding cuts to deliver that very service.”
CQC inspectors will return to the hospital in due course to check on progress.
For the full report see www.theargus.co.uk OUTPATIENTS SERVICES need improvement at both hospitals.
On the day of inspection, two clinics at the Royal Sussex had been cancelled as consultants had not been allocated to them.
There was a lack of clarity and understanding in the outpatient department concerning information about patient outcomes.
Staff at the Princess Royal said the centralised booking system for all outpatient services introduced last year had caused significant difficulties for patients attending outpatient services.
END OF LIFE PATIENT CARE
SERVICES are good at both hospitals.
Patients received appropriate care and support with up-to-date symptom control advice for adults with advanced, progressive and incurable illness in their last year of life.
Patients were reviewed in a professional, caring, compassionate manner.
SERVICES at Royal Sussex needed improvement but were good at Princess Royal.
The surgical care teams at both hospitals were highly motivated, committed and compassionate about the services they provided to patients.
Staff were caring and supported to deliver high standards of care with strong and effective leadership.
People who were receiving care and their relatives reported a high level of satisfaction with the quality of care and their experience of using the hospital.
Nursing staffing levels were improving but there was a high use of bank staff at the Royal Sussex to cover vacancies and unplanned absence.
MATERNITY WARDS AND FAMILY PLANNING
SERVICES need improvement at both hospitals.
The department at both hospitals had serious ongoing cultural issues which has affected patient safety as well as staff sickness.
There was a lack of leadership amongst a small group of consultant staff, for example consultants not willing to hold a pager and not attending key meetings.
There was also a distinctively high level of grievances.
CRITICAL CARE AND INTENSIVE MONITORING
SERVICES good at both hospitals.
Care and treatment delivered in critical care at both hospitals was safe and effective.
The teams leading the units were dedicated and committed to patients, their families and their staff. Patients spoke highly of their care and feedback was overwhelmingly positive.
CHILDREN AND YOUNG PEOPLE'S SERVICES
SERVICES good at both hospitals.
Children and young people’s services were safe at both hospitals.
However there were concerns about nursing and medical staffing levels and the low number of staff that had completed their mandatory training.
The wards and units were all clean and staff followed the trust’s infection prevention and control policy.
Equipment and environment was satisfactory in all areas and had been regularly checked and maintained.
There were shortages of nursing staff in the general units, a situation that was improving but the department still had to make use of temporary staff on a regular basis.
Senior managers have struggled to address these issues in the past but the trust has now employed the services of an external agency to help address this.
Bed occupancy, discharge and flow meant that there were times when patients waited for beds on a surgical ward or were nursed in inappropriate areas.
A & E DEPARTMENTS
SERVICES at both hospitals needed improvement.
The Royal Sussex was challenged with capacity issues both within the department and trust-wide.
Patients were observed waiting on trolleys and chairs in the cohort area (waiting with ambulance service staff before being admitted to the department) for periods of two hours.
The cleaning contractor was not able to fully meet the needs of the service to ensure that patients were cared for in a clean and hygienic environment both at the Royal Sussex and Princess Royal.
MEDICAL CARE LEVEL
SERVICES at Royal Sussex needed improvement while those in Princess Royal were rated as good.
Medical care services at both hospitals were delivered by caring and compassionate staff who were dedicated to providing the highest possible standards of care.
There was an ongoing inability to ensure adequate numbers of staff attended some wards to the identified safe levels and with the correct skills mix at all times.
This meant staff felt care and treatment was not always safe and placed patients at risk at the Royal Sussex.
Lower than agreed staffing levels on some wards at the Princess Royal led to staff being placed under pressure.
Staff were seen to be caring and attentive to people’s needs.
The Princess Royal consistently met the four hour national target.