Watchdog targets under-fire A&E

Major failings highlighted again at an under-fire hospital trust’s emergency department have led health watchdogs to take enforcement action.

The Care Quality Commission (CQC) said the emergency department at the Medway Maritime Hospital in Gillingham, Kent, lacked “any form” of clinical leadership.

There was a lack of “cohesive working” between nursing, medical and other healthcare professionals – while the process of initially assessing patients “remained flawed”.

A report, published by the CQC today, highlighted confusion over the movement of patients from the emergency department to a ward bed.

One elderly patient, who had been on the department for more than 12 hours, was assigned a ward bed only to be told later it was no longer available.

It also emerged the patient had remained on a trolley for nine hours, when policy dictated that all patients should be transferred to a bed within six hours of arrival.

Inspectors found another elderly patient, with a potentially life-threatening gastrointestinal disorder, who had been waiting in a holding bay without intravenous fluids or an initial clinical assessment for two hours.

The day before the unannounced inspection on August 26, the report noted a patient with a known heart problem had a cardiac arrest while waiting for their first clinical assessment.

The report said: “We have taken enforcement action against Medway Maritime Hospital to protect the health, safety and welfare of people using this service.

“Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate).

“When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes.

“We will publish a further report on any action we take.”

The catalogue of concerns highlighted in the report followed previous CQC inspections earlier this year. One inspection found A&E staff at the trust – which was placed in special measures in July 2013 – claiming to be “under siege”.

Chiefs then found a “crisis situation”, with blood-stained walls, serious overcrowding, problems with ambulances queuing outside, not enough staff and unsafe practices which could be life-threatening.

The CQC wrote to the chief executive of Medway NHS Foundation Trust in July with its concerns, leading to an action plan being devised.

But following the inspection a month later, leading to the report being published today, the watchdog still found serious failings.

The CQC report said: “In conclusion, in terms of the emergency department at Medway Maritime Hospital, we found little evidence of improvement following our inspections in April and July.

“Whilst the trust had provided us with an action plan to address the plethora of issues we had identified, the pace of change remained slow, the ability to introduce change was hindered by the continued lack of leadership within the department.

“However, we were reassured that the trust was in the process of appointing experienced nurses to lead the workforce as well as commissioning external specialists in emergency medicine to help improve the safety of the department.

“We have judged that the trust continues to fail to ensure that patients are protected from the risks of receiving care or treatment that is inappropriate or unsafe because they are failing to plan and deliver care which meets the individual needs of people whilst also ensuring their safety and welfare.

“We have taken the necessary action to impose urgent conditions on the trust’s registration.”

The conditions include that an effective system must operate ensuring patients attending A&E have an initial assessment by qualified clinical staff within 15 minutes of arrival and that sufficient numbers of qualified clinical staff should be employed.

The CQC’s deputy chief inspector of hospitals in the south, Professor Edward Baker, said: “When we inspected the emergency department at Medway Maritime Hospital in August, we found that the trust had failed to make the improvements required.

“As a result of the inspection, we took action to make sure the trust addressed our immediate safety concerns. Since that inspection, we have been working with Monitor, NHS England and other stakeholders to monitor progress at the trust closely.

“A great deal of effort has been made to drive improvements at the hospital, and we will return in due course with the expectation that significant improvements will have been made.”

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Watchdog targets under-fire A&E