Health inspectors raise concerns about impact of ambulances waiting at Treliske
An RCHT board meeting has heard about how waits are affecting A&E
Last updated 6th May 2022
Health inspectors have raised concerns about the number of ambulances waiting outside Royal Cornwall Hospital and the impact it is having on the emergency department.
The issue was one of several raised by the Care Quality Commission (CQC) following an inspection of the emergency department and medical care at RCH and the urgent treatment centre at West Cornwall Hospital.
A letter outlining the comments of the CQC, which was issued in March, was presented to a meeting of the board of RCHT on Thursday morning.
The document gives an overview of feedback which was given to the trust following the unannounced inspection which was undertaken over two days in March.
On feedback from the emergency department it starts positively stating that "the department felt controlled and being managed well" and "staff are sighted on the risks and were responding where needed".
However, it then goes on to state: "The number of ambulances awaiting offload and the length of time patients are spending on ambulances and in the department is a major issue. We understand how the wider system issue is impacting on the delays at the front door".
It has previously been stated by RCHT that due to problems with discharging patients from the hospital due to a lack of residential care home places and home care packages there has been an impact all through the hospital.
It has been explained that there have been patients who are medically fit for discharge but are unable to go home or into care homes.
The CQC letter explains that the delays are having an impact on staff, stating: "Staff are frustrated about the delays and do not feel that they are achieving a good outcome for patients".
It adds that nurse staffing the department is an "issue" and highlights "significant staff turnover" and says that staff are also not getting time to complete mandatory training.
On operational issues in the department the letter states: "The mental health room was not always available/ready for use, for patients who needed mental health assessments. We observed a patient being assessed in a cubicle and the conversation could be overheard".
However the section on the emergency department concludes saying: "Staff’s frustration at all levels demonstrated how dedicated and passionate they are to care for patients. Patients were at the centre of care.
"Patients we spoke with were complimentary of the care they had received".
The section on medical care highlights some of the issues that the hospital has faced during the Covid-19 pandemic with beds having to be closed due to outbreaks and delays for patients.
However it states: "The discharge arrangements need to be reviewed. There is not an effective integrated discharge team and not always coordinated by the same member of staff".
It also adds that the Wheal Vor ward, which was established to look after patients who are medically fit to leave hospital but are awaiting care packages or assessment "had not completely served the purpose it was intended for".
The section again ends on a positive note saying: "Staff in all areas of medical care showed commitment and dedication. They are tired but engaged and had good ideas on how to improve some things. There are perhaps opportunities for quick wins through staff engagement".
At the West Cornwall Hospital Urgent Treatment Centre the CQC found there "is a very skilled workforce at the centre. The team are very dedicated and knowledgeable".
But it adds: "The biggest risks are with acuity of patients coming to the urgent treatment centre either as 'walk-in' or referred by NHS 111 when the location converts to a minor injuries unit. There is a lack of medical support on site after 10pm. Although staff are able to access support remotely from Royal Cornwall Hospital there are long delays for patients to be transferred to the emergency department if this has been identified".
A full report is being prepared by the CQC following the inspection and RCHT chief executive Steve Williamson said that this was expected by the end of this month.
There was no discussion of the letter at the board meeting but Mr Williamson said that the final report would be provided for the board to oversee and scrutinise along with any plan to address any issues raised.