Urgent and emergency care at Royal Cornwall Hospitals NHS Trust 'requires improvement'

Improvements are still needed in urgent and emergency care at the Royal Cornwall Hospitals NHS Trust (RCHT), according to a new report.

The Care Quality Commission (CQC) carried out an inspection in May and July, which it said was in response to concerns regarding the Trust's performance around waiting times.

The watchdog says the overall rating remains unchanged following the inspection, and is re-rerated as "requires improvement" - as are the ratings for the effective and responsive.

However, urgent and emergency care services have been re-rated "good" for being safe, caring and well-led.

"Report recognises improvement and acknowledges continued pressure"

RCHT say the report is "fair" and "captures the challenging circumstances its emergency care teams and hospitals face".

Chief Executive Officer, Steve Williamson said: "It is reassuring to see the rating for Safe has improved to Good but we accept that, together with our partners across the health and care system, we have more to do to further improve our ability to provide timely care, even at times of intense pressure, as we are currently seeing."

The Trust adds that in the seven months since the emergency department inspection, "a great deal has been done to improve urgent and emergency care pathways".

Director of Nursing, Midwifery and Allied Health Professionals, Bernadette George said: "None of us want patients to experience delays in any part of their emergency care pathway and our own staff and colleagues across health and care services are working tirelessly to prevent that happening.

"What does shine through the CQC’s report is the kindness and compassion of our staff who assessors observed were 'doing their best to mitigate risk at times of very high occupancy.'

"It is also reassuring to see acknowledgement of the high calibre of leadership across the team and the open and honest culture that is so important to patient care and safety."

CQC inspectors found in urgent and emergency care:

• There was a strong safety culture with staff feeling confident to raise concerns
• The service now had enough staff with the right qualifications, skills, training and experience - and also improve staffing levels
• The department had passports for people with learning disabilities and made adaptions to try and reduce any possible distress
• The service accessed a translation service for people whose first language wasn't English
• There was good external partner engagement
• Members of the NHS ambulance service spoke highly about the camaraderie and teamwork in the department

However, it found:

• MRI services were unavailable between 7.30pm and 7am the next day
• There was a mental health assessment room which was due for updating as it did not entirely confirm to the national guidelines
• Essential staff training had been frequently cancelled due to staffing pressures
• Staff said they were worried about the pressure they were under and how this affected their ability to provide safe and quality care

Catherine Campbell, CQC deputy director of operations in the south, said: "Throughout our inspection of Royal Cornwall Hospitals NHS Trust’s urgent and emergency care, we saw staff were working hard to provide safe care in challenging conditions.

"The trust faced issues with the high number of people attending the department and with discharging people to the local community, which in turn created a problem of flow around the hospital.

"We also found people who were fit for discharge were staying in the hospital longer than they needed to because their care outside the hospital wasn’t ready.

"This over-crowding in the emergency department created issues that the trust couldn’t solve alone, and further support was needed from the local health and social care system to address.  

"People faced unacceptable delays for care when the department was at capacity, people could also face lengthy waits in ambulances. This had an impact on the ambulance trust’s emergency response times in responding to other people.

"We saw people being cared for in one of the corridors of the department. While they were treated with kindness, people and staff told us it was difficult to maintain privacy in such conditions.

"We found the senior leadership team was open to challenge and understood the problems the service faced. They were supporting staff to manage the priorities and issues and deal with difficult circumstances."

First for all the latest news from across the UK every hour on Hits Radio on DAB, at hitsradio.co.uk and on the Rayo app.