The DGH’s accident and emergency department has also been criticised in the CQC report for not having enough staff and patients having to wait too long.
Staff have been praised in this morning’s report but inspectors said the department requires “improvement to ensure that patients are protected from avoidable harm” and not enough consultants to provide cover was “negative for patients”.
The report said, “The trust did not meet the College of Emergency Medicine recommendation that an A&E department should have enough consultants to provide cover 16 hours a day, seven days a week. This compromises senior clinical decision making which could negatively impact the patient’s pathway of care.
“Nurse staffing levels did not consistently meet the Royal College of Nursing Baseline Emergency Staffing Tool recommendations. Tools for monitoring patient’s condition were not consistently used, which increases the risk of an oversight of patient deterioration.
“Compliance with mandatory training requires improvement to achieve a safe workforce.
“Staff in the A&E department showed good clinical practice following accepted national and local guidelines. The department had
developed a number of pathways to ensure that patients received treatment focused on their medical needs. The pathways were revised annually to ensure current practice.
“Patients were given timely pain relief although pain scoring tools were not used effectively.
“There was a multidisciplinary, collaborative approach to care and treatment that involved a range of health and social care professionals.
“Overall, the A&E provided a caring and compassionate service. We observed staff treating patients with respect. Patients and their relatives and carers told us that they felt well-informed and involved in the decisions and plans of care. We saw that staff respected patients’ choices and preferences and were supportive of their cultures, faiths and backgrounds.
“The A&E department requires improvement to ensure that people’s needs are taken into account and met. Recent reconfiguration of services has meant that some patients need to be transferred to Conquest hospital. Treating patients, especially children, further away from their homes makes visiting more difficult and costly.
“The facilities and premises do not always meet patients’ needs. The layout of the department does not support patients’ privacy, dignity and confidentiality.
“Poor out of hours access to mental health liaison team meant the needs of patients presenting with ill health were not met in a timely way. If patients were experiencing a mental health crisis, their behaviour in the department could be very disruptive.
“Once patients were within the treatment areas of the A&E their initial needs were responded to quickly and effectively. In the year leading
up to our inspection, the trust consistently met the national target of admitting or discharging 95 per cent of patients within four hours. However, the total time in A&E was consistently higher than the national average.
“The leadership and culture require improvement so that the delivery of high quality, person centred care is supported.
“Leadership roles had recently been restructured in the urgent care directorate. We found a lack of defined leadership “on the floor” of the departments.
“We found staff were not actively engaged and staff satisfaction was not seen as a high priority. Staff were concerned about the level and speed of change implemented in the urgent care directorate within the trust.
“There was a limited approach to obtaining the views of people using the service and no evidence that changes were made as a consequence of patient feedback.”