Hospital failings laid bare in damning report

Records show a hospital trust is "among the worst in England" for people spending more than 12 hours in the emergency department.

More than 900 people faced stays of such length in the month prior to a damning inspection.

The Care Quality Commission (CQC) has downgraded urgent and emergency care at Royal Albert Edward Infirmary in Wigan, Greater Manchester, after several concerns were raised over patient care.

A warning notice has been issued over the triage system, the identification of sepsis and how those with mental health needs are cared for after the unannounced inspection in May, with "rapid improvements" called for.

The trust said it was "working hard" to make improvements.

The NHS watchdog previously rated the urgent and emergency care and the medical care at the hospital - which was also inspected - as "good" but has downgraded them both to "requires improvement".

Inspectors said the service was not meeting any of its sepsis targets citing two cases where staff had identified potential sepsis and follow up actions had not been completed more than 18 hours later. National guidelines state they should be done within an hour.

Inspectors found leaders had not ensured there were dedicated spaces to safely accommodate high-risk young people with mental health needs, with some staff saying they had experienced physical and psychological harm as a result.

Inspectors said the physical limitations of the department meant staff could not always respect people's dignity and privacy. Some people raised concerns about being cared for in shared cubicles.

However, the report said staff were passionate about providing good care and people said staff treated them with kindness and understanding.

It said leaders had introduced transformation plans and "there were early signs of improvement in some areas, including the time taken to initially triage people and better ambulance handovers times".

Gill Hodgson-Reilly, of the CQC, said inspectors found the emergency department "under significant pressure".

"People told us staff were caring and compassionate but it was clear that widespread systemic pressures, and the environment in which staff were working, made it difficult for them to keep people safe and had a negative impact on many people's experience of care.

"We found that excessively long waits for speciality beds were causing delays throughout the emergency department. Records showed the trust to be among the worst performing in England for the proportion of people spending more than 12 hours in the emergency department and in the month prior to our inspection, over 900 people had to stay in the emergency department for more than 12 hours.

"Inspectors also had concerns about the main emergency department waiting room, which was often significantly overcrowded and couldn't accommodate the numbers, or needs, of people accessing the department."

She continued: "During the assessment we saw people in mental health crisis, people with intravenous fluids being administered, people in nightwear, and someone with a police escort, all together in the waiting room, whether they had been deemed safe to wait or assessed as needing escalation."

She said the trust was aware of the issues and risks but "hadn't always taken sufficient action".

For example, she said, at the last inspection leaders were told they needed more consultants to safely staff the emergency department but at this inspection there were even less consultants, with only 10 in post when national guidance recommends 18-25.

She added: "We've told leaders where we expect to see rapid improvements and will continue to monitor the department closely to ensure people are kept safe in the meantime."

The overall rating for the Royal Albert Edward Infirmary which is run by the Wrightington, Wigan and Leigh (WWL) Teaching Hospitals NHS Foundation Trust has changed from good to requires improvement.

However, it has retained its "good" overall rating for being effective and caring.

The trust's chief executive Mary Fleming said: "Providing safe, compassionate and high-quality care is our absolute priority and we remain fully committed to delivering the improvements needed for our patients and communities.

"Since the inspection, we have accelerated improvement work… this includes improving sepsis recognition and treatment, strengthening patient flow and the care environment, and working closely with mental health partners.

"We are already seeing improvements, but we know there is more work to do."

She said the report recognises the "compassion, kindness and professionalism of our staff" and thanked them for their "continued commitment to our patients and communities".

She added the trust will continue to work closely with the CQC, clinical teams and partners "to ensure improvements are embedded, sustained and deliver lasting benefits for patients and communities".

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